Return to sports after anterior cruciate ligament reconstruction - a review of patients with minimum 5-year follow-up

<p><b>INTRODUCTION</b>It is difficult to counsel the anterior cruciate ligament (ACL) deficient patient considering surgical reconstruction on the likelihood of eventual return to sports as information on this is lacking, especially in the Asian context. We wanted to determine how many of our patients who had ACL surgery returned to their previous levels of sports, 5 years after their surgery. For those that had not returned to their previous levels of sports, we wanted to identify their reasons for not doing so.</p><p><b>MATERIALS AND METHODS</b>Based on our inclusion criteria of a minimum 5-year follow-up after primary ACL reconstruction, 146 patients were identified for assessment. Sixty-four patients were successfully recalled. The mean age of our patients was 24.8 years (range, 18 to 40). The patients completed the Lysholm Knee, Tegner activity and the Subjective International Knee Documentation Committee (IKDC) questionnaires. Clinical examination of the operated knee was performed according to the Objective IKDC evaluation form and with a KT-1000 arthrometer.</p><p><b>RESULTS</b>The mean Lysholm score was 85.2 and the mean subjective IKDC score was 79.5. 81.2% of our patients had normal or nearly normal knees (IKDC A or B) with the remaining 18.8% at IKDC grade C. The mean side-side difference for anterior translation using the KT-1000 arthrometer was 1.2 mm. The median pre-injury Tegner activity level was 7 and the median 5-year post-surgery Tegner activity level was 6. Nineteen patients did not return to their pre-injury sports levels because of social reasons and were excluded. From the remaining 45 patients, 28 patients (62.2%) returned to their previous level of sports and 17 patients (28.8%) did not return to their previous level of sports. Of whom, 9 (20%) said that they did not return due to fear of re-injury and the remaining 8 (17.8%) said they had not returned because of knee instability and pain. At 5 years, the subgroup of patients who had returned to sport had the best scores: Lysholm (88.5), subjective IKDC (84.6) and IKDC Grade A&B (89.3%). When we compared this with the subgroups that did not return to sport because of fear of re-injury and because of an unstable knee, we found that the difference in knee outcome scores between these 3 groups were statistically significant.</p><p><b>CONCLUSION</b>Sixty-two per cent of our patients returned to their previous level of sport at 5 years after ACL reconstruction. Fear of reinjury is an important psychological factor for these patients not returning to sports. Our results would allow the attending surgeon to counsel the ACL deficient patient who is considering surgical reconstruction the likelihood of eventual return to sports.</p>

Coefficient Variations of Serum Levels of Phenytoin, Carbamazepine, and Valproic Acid in Compliant Epileptics

Compliance of epileptic patients is one of the most important factors for adequate therapy. Recently, it had been shown that the variability of three serial measurement of the serum levels of antiepileptic drug(AED) may be used as an indication of the degree of compliance. Coefficient variation(CV) of serum drug levels calculated by only one AED had been used to determine the compliance in epileptic patients who took multiple AEDs. We attempted to evaluate the CV of AEDs and then find the objective clue of compliance and the compatible therapeutic planing according to CV. Ninety seven epileptic patients of outpatients department of the Gyengsang National University Hospital were entered to this study. All patients were taking medication at least for 6 months without any changes of drug regimen. Patient's information was acquired by reviewing the chart and interview with questionnaire. With these informations, we determined the compliance of the patients. Antiepileptic serum levels were measured three times at intervals of at least two to four weeks apart, and their CV was calculated. We compared the CV between the compliant and non-compliant group in each AED(phenytoin, carbamazepine , valproic acid) and three drugs in the compliant group. The mean CVs of phenytoin, carbamazepine and valproic acid in the compliant group were 18.3+/-13.0, 15.2+/-10.2 and 23.8+/-8.9, respectively(mean+/-SD). The mean of CV in the compliant and the non-compliant group were 17.9+/-10.9 and 38.8+/-27.2, respectively. The CVs of the compliant group were significantly lower than those of the non-compliant group(p<0.05). However, CVs had no significant difference between three antiepileptic drugs. This study showed that CVs of AEDs were not different between each AEDs, even though they possess different pharmacokinetic properties. Therefore, the CV of one AED can be used in determining the compliance of the epileptics who are taking multiple AEDs.