Time to Rethink Rehab Protocol after Anatomic ACL Reconstruction?
The rate of graft failure following anatomic ACL reconstruction has been reported to be as high as 13%, nearly double the reported failure rate of transtibial reconstructions. The majority of anatomic graft failures occur six to nine months after surgery, when patients commonly return to full sports activity. Findings from a cadaver study by Araujo et al. in the November 4, 2015 edition of The Journal of Bone & Joint Surgery may help explain these phenomena.
The authors used a robotic system to measure in situ forces on 12 native cadaver ACLs and on three different reconstructions, one representing the anatomic approach and two reconstructions approximating traditional transtibial approaches. They measured forces on the grafts during anterior tibial loading and simulated pivot-shift loading.
Araujo et al. hypothesized that an anatomically positioned graft would experience increased in situ forces relative to transtibial positioning, and that is what the study revealed during knee flexion angles of 0°, 15°, and 30°. At 45°, 60°, and 90° of flexion, the transtibially positioned grafts experienced higher in situ loading forces than the anatomic ones.
While this cadaveric study is not the definitive word on this matter, with the high graft forces on the anatomic reconstructions, the authors suggest that “rehabilitation and return to sports progression may need to be modified to protect an anatomically placed graft after ACL reconstruction.”
JBJS Webinar Now On-Demand – Return to Sports after ACL Reconstruction
“When will I be able to play again?” Following ACL reconstruction surgery, that’s a question physical therapists and orthopaedic surgeons invariably hear—often repeatedly—from their athletically inclined patients.
The multiple factors that go into answering this difficult question are the subject of this complimentary webinar.
Current evidence suggests that approximately 50 to 60 percent of patients post ACL-reconstruction eventually return to sports at preinjury levels. But the timing of that return—and the many variables leading to it—create a series of challenging clinical decision points. This webinars explores the most relevant surgical, rehabilitative, and patient-centered factors that contribute to sound decisions in which surgeons, physical therapists, and patients participate fully.
Moderated by Robert Marx, MD, JBJS Associate Editor for Evidence-based Orthopaedics, this webinar focuses on two articles, one from each journal.
After the articles’ primary authors present their data, two additional return-to-sports experts add their perspectives to this body of research.
Moderator:
Robert Marx, MD
Presenting authors:
Freddie Fu, MD and Terese Chmielewski, PT, PhD, SCS
Commentators:
Kevin Wilk, PT, DPT, FAPTA and Kurt Spindler, MD
This webinar is brought to you by the Journal of Orthopaedic & Sports Physical Therapy and The Journal of Bone and Joint Surgery
JBJS Website: #1 Among Orthopaedic Surgeons
According to the orthopaedic surgeon edition of Kantar Media’s Website Usage & Qualitative Evaluation study, JBJS.org ranks hands down as the #1 orthopaedic site that surgeons visit most often and spend the most time on. The Kantar study evaluates the opinions of orthopaedic surgeons on 29 professional websites, including 8 orthopaedic sites. Not only does JBJS.org rank number 1 among the other 7 orthopaedic sites in frequency of visits (4.7 times/month), the website ranks first among all 28 sites evaluated in terms of time per session (20.31 minutes). Additionally, JBJS.org ranks #1 in delivering quality clinical content and keeping surgeons informed of the latest practices and procedures. JBJS ties for first place in the category of information on drugs, devices, or professional services. Also noteworthy is the fact that JBJS Reviews, a new online review journal from JBJS launched in November 2013, has already taken over third place in time spent and number of site visits.
JBJS Webinar Series
JBJS has held multiple live webinar events on a wide variety of topics, and we are pleased to announce the expansion of the JBJS Webinar Series in 2014. Each webinar has proven to be a successful tool in educating, informing and engaging orthopaedic surgeons around the world. In 2014, JBJS is continuing this educational program through a new series of interactive online events.
