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dc.contributor.authorSamuelsson, Kristian
dc.date.accessioned2012-03-30T07:28:35Z
dc.date.available2012-03-30T07:28:35Z
dc.date.issued2012-03-30
dc.identifier.isbn978-91-628-8422-2
dc.identifier.urihttp://hdl.handle.net/2077/28254
dc.description.abstractInjury to the anterior cruciate ligament (ACL) is one of the most common orthopedic diagnoses. It is also one of the most researched areas in orthopedic surgery, with well over eleven thousand publications. Despite this, the solution for the best reconstructive technique is still not known and patients still suffer from their injury in both the short- and the long-term. An assessment of the outcomes was performed on randomized clinical trials. In terms of rehabilitation, a postoperative knee brace did not affect the clinical outcome and closed kinetic chain exercises produced less anteroposterior laxity and better subjective outcomes than open kinetic chain exercises. In terms of graft type, the patellar tendon graft produced initially more anterior knee pain and kneeling pain than the hamstring tendon graft. Moreover, the harvest site affected muscle strength initially and the hamstring tendon graft produced more tunnel widening. In terms of surgical technique, double-bundle ACL reconstruction produced less rotatory laxity than single-bundle. Finally, bioabsorbable screws and titanium screws produced equal clinical outcome. An analysis and systematic review was performed on studies of primary ACL reconstruction. This analysis revealed that most therapeutic studies were of a low level of evidence and that the most common study type was case series. The three most common represented journals were Arthroscopy, Knee Surgery Sports Traumatology Arthroscopy and The American Journal of Sports Medicine. Furthermore, there was a correlation between the journals’ impact factor and the mean level of evidence and there was a higher mean level of evidence over time. Anatomic ACL reconstruction is currently one of the modern techniques for ACL reconstruction. This shift in paradigm has created confusion about the term “anatomic”. Two systematic reviews assessed surgical data from studies claiming anatomic ACL reconstruction. The reviews revealed substantial under-reporting, making it difficult to do valid interpretations of the outcomes. A current concepts article was therefore published, outlining the concepts of anatomic ACL reconstruction, including principles and a definition: the functional restoration of the ACL to its native dimensions, collagen orientation and insertion sites. Ultimately, a scoring system was developed for the objective grading of surgical methods in studies of anatomic ACL reconstruction. This scoring system was subsequently implemented in studies comparing single- and double-bundle ACL reconstruction, which revealed means of the score well below a proposed minimum. In summary, a thorough analysis and review of what constitutes an anatomic ACL reconstruction was done, and an assessment was performed on studies comparing single- and double-bundle ACL reconstruction and studies claiming anatomic ACL reconstruction.sv
dc.language.isoengsv
dc.relation.haspartI. Treatment of anterior cruciate ligament injuries with special reference to surgical technique and rehabilitation: an assessment of randomized controlled trials Andersson D, Samuelsson K, Karlsson J. Arthroscopy, 2009; 25(6): 653-85 ::PMID:: 19501297sv
dc.relation.haspartII. Treatment of anterior cruciate ligament injuries with special reference to graft type and surgical technique: an assessment of randomized controlled trials Samuelsson K, Andersson D, Karlsson J. Arthroscopy, 2009; 25(10): 1139-74 ::PMID:: 19801293sv
dc.relation.haspartIII. Systematic review on level of evidence in anterior cruciate ligament reconstruction Samuelsson K, Desai N, McNair E, van Eck CF, Petzold M, Fu FH, Bhandari M, Karlsson J. Unpublished manuscriptsv
dc.relation.haspartIV. Anatomic single- and double-bundle anterior cruciate ligament reconstruction, part 2: clinical application of surgical technique Karlsson J, Irrgang JJ, van Eck CF, Samuelsson K, Mejia HA, Fu FH. The American Journal of Sports Medicine, 2011; 39(9): 2016-26 ::PMID:: 21602567sv
dc.relation.haspartV. Systematic review on cadaveric studies of anatomic anterior cruciate ligament reconstruction. van Eck CF, Samuelsson K, Vyas SM, van Dijk CN, Karlsson J, Fu FH. Knee Surg Sports Traumatol Arthrosc., 2011; 19(S1): 101-8 ::PMID:: 21584719sv
dc.relation.haspartVI. "Anatomic" anterior cruciate ligament reconstruction: a systematic review of surgical techniques and reporting of surgical data van Eck CF, Schreiber VM, Mejia HA, Samuelsson K, van Dijk CN, Karlsson J, Fu FH. Arthroscopy, 2010; 26(9): 2-12 ::PMID:: 20810090sv
dc.relation.haspartVII. Anatomic anterior cruciate ligament reconstruction scoring system: development and validation van Eck CF, Gravare-Silbernagel K, Samuelsson K, Musahl V, van Dijk CN, Karlsson J, Irrgang JJ, Fu FH. Unpublished manuscriptsv
dc.relation.haspartVIII. Anatomic anterior cruciate ligament reconstruction scoring system: a systematic review of single- versus double-bundle Samuelsson K, Desai N, Ahldén M, van Eck CF, Fu FH, Musahl V, Karlsson J. Unpublished manuscriptsv
dc.subjectAnatomicsv
dc.subjectAnterior Cruciate Ligamentsv
dc.subjectReconstructionsv
dc.subjectScoresv
dc.subjectLevel of Evidencesv
dc.titleAnatomic anterior cruciate ligament reconstruction - current evidence and future directionssv
dc.typetexteng
dc.type.svepDoctoral thesiseng
dc.gup.mailkristian@samuelsson.ccsv
dc.type.degreeDoctor of Philosophy (Medicine)sv
dc.gup.adminSpikning är planerad till 29 mars.sv
dc.gup.originUniversity of Gothenburg. Sahlgrenska Academysv
dc.gup.departmentInstitute of Clincial Sciences. Department of Orthopaedicssv
dc.gup.defenceplaceFredagen den 20 april 2012, kl 9.00, Mölndalsaulan, V-huset, Sahlgrenska Universitetssjukhuset/Mölndalsv
dc.gup.defencedate2012-04-20
dc.gup.dissdb-fakultetSA


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