Treatment after ACL injury: Panther Symposium ACL Treatment Consensus Group
Treatment after ACL injury: Panther Symposium ACL Treatment Consensus Group
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DOI：
10.1136/bjsports-2020-102200
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发表时间：
2021-01-01
影响因子：
18.4
通讯作者：
Musahl, Volker
中科院分区：
文献类型：
--
作者：
Diermeier, Theresa Anita;Rothrauff, Ben B.;Musahl, Volker
前交叉韧带损伤的治疗策略仍在不断发展。支持处理前交叉韧带损伤的最佳实践指南的证据很大程度上是基于低水平证据的研究。召集了一个国际共识专家组，就前交叉韧带损伤的手术和非手术治疗的最佳可用证据达成共识。本研究的目的是报告在2019年前交叉韧带共识会议豹研讨会上就前交叉韧带损伤的手术治疗与非手术治疗达成的共识声明。来自18个国家的66名前交叉韧带损伤管理国际专家召集并参与了以德尔菲法为基础的达成共识的进程。拟议的协商一致声明是由科学组织委员会和届会主席起草的。小组与会者在会前审查了初步声明，并通过在线调查提供了对声明的初步同意和意见。在会议期间，对每一项发言进行了讨论和辩论，之后进行了最后表决。80%的协议被先验地定义为共识。在研讨会期间，关于前交叉韧带损伤的手术和非手术治疗的13项声明中，共有11项达成了共识。9项发言获得一致支持，2项达成强烈共识，1项未达成共识，1项因所提供信息重复而被删除。对于从事跳跃、切割和旋转运动的高活动度患者，由于延迟手术继发半月板和软骨损伤的风险较高，建议尽早进行解剖性前交叉韧带重建，但建议进行一段时间的渐进式康复以解决损伤和改善神经肌肉功能。对于寻求恢复平面活动的患者，非手术治疗结合结构化、渐进式康复是一种可以接受的治疗选择。然而，当持续的功能不稳定，或当出现退缩发作时，需要解剖重建前交叉韧带。来自该领域国际领导者的共识声明可能有助于临床医生决定对前交叉韧带损伤后的患者进行手术或非手术治疗。
Treatment strategies for ACL injuries continue to evolve. Evidence supporting best practice guidelines to manage ACL injury is largely based on studies with low-level evidence. An international consensus group of experts was convened determine consensus regarding best available evidence on operative versus non-operative treatment for ACL injury. The purpose of this study is to report the consensus statements on operative versus non-operative treatment of ACL injuries developed at the ACL Consensus Meeting Panther Symposium 2019. Sixty-six international experts on the management of ACL injuries, representing 18 countries, convened and participated in a process based on the Delphi method of achieving consensus. Proposed consensus statements were drafted by the Scientific Organising Committee and Session Chairs. Panel participants reviewed preliminary statements prior to the meeting and provided initial agreement and comments on the statement via online survey. During the meeting, discussion and debate occurred for each statement, after which a final vote was then held. Eighty per cent agreement was defined a priori as consensus. A total of 11 of 13 statements on operative versus non-operative treatment of ACL injury reached consensus during the Symposium. Nine statements achieved unanimous support, two reached strong consensus, one did not achieve consensus, and one was removed due to redundancy in the information provided. In highly active patients engaged in jumping, cutting and pivoting sports, early anatomical ACL reconstruction is recommended due to the high risk of secondary meniscus and cartilage injuries with delayed surgery, although a period of progressive rehabilitation to resolve impairments and improve neuromuscular function is recommended. For patients who seek to return to straight plane activities, non-operative treatment with structured, progressive rehabilitation is an acceptable treatment option. However, with persistent functional instability, or when episodes of giving way occur, anatomical ACL reconstruction is indicated. The consensus statements derived from international leaders in the field may assist clinicians in deciding between operative and non-operative treatment with patients after an ACL injury.