Our webinars bring together groups of authors to present recently published scientific research and data, and they include commentary from guest experts. Live Q&A sessions follow the author and commentator presentations to provide the audience with the opportunity to further explore the concepts and data presented. Webinars continue to be available on-demand for several months after the event.
AVAILABLE ON-DEMAND (Previously Recorded Events)
Total Knee Arthroplasty Critical Decision Making: Socioeconomic and Clinical Considerations (June 10, 2014) – Moderated by Charles R. Clark, MD
Panelists/Authors: Kevin J. Bozic, MD and Thomas S. Thornhill, MD
Commentators: Daniel J. Berry, MD and Kevin Garvey, MD
Preventing Arthroplasty-Associated Venous Thromboembolism (VTE) (May 12, 2014) – Moderated by Thomas A. Einhorn, MD
Panelists/Authors: Clifford W. Colwell Jr, MD and John T. Schousboe, MD
Commentators: Vincent Pellegrini Jr, MD and Jay Lieberman, MD
Anterior Cruciate Ligament (ACL) Reconstruction (March 5, 2014) – Moderated by Mark Miller, MD
Panelists/Authors: Freddie Fu, MD and Christopher Kaeding, MD
Commentators: Brett Owens, MD and Darren L. Johnson, MD
Adhesive Capsulitis/Frozen Shoulder (December 2013) – Moderated by Andrew Green, MD
Presented in conjunction with the Journal of Orthopaedic & Sports Physical Therapy.
Panelists/Authors: George Murrell, MD, Martin J. Kelley, DPT, Jo Hannafin, MD, PhD, and Philip W. McClure, PT, PhD
Periprosthetic Joint Infection (October 2013) – Moderated by Charles R. Clark, MD
Panelists/Authors: Kevin J. Bozic, MD and Craig J. Della Valle, MD
Commentators: Javad Parvizi, MD, FRCS, and Geoffrey Tsaras, MD, MPH
Measuring Value in Orthopaedic Surgery (September 2013) – Moderated by James Herndon, MD
Panelist/Author: Kevin J. Bozic, MD
Commentators: David Jevsevar, MD and Jon J.P. Warner, MD
Editor, JBJS Reviews: Thomas A. Einhorn, MD
JBJS Webinar: Experts Call for Better Outcome Measures in ACL Studies
Changes in and current “best practices” for anterior cruciate ligament (ACL) reconstruction were the subject of a recent JBJS webinar that is available for free viewing until March 5, 2015.
The webinar focused on the procedural and outcome differences between nonanatomic transtibial tunnel drilling and more anatomic anteromedial portal drilling. Drs. Freddie Fu and Christopher Kaeding summarized their recent JBJS papers on ACL tunnel drilling, and Drs. Brett Owens and Darren Johnson commented on the authors’ findings. Dr. Mark Miller moderated the webinar.
One of several points the four ACL experts agreed upon during the webinar was the need for more objective outcome measures to help surgeons distinguish success from failure. For example, Dr. Fu argued for measuring outcomes with biomarkers and advanced imaging such as dynamic stereoradiography and 3-D computed tomography. As important as patient-centered outcomes are, Dr. Fu cited their subjectivity as a downside. “Getting back to sport in 6 months may not be so good if your ACL isn’t reconstructed anatomically,” he said.
Dr. Kaeding’s study found no KOOS-score differences between the two drilling techniques, but the transtibial group had a nearly 2.5-fold increased risk of subsequent ipsilateral knee surgery when compared to the anteromedial group. Commenting on that study, Dr. Johnson lauded the six-year follow-up and outcome metric of subsequent same-knee surgery. But he stressed that a combination of clinical outcomes–including patient satisfaction, knee stability, re-tear rates, and subsequent arthritis–would help surgeons make more informed decisions. He expressed hope that the patients in Dr. Kaeding’s study will continue to be followed so longer-term clinical data can been obtained.
To view the webinar in its entirety, free of charge, go to
https://vts.inxpo.com/Launch/QReg.htm?ShowKey=18001
You can also read a JBJS Reviews critical analysis of ACL tunnel placement here.
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