Original title: The American Academy ofOrthopaedic Surgeons Evidence-Based Guideline on: Management of AnteriorCruciate Ligament InjuriesWang Shanfu, Department of Joint Orthopedics, Wuxi City Hospital of Traditional Chinese Medicine
原文作者： Shea KG, Carey JL, Richmond J, Sandmeier R,et al.
Original source: J Bone Joint Surg Am. 2015;97:672-4
Presentation.
The AAOS evidence-based guidelines for the management of anterior cruciate ligament injuries include diagnosis and treatment,This clinical practice guideline is supported by NASM, AOSSM, NATA, AAPM&R, and this article summarizes a series of recommendations and evidence-based strength ratings at www.aaos.org上讨论每个建议是如何开发和完整证据报告中包含完整的指南.
Summary of Recommendations.
History and Examination for ACL
Strong evidence supports that physicians should obtain a relevant history and perform an examination of the muscles of the extremities, which are valid diagnoses for diagnosing ACL injuries.
Strength of Recommendation: Strongly Recommended, ★★★★
ACL radiological examination
In the absence of reliable evidence, an initial assessment of the patient’s knee injury and associated clinical signs, as well as frontal and lateral radiographs of the knee, are relied upon to identify a fracture or a dislocation requiring emergency management.
Recommended intensity: General recommendation, ★☆☆☆☆
ACL Magnetic Resonance Imaging
There is strong evidence that MRI can confirm an ACL injury and can also differentiate between other knee injuries such as other ligament, meniscus or articular cartilage injuries.
Recommended intensity: highly recommended, ★★★★
ACL in young active adults
Moderate evidence supports surgical reconstruction to manage ACL tears in young active patients (18-35 years).
Strength of recommendation: moderately recommended, ★★★★★☆
ACL meniscus repair
The provisional evidence for meniscal tears accompanying ACL tears is more limited, but physicians are still advised to repair the meniscus at the time of ACL reconstruction because it will improve the patient’s postoperative outcome.
Strength of recommendation: limited recommendation, ★★★☆☆
Recurrent ACL instability
There is relatively little evidence comparing nonsurgical treatment to ACL reconstruction in patients with recurrent ACL instability, but it is still recommended that physicians reconstruct the ACL as this may reduce pathologic laxity.
Strength of recommendation: limited recommendation, ★★★☆☆
Conservative treatment of ACL
There is relatively limited evidence related to conservative treatment of less active patients with a less flaccid ACL.
Strength of recommendation: limited recommendation, ★★★☆☆
Timing of ACL surgery
Once guidelines for ACL reconstruction are met, moderate evidence supports that reconstruction within 5 months of injury is effective in preserving articular cartilage and meniscus.
Strength of recommendation: Moderate recommendation, ★★★★★☆
ACL composite MCL injury
In patients with acute ACL injuries combined with MCL tears, limited evidence supports physician reconstruction of the ACL and conservative treatment of MCL tears.
Strength of recommendation: limited recommendation, ★★★★☆☆
ACL leading to knee lockout
In the absence of reliable evidence at this time, the Working Group recommends that ACL tears with meniscal freeing leading to knee lock-up should be unlocked immediately to avoid fixation of the knee joint with flexion contracture.
Recommended strength: general recommendation, ★☆☆☆☆
ACL single or double bundle reconstruction
There is strong evidence to support the patient’s choice of single- or double-bundle reconstruction when undergoing intra-articular ACL reconstruction, and the measurements are generally consistent between the two types of reconstruction.
Strength of recommendation: highly recommended, ★★★★
ACL autograft
Strong evidence supports the use of autologous tissues such as bone-patellar ligament-bone or N-cord tendon grafts when patients undergo intra-articular ACL reconstruction, both of which are generally consistent in terms of measurements.
Strength of recommendation: highly recommended, ★★★★
ACL autograft vs. allograft
Strong evidence supports the use of autografts or appropriately treated allografts when patients undergo ACL reconstruction, although these results may not be generalized to all allografts or all patients, such as younger patients or athletically active patients, but the clinical outcomes are generally similar
Strength of recommendation: highly recommended, ★★★★
ACL Femoral Tunneling Technique
Moderate evidence supports that when a patient undergoes intra-articular ACL reconstruction, the surgeon may choose either a simple tibial approach or a femoral tunnel technique with a transverse tibial approach, as the measurements are essentially the same for both.
Recommended strength: moderate recommendation, ★★★★★☆
Functional bracing after ACL surgery
Moderate evidence does not support the routine use of functional bracing after ACL reconstruction, as there is no proven effect.
Strength of recommendation: moderate recommendation, ★★★★★☆
ACL prophylactic brace
Limited evidence supports that physicians may not prescribe knee injury prevention braces because they do not reduce the risk of ACL injury.
Recommended intensity: Limited recommendation, ★★★☆☆
ACL Neuromuscular Training Program
Moderate evidence from a combined analysis with a small effect size (sample size 109) supports that neuromuscular training programs can reduce ACL injuries.
Recommended intensity: Moderate recommendation, ★★★★★☆
Postoperative Physical Therapy for ACL
Moderate evidence supports early, accelerated versus non-accelerated rehabilitation for patients undergoing post-operative rehabilitation for ACL reconstruction, and their outcomes are generally consistent.
Recommended intensity: Moderate recommendation, ★★★★★☆
ACL Recovery Exercise
Limited evidence does not support waiting a specific time for surgery or completing a specific functional goal before resuming participation in sports after ACL injury or reconstruction.
Recommended intensity: limited recommendations, ★★★☆☆