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AAOS releases new guidelines for ACL injury prevention, treatment
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The American Academy of Orthopaedic Surgeons recently approved appropriate use criteria for ACL injury prevention programs and treatment and released rehabilitation and function checklists.
“What we showed in the [Clinical Practice Guideline] CPG is that the good news both for patients and practitioners is that ACL reconstruction with autograft or allograft is successful,” Robert H. Quinn, MD, the appropriate use criteria section leader on the Committee on Evidence-Based Quality and Value for the American Academy of Orthopaedic Surgeons (AAOS), told Orthopedics Today. “We have good evidence to suggest that both prevention and treatment are effective. The [Appropriate Use Criteria] AUC helps alleviate some of the controversy about when some of the good options are most applicable.”
Based on patient indications including age, activity level, presence of advanced arthritis and the status of the ACL tear, the new “Appropriate Use Guideline for the Treatment of Anterior Cruciate Ligament Injuries” provides more specific guidance for orthopedic surgeons and recommends next steps and procedures to ensure optimal recovery, according to a press release.
Advice about a supervised ACL injury prevention program for athletes with no prior history of ACL reconstruction, no current history of ACL deficiency and who are involved in either competitive or recreational sports is provided in the “Appropriate Use Guideline for ACL Injury Prevention Programs.”
“The AUC takes the recommendations of the previously published clinical practice guidelines in what could be viewed as a somewhat complex array of prevention and treatment options and puts forth a mechanism that makes it easier for practitioners — or patients — to see what is most appropriate for their scenario,” Quinn said.
In addition, the new ACL “Return to Play” and “Postoperative Rehabilitation” checklists “are evidence-based lists on what should be going on before an athlete returns to play, and are constructed in a way that realistically sets expectations for what needs to be accomplished,” Quinn stated in an AAOS press release.
The return-to-play checklist details items, such as making sure the patient is confident in returning to sport, ensuring the graft and surgical site have fully healed and that range of motion, balance, knee stability, strength and function have been restored.
“The checklists are single-page documents that can be discussed and shared with the patient and included in the medical record,” Quinn told Orthopedics Today. “The return to play checklist is constructed in a way that realistically sets expectations for what needs to be accomplished. The postoperative rehabilitation checklist outlines the post-surgical protocol, from early range of motion, weight-bearing, and closed and open chain quad and hamstring therapy, to optional rehabilitative bracing and neuromuscular stimulation.” – by Casey Tingle
- References:
- Appropriate Use Criteria. Available at: www.orthoguidelines.org/auc. Accessed Nov. 25, 2015.
- American Academy of Orthopaedic Surgeons Board of Directors. Appropriate use criteria for the treatment of anterior cruciate ligament injuries. Available at: www.aaos.org/research/Appropriate_Use/aclauctreatment.pdf. Accessed Nov. 25, 2015.
- American Academy of Orthopaedic Surgeons Board of Directors. Appropriate use criteria for ACL injury prevention programs. Available at: www.aaos.org/research/Appropriate_Use/aclaucprevention.pdf. Accessed Nov. 25, 2015.
- For more information:
- Robert H. Quinn, MD, can be reached at the University of Texas Health Science Center at San Antonio, Mail Code 7774, 7703 Floyd Curl Dr., San Antonio, TX 78229; email: quinnr@uthscsa.edu.
Disclosure: Quinn reports no relevant financial disclosures.