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KNEE IMMOBILIZATION FOR PAIN CONTROL AFTER A HAMSTRING TENDON ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION. Hiemstra LA, Heard SM, Sasyniuk TM, et al. American Journal of Sports Medicine 2009;37:56–64
A total of 102 patients aged 18–40 years were enrolled; 88 patients were randomised, and 14 were excluded intraoperatively. The patients were randomised (immobiliser or no immobiliser) after wound closure. The immobiliser used
was a soft, unhinged brace with Velcro®. The primary outcome was patient self-assessed pain using a 0–100 mm visual analogue scale on day 2 after surgery. Secondary outcomes included pain and analgesic use in the first 14 days after surgery, complications, and range of motion (approximately 3 weeks postoperatively). A sample size estimate was calculated and resulted in the need for 44 patients per group. Results: There was no difference in mean visual analogue scale pain scores 2 days after surgery between immobilised and non-immobilised patients. There were no differences between groups in medication consumed, range of motion or complications. Pain and analgesic use were the same for both groups at 7 and 14 days postoperatively.
sportEX comment
There is a constant stream of research papers into all aspect of anterior cruciate ligament reconstruction, which is creating a substantial knowledge base on what is and, more importantly, what is not effective. This paper shows that there is no difference in pain or analgesic use between immobilised and non-immobilised patients, so it is safe to spare the trouble and expense of a brace.
INCIDENCE OF SUBSEQUENT INJURY TO EITHER KNEE WITHIN 5 YEARS AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION WITH PATELLAR TENDON AUTOGRAFT. Shelbourne KD, Gray T, Haro M. American Journal of Sports Medicine 2009;37:246–251
A 5-year follow-up was obtained on 1,415 patients after
primary anterior cruciate ligament (ACL) reconstruction. Subsequent injury was evaluated based on sex, age and activity level. Seventy-five patients (5.3%) had an injury to the contralateral knee, and 61 patients (4.3%) suffered an injury to the reconstructed knee. Women suffered more injuries (7.8%) to the contralateral normal knee than men (3.7%), but not more injuries to the reconstructed knee (4.3% v. 4.1%). The risk of subsequent injury to either knee was 17% for patients under 18 years of age, 7% for patients aged 18–25 years, and 4% for patients older than 25 years. There was no difference in injury rate between patients
who returned before and after 6 months postoperatively.
sportEX comment
The incidence of injury to either knee after reconstruction is associated with younger age and higher activity level, but returning to full activities before six months postoperatively does not increase the risk of subsequent injury. Women have a higher incidence of ACL injury to the contralateral knee than men after reconstruction. The question is, why? Another paper (Varus alignment leads to increased forces in the anterior cruciate ligament. Van de Pol GJ, Arnold MP, Verdonschot N, van Kampen A. Journal of Sports Medicine 2009;37:481– 487) published in the same journal concludes that there is a direct relationship between varus alignment and ACL tension. This is a small study using cadavers, but it might point towards the role of knee alignment strategies in the prevention of ACL injury.