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    ACL Recon Outcomes Ireland

    Uploaded by

    Jarek Plaszczyca

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    © All Rights Reserved
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    ACL Recon Outcomes Ireland

    Uploaded by

    Jarek Plaszczyca
    3 views45 pages

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    ACL%20Recon%20Outcomes%20Ireland

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    3 views45 pages

    ACL Recon Outcomes Ireland

    Uploaded by

    Jarek Plaszczyca

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 45

    Comparison

    Comparison of of
    Outcomes
    Outcomes
    Between
    Between Males
    Males
    and
    and Females
    Females
    After
    After Anterior
    Anterior
    Cruciate
    Cruciate
    Ligament
    Ligament
    Reconstruction
    Reconstruction February,
    February, 2002
    2002

    Mary
    Mary Lloyd
    Lloyd Ireland,
    Ireland, M.D.
    M.D.
    Comparison of Outcomes
    Between Males and
    Females After ACL
    Reconstruction
    Susan M. Ott, D.O.
    Mary Lloyd Ireland, M.D.
    Bryon Ballantyne, P.T.
    Irene McClay, Ph.D., P.T.
    Kentucky Sports Medicine
    Joyner Sportsmedicine Institute
    Presented at ACSM Annual Meeting, 2000

    Submitted for publication to the ESSKA


    journal:
    Traumatology,,
    Knee Surgery, Sports Traumatology
    Arthroscopy.
    Purpose:
    Compare Male & Female Outcomes by
    Subjective Rating Scales
    after ACL Reconstructions with
    B-PT-B.

    The hypothesis – What is the question?


    What are the differences in ACL
    reconstruction using bone patellar tendon
    bone comparing males and females?
    Study Population

    • Autogenous bone patella tendon


    bone ACL reconstructions
    • Minimum two year followup
    • All ages
    • Acute and Chronic
    • With and without meniscal
    pathology
    Inclusion Criteria:

    • 2 Year Minimum Follow Up


    • Unilateral ACL Reconstruction with
    ipsilateral Bone-central third
    patellar tendon-Bone
    • KSM Questionnaire designed to
    assess exclusion criteria
    Exclusion Criteria
    • Bilateral ACL surgery
    • Litigation
    • Workers compensation
    • Prior back surgery
    • Prior serious ipsilateral ankle injury
    or surgery
    • Prior ipsilateral knee surgery
    Outcome Instruments Used:

    • Tegner Activity Rating Scale (ARS)


    Mohtadi Quality of Life measure (QOL)
    • Subjective portion Cincinnati Knee
    Rating Scale (CKS - Noyes)
    • Kentucky Sports Medicine
    questionnaire
    Tegner activity rating scale

    • 10 point scale
    • Activity before injury
    • Highest activity after surgery
    • Current activity level
    Mohtadi quality of life scale

    • 100 point scale


    • Visual analog scale
    • Quality of life after ACL
    reconstruction
    Cincinnati knee rating scale

    • Subjective portion only


    • 100 point scale
    • Assesses symptoms, pain and level
    of function
    Results Whole Group
    • No significant differences between males
    and females on activity rating scale
    • No significant differences between males
    and females on quality of life measure
    • Females scored significantly lower on the
    Cincinnati scale p=0.032
    • No difference in number of patients who
    complained of anterior knee pain
    Study Population

    • 77 females: (22 chronic, 55 acute)


    • 74 males: (34 chronic, 40 acute)
    Tegner scale: whole group
    Females
    8 7.1
    6.6 Males
    7 6.2
    5.8
    5.4
    6 5.0
    5 p-values
    4 > 0.05
    3 [not
    2 significant]
    1 are not
    0
    shown
    Prior Activity Highest Activity Current Activity

    No statistically-significant differences
    between males and females
    Quality of life scale: whole group
    100.0 94.3
    84.7 86.5 82.9 79.9
    81.0 80.4 76.0 80.2
    90.0
    77.3
    80.0

    70.0

    60.0

    50.0 Females
    40.0
    Males
    30.0

    20.0

    10.0

    0.0
    Symptoms Work Lifestyle Social Total

    No statistically-significant differences
    between males and females
    Cincinnati scale: whole group
    97.6 98.1
    100 86.0
    90 80.3
    80

    70

    60 Females
    50
    Males
    40

    30

    20

    10
    0

    Involved Uninvolved

    Statistically-significant difference between


    males and females for the involved side p=0.032
    Results Whole Group

    • No significant difference between


    acute and chronic males or acute
    and chronic males
    • Females tore their ACLs at a
    significantly younger age than
    males
    ACL Tears vs. Age Groups
    Top Five Sports of Injury
    FEMALES MALES
    • Basketball 26 (34%) 35 (47%)
    • Skiing 11 (14%) 3 (4%)
    • Football 11 (15%)
    • Soccer 7 (9%) 4 (5%)
    • Softball 7 (9%) 3 (4%)

    Total 77 (100%) 74 (100%)


    Results
    basketball soccer subgroup
    • Results in basketball/soccer
    athletes with prior activity level of 7
    or above
    • 32 females and 15 males
    • No significant differences on any
    scale
    Subsets of
    Basketball and Soccer:
    No Significant Difference
    Females Males
    Basketball 26 (34%) 35 (47%)
    Soccer 7 (9%) 4 (5%)
    Tegner Activity Scale:
    Basketball/Soccer subgroup
    7.8
    7.3 7.1
    8
    6.3
    7
    5.5 5.8
    6

