Dunn, Am J Sports Med 2004 - The Effect of Anterior Cruciate Ligament Reconstruction on the Risk of Knee Reinjury - Article Summary

The Effect of Anterior Cruciate Ligament Reconstruction on the Risk of Knee Reinjury

Dunn, Marx, et al.·Am J Sports Med·2004·151 citations·Retrospective cohort

Background

Although there is evidence that very active, young patients are better served with anterior cruciate ligament reconstruction, there is a lack of objective data demonstrating that future knee injury is prevented by these procedures.

Purpose

Hypothesis: Anterior cruciate ligament reconstruction protects against reinjury of the knee that would require reoperation.

Methods

Study Design: Retrospective cohort study.

A cohort of 6576 active-duty army personnel who had been hospitalized for anterior cruciate ligament injury from 1990 to 1996 were identified.
Using the Total Army Injury and Health Outcomes Database, the authors followed these individuals for up to 9 years and collected clinical, demographic, and occupational data.
These data were evaluated with bivariate and multivariable analyses to determine the effect of anterior cruciate ligament reconstruction on the rate of knee reinjury that required operation.

Results

Of the 6576 study subjects, 3795 subjects (58%) underwent anterior cruciate ligament reconstruction and 2781 (42%) did not.
The rate of reoperation was significantly lower among the anterior cruciate ligament reconstruction group (4.90/100 person-years) compared with those treated conservatively (13.86/100 person-years; P < .0001).
Proportional hazard regression analyses adjusted for age, race, sex, marital status, education, and physical activity level confirmed that anterior cruciate ligament reconstruction was protective against meniscal and cartilage reinjury (P < .0001).
Secondary medial meniscal injury was more common than secondary lateral meniscal injury (P < .003).
Younger age was the strongest predictor of failure of conservative management leading to late anterior cruciate ligament reconstruction (P < .0001).

Conclusions

Anterior cruciate ligament reconstruction protected against reoperation in this young, active population; younger subjects were more likely to require late anterior cruciate ligament reconstruction.

Clinical Relevance: Strong consideration should be given to anterior cruciate ligament reconstruction after anterior cruciate ligament injury in young, active individuals.

Core

The Effect of Anterior Cruciate Ligament Reconstruction on the Risk of Knee Reinjury

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Acetabular Defect Classification and Surgical Reconstruction in Revision Arthroplasty. A 6-Year Follow-Up Evaluation.

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Effects of Bracing in Adolescents with Idiopathic Scoliosis.

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Problems in the Management of Type III (Severe) Open Fractures: A New Classification of Type III Open Fractures.

Gustilo, Williams, et al.J Trauma19842,361 citationsRetrospective cohort

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Neer Award 2005: The Grammont Reverse Shoulder Prosthesis: Results in Cuff Tear Arthritis, Fracture Sequelae, and Revision Arthroplasty.

Boileau, Hovorka, et al.J Shoulder Elbow Surg20061,115 citationsProspective cohort

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A System for the Surgical Staging of Musculoskeletal Sarcoma.

Enneking, Goodman, et al.Clin Orthop Relat Res19802,112 citationsRetrospective cohort

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Fracture Fixation in the Operative Management of Hip Fractures (FAITH): An International, Multicentre, Randomised Controlled Trial.

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A New Classification of Thoracolumbar Injuries: The Importance of Injury Morphology, the Integrity of the Posterior Ligamentous Complex, and Neurologic Status.

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Curve Progression in Idiopathic Scoliosis.

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Arnoczky, WarrenAm J Sports Med19821,227 citationsAnatomic study

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Metastatic Disease in Long Bones. A Proposed Scoring System for Diagnosing Impending Pathologic Fractures.

MirelsClin Orthop Relat Res19891,222 citationsRetrospective cohort

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Cuff-Tear Arthropathy.

Neer, Fukuda, et al.J Bone Joint Surg Am1983774 citationsCase series

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A System of Staging Musculoskeletal Neoplasms.

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Landmark

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Landmark

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PipkinJ Bone Joint Surg Am1957445 citationsCase series

Landmark

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Anderson, Park, et al.J Bone Joint Surg Am1975416 citationsCase series

Landmark

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Herring, Browne, et al.J Bone Joint Surg Am2004143 citationsProspective cohort

Landmark

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KiblerAm J Sports Med19981,240 citationsReview article

Landmark

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Watson, BalletJ Hand Surg Am19841,138 citationsRetrospective cohort

Landmark

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Valle, PaproskyJ Bone Joint Surg Am2003199 citationsRetrospective cohort

Landmark

The Tibial Plateau Fracture. The Toronto Experience 1968--1975.

Schatzker, Bruce, et al.Clin Orthop Relat Res19791,029 citationsRetrospective cohort

Landmark

Surgical Dislocation of the Adult Hip a Technique with Full Access to the Femoral Head and Acetabulum without the Risk of Avascular Necrosis.

Ganz, Berlemann, et al.J Bone Joint Surg Br20011,367 citationsCase series

Landmark

Predictors of Humeral Head Ischemia after Intracapsular Fracture of the Proximal Humerus.

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Landmark

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Landmark

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Landmark

A Novel Classification System for Spinal Instability in Neoplastic Disease: An Evidence-Based Approach and Expert Consensus from the Spine Oncology Study Group.

