Artikkelforfatter Lars Engebretsen.
36 Norsk Ortopedpost • 4 - 2014
example ESSKA and ISAKOS. For countries that need a separate database due to legal reasons, the software could be the same for all countries.
In a very short time a huge amount of data could be obtained and fruitful international comparisons would be possible. Currently work is going on with EsskA to create a registry for children ACL reconstructions.
specifically, registries are meant to serve three specific purposes; to improve treatment outcomes through feed-back to the hospitals and surgeons, to detect procedures and devices that result in premature failure,20,21 and to identify prognostic factors asso-ciated with good and poor outcomes.13,14,17 However, to serve these purposes, the accuracy of the outcome measures used is critical. The arthro-plasty registries use revision surgery as the sole end point. Thus, patients may have a poor result without this being registered. In contrast, in addition to revi-sion surgery, the knee ligament registries therefore also include routine follow-ups with patient-reported koos scores. koos scores are collected pre- operatively from the patients, as well as after 2, 5 and 10 years. The intention is to detect inferior results and early failures, regardless if patients with a failed graft decide to go through revision surgery or not. The koos is commonly used to evaluate the outcome following ACLr. koos data from more than 20,000 patients are available from ACL registries in sweden, Norway and Denmark.
Data from these registries show post-operative
mean koos scores corresponding to mild pain (mean scores 84-89), moderate to mild symptoms (60-86), no problems with activities of daily living (90-97), moderate to mild problems with sport and recreational activities (63-78) and moderate to mild reductions in knee-related quality of life (60-69) at 1-2 years following reconstructive surgery.9,28 koos < 44 has been defined as a failed ACL reconstruction thus enabling the registries to detect failures that are not undergoing a revision. koos has been criticzied for including too many questions and too little ability to differentiate between patients, but at this stage no better tool is available.
Also, at a later stage data from cruciate registries can be combined with data from registries on knee arthroplasties, thus using surgically verified severe osteoarthritis as an additional end point.
Whereas the registries published epidemiological data the first years, current publications are concentrating on the effect of additional ligament, cartilage and meniscal injuries on the ACL reconstruction revision rate and ProM result.
Additionally, at this stage we can see the effect of the graft choices, fixation devices and various forms of rehabilitation on the final results of the surgery (20-28) based on analyzes of > 40 000 ACL reconstructions. Today the ACL registries play an important role in decision on surgical procedures, fixation devices and rehabilitation protocols. As the registry information becomes increasingly transparent, results from each hospital and clinic and ultimately from each surgeon on ACL reconstructions should improve patient care.
why registries analyzing cruciate ligament surgery are important
fortsatt ...” ... the accuracy
references
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38 Norsk Ortopedpost • 4 - 2014