Single and double bundle posterior cruciate ligament reconstruction yield comparable clinical and functional outcomes: a systematic review and meta-analysis.

PURPOSE: To perform a systematic review and compare the functional and objective outcomes after single-bundle (SB) vs. double-bundle (DB) posterior cruciate ligament reconstruction (PCLR). Where possible to pool outcomes and arrive at summary estimates of treatment effect for DB PCLR vs. SB PCLR via an embedded meta-analysis. METHODS: A comprehensive PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) literature search identified 13 eligible studies evaluating clinical outcomes of both techniques for PCLR. Clinical outcome measures included in the meta-analysis were functional outcomes (Lysholm Score, Tegner Activity Scale) and objective measurements of posterior laxity of the operated knee (arthrometer and stress radiographs). RESULTS: The meta-analysis included 603 patients. Three hundred and fifteen patients were treated with SB and two hundred and eighty-eight patients with DB PCLR. There were no significant differences between SB and DB PCLR in postoperative functional Lysholm Scores (CI [- 0.18, 0.17]), Tegner Activity Scales (CI [- 0.32, 0.12]) and IKDC objective grades (CI [- 0.13, 1.17]). Regarding posterior stability using KT-1000 and Kneelax III arthrometer measurements, there were no differences between the SB and DB group. However, double-bundle reconstruction provided better objective outcome of measurement of posterior laxity (CI [0.02, 0.46]) when measured with Telos stress radiography. CONCLUSION: A systematic review was conducted to identify current best evidence pertaining to DB and SB PCLR. An embedded meta-analysis arrived at similar summary estimates of treatment effect for motion, stability and overall function for both techniques. There is no demonstrable clinically relevant difference between techniques based on the currently available evidence. LEVEL OF EVIDENCE: III.

The Comprehensive Aachen Knee Score: Development and validation of a new patient-reported outcome measure for patellofemoral pathologies.

BACKGROUND: Existing patient-reported outcome measures (PROMs) that assess knee pain and symptoms show insufficient quality regarding their psychometric properties. We developed and validated a new PROM assessing knee pain and especially patellofemoral pathologies, the COMPrehensive AaChen Knee Score (COMPACK). METHODS: We followed a three-phase process of development and validation. (1) Scale development: we conducted a systematic literature research to collect and analyse the most commonly used PROMs for knee and patellofemoral pathologies to identify appropriate items. (2) Pilot testing: we assessed the content validity of the COMPACK based on interviews with patients and health experts regarding relevance, comprehensibility and comprehensiveness of the used items. (3) Field testing: we used the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines to evaluate the structural validity, internal consistency and test-retest reliability of the COMPACK. RESULTS: The COMPACK scale showed good structural validity, with two subscales measuring pain intensity and frequency. Further, scores of the COMPACK correlated positively with those obtained from the International Knee Documentation Committee Subjective Knee Form (IKDC) (r = 0.64) and the 12-item Short Form Health Survey subscale of physical function: (r = 0.43). Both the total scale and the two subscales showed good internal consistency (Cronbach's α > 0.82) and good to excellent test-retest reliability (Cronbach's α > 0.82). CONCLUSIONS: The final COMPACK score was shown to be a valid and reliable instrument and thus meets the most important psychometric quality criteria. In its development, we specifically focused on its content validity, structural validity and applicability.

3-Dimensional Cervical Movement Characteristics and the Influence of Thoracic Treatment on a Subgroup of Acute Neck Pain Patients.

OBJECTIVE: The purpose of this study was to investigate the influence of thoracic high-velocity low-amplitude thrust (HVLAT) manipulation on quantitative and qualitative 3-dimensional cervical spine kinematic patterns in a subgroup of patients with acute neck pain. METHODS: Thirty patients with acute neck pain, aged 20 to 59, received a thoracic HVLAT manipulation. Three-dimensional kinematics of the cervical spine were registered pretreatment and posttreatment using an electromagnetic tracking system. Quantitative and qualitative parameters were calculated for axial rotation, lateral bending, and flexion-extension movement. Subjective pain ratings were measured with the visual analogue scale and the Neck Disability Index and were collected pretreatment and posttreatment. RESULTS: After treatment, the range of motion of the main motion improved significantly for axial rotation (P = .034), lateral bending (P < .001), and flexion-extension (P = .031). Although for axial rotation as the main motion, the smoothness of the flexion-extension movement improved significantly after treatment (P = .036), the reverse was true for flexion-extension as the main motion. Visual analogue scale scores exhibited a statistically (P < .001) and clinically significant reduction of pain sensation. The mean change in Neck Disability Index scores only exhibited a statistically significant improvement 1 week after treatment. CONCLUSION: Thoracic HVLAT manipulation led to positive changes in quantitative and qualitative aspects of 3-dimensional cervical spine kinematics. Because of the 1-intervention group design, external factors influencing the healing process could not be eliminated.