    4 Females
    3 Males
    2

    0
    Prior Activity Highest Activity Current Activity

    No statistically-significant differences
    between males and females
    Quality of life
    basketball soccer subgroup
    87.8
    85.9 83.4
    90.0 81.6 83.0 79.5
    76.3 76.2 75.4
    80.0 72.7

    70.0

    60.0
    Females
    50.0
    Males
    40.0

    30.0

    20.0

    10.0

    0.0
    Symptoms Work Lifestyle Social Total
    No statistically-significant differences
    between males and females
    Cincinnati scale
    Basketball / soccer subgroup
    97.1 98.4
    100
    90
    82.5 84.1
    80
    70 Females
    60 Males
    50
    40
    30
    20
    10
    0
    Involved Uninvolved

    No statistically-significant differences
    between males and females p=0.059
    FEMALES MALES
    Number: 77 74
    Average Age at Injury: 21.7 26.5 p=.001
    Acute (< 3 months): 55 40
    Chronic (> 3 months): 22 34
    Acute vs. Chronic
    FEMALES MALES
    Activity Scale Acute Chronic Acute Chronic
    Prior 7.2 6.9 6.7 6.4
    Highest 6.4 5.5 6.0 5.7
    Current 5.1 4.8 5.5 5.2
    Acute vs. Chronic
    FEMALES MALES
    Cincinnati Acute Chronic Acute Chronic
    Involved 79.9 81.1 85.4 86.7
    Uninvolved 97.7 97.5 97.8 98.6
    QOL 74.5 80.0 85.4 97.8
    Summary

    • Males and females did equally well


    on two of the three scales
    • In the basketball soccer group,
    males and females did equally well
    on all scales
    Summary

    • Females tore their ACLs at a


    significantly younger age than
    males in the study population
    • Chronicity of injury did not have an
    effect on outcome in males or
    females
    Discussion

    • Result on the Cincinnati scale is


    inconsistent from previously
    published data
    • Tegner and Mohtadi results
    • Age results
    Conclusion

    • Activity level rather than gender


    should be used for surgical
    decision making
    • Further study should be done to
    assess the importance of the
    Cincinnati result and the age at
    which females sustain this injury
    Future Studies
    • Prospective instead of retrospective
    • Need to Be Done Comparing
    Gender
    • Why Females Lower on CKS and
    Equal on QOL and TRS?
    • Choice of Knee Rating Scale
    IKDC Consensus ACL Study Group?
    The End . . . Thank You!
    A Rigorous Comparison
    Between the Sexes of Results and
    Complications After Anterior
    Cruciate Ligament Reconstruction

    Sue D. Barber-Westin,
    Frank R. Noyes, M.D.
    Michelle Andrews, M.D.

    – AJSM, Vol. 25, No. 4, 1997


    94 Patients
    47 Males / 47 Females
    B -PTG-B Autogenous
    B-PTG-B
    Reconstruction
    Results
    • 26 Month Post Op
    • Same Outcome Cincinnati Knee Scale
    • No Difference in Complications
    • Females 6 More Rehab Visits
    • Failure: 6% Females / 4% Males
    Ferrari, JD, Bach BR, Bush -Joseph
    Bush-Joseph
    CA, Wang T, Bojchuk J.
    Anterior Cruciate Ligament
    Reconstruction in Men and Women:
    An Outcome Analysis Comparing
    Gender. Arthroscopy 2001;17(6):
    588 -596.
    588-596.
    279 ACL Reconstructions
    • B-PTG-B grafts
    • 249 (91%) contacted
    • 200 (72%) evaluated
    PE, KT 1000
    Functional assessment
    Radiographs
    Knee Rating Scales
    Tegner, Lysholm, Modifed HSS,
    Cincinnati
    Results

    137 Men 63 Women


    Gender Comparison: No Difference In:
    Rating Scale Scores
    Donor site pain
    PF crepitance
    Stair climbing
    SF -36
    SF-36
    Stability by PE
    Functional assessment
    Men Had:

    • Statistically-significant lower HSS


    radiographic scores
    • Greater prone heel-height difference
    1.8 vs. 1.1 cm.
    • Greater Mean KT1000 Difference
    0.76 vs. 1.73 mm.
    Men and Women Both Had:

    • High Satisfaction Rate


    • Same knee scale scores
    Conclusions
    No basis exists for inclusion of gender as
    determining factor regarding desire to perform
    ACL reconstruction with B-PTG-B
    Corry IS, et. Al., Arthroscopic
    reconstruction of the anterior
    cruciate ligament: A comparison of
    patellar tendon autograft and four
    four--
    strand hamstring tendon autograft.
    Am J Sports Med 27 -444-54, 1999
    27-444-54,
    Prospective Study
    • Hamstring vs. PTG
    • Gender comparisons
    No difference in outcomes
    KT-1000 greater in females hamstring group
    2.5 mm. (2.2-2.8) p=0.02
    PTG female 1.0 (0.7-1.3) p=0.01
    male 0.9 (0.6-1.2) p=0.0003
    Hamstring male 0.9 (0.7-1.1) p<0.0001

    What is the significance of 2.5mm KT-1000?

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