There are large variations in how anterior cruciate ligament (ACL) injuries are treated. The long term outcomes from ACL surgery are uncertain, especially when it comes to the effect of ACL surgery on the development of osteoarthritis in the knee. There are no agreements on if the athlete should return to his sport and if thats the case when it should occur. This is one of the questions we hope to answer now that the worlds first national cruciate ligament registry is established after an initiative from the Oslo Sports Trauma Research Center (OSTRC).
|The new registry will provide valuable information about various aspects of ACL injuries. Illustration by Tommy Bolic. © Tommy Bolic & Gazette book. From the book "Clinical Guide to Sports Injuries" (www.HumanKinetics.com)|
Today there are no precise or complete summary of the ACL surgery in Norway, and there do not exist any national directions for the treatment of ACL ruptures. This together with the lack of randomized clinical trials and validated epidemiological data to support the choice of treatment strategies were the framework for a survey conducted by OSTRC during the spring 2003 among surgical divisions in Norway in which performed ACL surgery in 2002. The results from this survey have been introduced on Ortopedisk Høstmøte in Oslo and onIdrettsmedisinsk Høstkongress in Stavanger. They will also appear in print in the journal of the Norwegian Medical Association in 2004.
On the annual general meeting in the Norwegian Orthopaedic Association in October 2003 the motion from OSTRC about establishment of a national cruciate ligament registry was carried.
The objective of such a registry will be to contribute to quality control and improvement of the ACL surgery procedures through:
- Eliminating methods that result in an unacceptable
outcome at an early stage.
- Evaluating the outcome after surgical treatment with
- Mapping the importance of prognostic factors.
- Evaluating the importance of different methods of rehabilitation after
The cruciate ligament registry will be a registry of procedures for all surgical treatment of cruciate ligament injuries based on a model of the Norwegian Arthroplasty Register and there will be follow-ups at 2, 5 and 10 years after the operation. In addition re-reconstructions will be registered. The cruciate ligament registry will document the surgical indicators, the patients risk factors, the actual procedure and the outcome. The main end points for the registry will be:
1) Re-reconstruction of cruciate ligaments, and
2) Total knee replacement in a previously reconstructed knee.
Furthermore the registry will lend itself to systematic follow-up studies of special patient groups through the application of questionnaires, clinical examinations or imaging, also beyond regular controls.
The registry management will consist of a steering committee where three members are designated by the Norwegian Orthopaedic Association and three members by OSTRC. The technical running of the registry will be managed by the Norwegian Arthroplasty Register in Bergen. The advantage of such a distribution is the already existing infrastructure and competence on management of a registry in Bergen, besides the community at the Norwegian Arthroplasty Register will be enforced with two part-time employees, a secretary and a computer operator, on behalf of the national cruciate ligament registry.
OSTRC has also taken the initiative in collaboration with Swedish research groups to establish a corresponding registry in Sweden. These two registries will be of identical design and enable an immediate cooperation, exchange of experiences, studies, and increased amount of raw data for research purposes. A common steering committee will provide that these aspects exceed both countries when the Swedish registry is a reality. A common database is expected to gain an annualmaterial of approximately 4500-5000 surgeries.
The registry has already received solid support from the Norwegian Orthopaedic Association, the Norwegian Arthroplasty Register, the Norwegian Medical Association, OSTRC, Norwegian University of Sport and Physical Education and Orthopaedic Center, Ullevaal University Hospital.
Due to the large and increasing number of cruciate ligament injuries in Norway, we are of that opinion that a registry will make a contribution in ensuring good quality for the patients. Data from such a registry will be able to contribute in the development of national surgical directions for the ACL injured patients, and will enable every hospital a possibility to compare their results with the average of the entire database. Another important reason for a national cruciate ligament registry is that it will form the basis for large cohort studies. There are great requirements for research in this field to enable development of better treatment strategies than we can offer today. Follow-up studies reveal that long term outcomes are far from satisfactory with great risk for development of osteoarthritis and impaired knee function. Alternative forms of treatment should preferably been examined in randomized controlled trials, but there are several aspects that will make such a design impossible. For instance, the question about whether an athlete should be advised to quit his sport after an ACL reconstruction and if not so, when should he return? This is one of the questions we hope to answer now that the worlds first national cruciate ligament registry is established.
Read more about the study here.