Fisher, Fourney, et al.Spine (Phila Pa 1976)20101,224 citationsConsensus statement

Landmark

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Rangan, PROFHER Trial Collaborators, et al.JAMA2015540 citationsRCT

Landmark

Lumbar Disc Herniation. A Controlled, Prospective Study with Ten Years of Observation.

WeberSpine (Phila Pa 1976)19831,149 citationsRCT

Landmark

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Landmark

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The Effect of Anterior Cruciate Ligament Reconstruction on the Risk of Knee Reinjury

Dunn, Marx, et al.·Am J Sports Med·2004·151 citations·Retrospective cohort

DOI·PubMed

Background

Purpose

Hypothesis: Anterior cruciate ligament reconstruction protects against reinjury of the knee that would require reoperation.

Methods

Study Design: Retrospective cohort study.

A cohort of 6576 active-duty army personnel who had been hospitalized for anterior cruciate ligament injury from 1990 to 1996 were identified.
Using the Total Army Injury and Health Outcomes Database, the authors followed these individuals for up to 9 years and collected clinical, demographic, and occupational data.
These data were evaluated with bivariate and multivariable analyses to determine the effect of anterior cruciate ligament reconstruction on the rate of knee reinjury that required operation.

Results

Of the 6576 study subjects, 3795 subjects (58%) underwent anterior cruciate ligament reconstruction and 2781 (42%) did not.
The rate of reoperation was significantly lower among the anterior cruciate ligament reconstruction group (4.90/100 person-years) compared with those treated conservatively (13.86/100 person-years; P < .0001).
Proportional hazard regression analyses adjusted for age, race, sex, marital status, education, and physical activity level confirmed that anterior cruciate ligament reconstruction was protective against meniscal and cartilage reinjury (P < .0001).
Secondary medial meniscal injury was more common than secondary lateral meniscal injury (P < .003).
Younger age was the strongest predictor of failure of conservative management leading to late anterior cruciate ligament reconstruction (P < .0001).

Conclusions

Anterior cruciate ligament reconstruction protected against reoperation in this young, active population; younger subjects were more likely to require late anterior cruciate ligament reconstruction.

Clinical Relevance: Strong consideration should be given to anterior cruciate ligament reconstruction after anterior cruciate ligament injury in young, active individuals.

Background

Purpose

Hypothesis: Anterior cruciate ligament reconstruction protects against reinjury of the knee that would require reoperation.

Methods

Study Design: Retrospective cohort study.

A cohort of 6576 active-duty army personnel who had been hospitalized for anterior cruciate ligament injury from 1990 to 1996 were identified.
Using the Total Army Injury and Health Outcomes Database, the authors followed these individuals for up to 9 years and collected clinical, demographic, and occupational data.
These data were evaluated with bivariate and multivariable analyses to determine the effect of anterior cruciate ligament reconstruction on the rate of knee reinjury that required operation.

Results

Of the 6576 study subjects, 3795 subjects (58%) underwent anterior cruciate ligament reconstruction and 2781 (42%) did not.
The rate of reoperation was significantly lower among the anterior cruciate ligament reconstruction group (4.90/100 person-years) compared with those treated conservatively (13.86/100 person-years; P < .0001).
Proportional hazard regression analyses adjusted for age, race, sex, marital status, education, and physical activity level confirmed that anterior cruciate ligament reconstruction was protective against meniscal and cartilage reinjury (P < .0001).
Secondary medial meniscal injury was more common than secondary lateral meniscal injury (P < .003).
Younger age was the strongest predictor of failure of conservative management leading to late anterior cruciate ligament reconstruction (P < .0001).

Conclusions

Anterior cruciate ligament reconstruction protected against reoperation in this young, active population; younger subjects were more likely to require late anterior cruciate ligament reconstruction.

Clinical Relevance: Strong consideration should be given to anterior cruciate ligament reconstruction after anterior cruciate ligament injury in young, active individuals.

Background

Purpose

Hypothesis: Anterior cruciate ligament reconstruction protects against reinjury of the knee that would require reoperation.

Methods

Study Design: Retrospective cohort study.

A cohort of 6576 active-duty army personnel who had been hospitalized for anterior cruciate ligament injury from 1990 to 1996 were identified.
Using the Total Army Injury and Health Outcomes Database, the authors followed these individuals for up to 9 years and collected clinical, demographic, and occupational data.
These data were evaluated with bivariate and multivariable analyses to determine the effect of anterior cruciate ligament reconstruction on the rate of knee reinjury that required operation.

Results

Of the 6576 study subjects, 3795 subjects (58%) underwent anterior cruciate ligament reconstruction and 2781 (42%) did not.
The rate of reoperation was significantly lower among the anterior cruciate ligament reconstruction group (4.90/100 person-years) compared with those treated conservatively (13.86/100 person-years; P < .0001).
Proportional hazard regression analyses adjusted for age, race, sex, marital status, education, and physical activity level confirmed that anterior cruciate ligament reconstruction was protective against meniscal and cartilage reinjury (P < .0001).
Secondary medial meniscal injury was more common than secondary lateral meniscal injury (P < .003).
Younger age was the strongest predictor of failure of conservative management leading to late anterior cruciate ligament reconstruction (P < .0001).

Conclusions

Anterior cruciate ligament reconstruction protected against reoperation in this young, active population; younger subjects were more likely to require late anterior cruciate ligament reconstruction.

Clinical Relevance: Strong consideration should be given to anterior cruciate ligament reconstruction after anterior cruciate ligament injury in young, active individuals.