Journal of Orthopaedic Translation (Sep 2024)
Diagnosis and treatment of anterior cruciate ligament injuries: Consensus of Chinese experts part II: Graft selection and clinical outcome evaluation
- Tianwu Chen,
- Xizhuang Bai,
- Lunhao Bai,
- Wai Sin Chan,
- Shiyi Chen,
- Chen Chen,
- Jiwu Chen,
- Liaobin Chen,
- Guofeng Dai,
- Zhizeng Gao,
- Yang Guo,
- Yong Hu,
- Ning Hu,
- Huayang Huang,
- Xunwu Huang,
- Xuan Huang,
- Jingmin Huang,
- Yifan Kang,
- Hung Maan Lee,
- Hongyun Li,
- Yunxia Li,
- Jin Li,
- Kuanxin Li,
- Yanlin Li,
- Jian Li,
- Qi Li,
- Ruixin Lin,
- Xinwei Liu,
- Ning Liu,
- Wei Lü,
- Hongbin Lü,
- Xiaogang Ma,
- Kun Mi,
- Zhiming Qi,
- Luning Sun,
- Jun Tao,
- Xueren Teng,
- Xuesong Wang,
- Jianquan Wang,
- Kai Wang,
- Fei Wang,
- Hong Wang,
- Weiming Wang,
- Meng Wu,
- Yayi Xia,
- Gengyan Xing,
- Weidong Xu,
- Youjia Xu,
- Kun Yin,
- Hongbo You,
- Jia-Kuo Yu,
- Patrick Yung,
- Hui Zhang,
- Xinghuo Zhang,
- Xintao Zhang,
- Chunli Zhang,
- Wentao Zhang,
- Weiguo Zhang,
- Yufei Zhang,
- Keyuan Zhang,
- Yadong Zhang,
- Lei Zhang,
- Qichun Zhao,
- Jiapeng Zheng,
- Jingbin Zhou,
- Liwu Zhou,
- Yongsheng Xu
Affiliations
- Tianwu Chen
- Huashan Hospital Fudan University, Shanghai, China
- Xizhuang Bai
- Liaoning Provincial People's Hospital, Shenyang, Liaoning Province, China
- Lunhao Bai
- Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
- Wai Sin Chan
- Health Bureau of Macau Special Administrative Region Government, Macau Special Administrative Region, China
- Shiyi Chen
- Huashan Hospital Fudan University, Shanghai, China; Corresponding author. No. fax: 433, Huashan Road, Jingan District, Shanghai 200020, China.
- Chen Chen
- Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
- Jiwu Chen
- The First Affiliated Hospital of Shanghai Jiao Tong University, Shanghai, China
- Liaobin Chen
- Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China
- Guofeng Dai
- Qilu Hospital of Shandong University, Jinan, Shandong Province, China
- Zhizeng Gao
- The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
- Yang Guo
- The First Affiliated Hospital of Xiamen University, Xiamen, Fujian Province, China
- Yong Hu
- Sichuan Provincial Orthopedic Hospital, Chengdu, Sichuan Province, China
- Ning Hu
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Huayang Huang
- General Hospital of the Southern Theater Command of the People's Liberation Army, Guangzhou, Guangdong Province, China
- Xunwu Huang
- The Eighth Medical Center of the Chinese People's Liberation Army General Hospital, Beijing, China
- Xuan Huang
- Changhai Hospital, Naval Medical University, Shanghai, China
- Jingmin Huang
- Tianjin Hospital, Tianjin University, Tianjin, China
- Yifan Kang
- Shanghai Fourth People's Hospital Affiliated to Tongji University, Shanghai, China
- Hung Maan Lee
- Hualien Tzu Chi Medical Center, Hualien City, Taiwan, China
- Hongyun Li
- Huashan Hospital Fudan University, Shanghai, China
- Yunxia Li
- Huashan Hospital Fudan University, Shanghai, China
- Jin Li
- Ningbo Medical Center LiHuiLi Hospital, Ningbo, Zhejiang Province, China
- Kuanxin Li
- The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui Province, China
- Yanlin Li
- The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, China
- Jian Li
- West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
- Qi Li
- West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
- Ruixin Lin
- Renji Hospital, Shanghai Jiao Tong University, Shanghai, China
- Xinwei Liu
- General Hospital of the Northern Theater Command of the People's Liberation Army, Shenyang, Liaoning Province, China
- Ning Liu
- Zhengzhou Orthopedics Hospital, Zhengzhou, Henan Province, China
- Wei Lü
- Heilongjiang Provincial Hospital, Harbin, Heilongjiang Province, China
- Hongbin Lü
- Xiangya Hospital Central South University, Changsha, Hunan Province, China
- Xiaogang Ma
- Tibet Autonomous Region People’s Hospital, Lhasa, Tibet Autonomous Region, China
- Kun Mi
- Guangxi International Zhuang Medicine Hospital, Guangxi University of Chinese Medicine, Nanning, Guangxi Zhuang Autonomous Region, China
- Zhiming Qi
- Dalian Orthopedic Hospital, Dalian, Liaoning Province, China
- Luning Sun
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, China
- Jun Tao
- The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
- Xueren Teng
- Qingdao Municipal Hospital, Qingdao, Shandong Province, China
- Xuesong Wang
- Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
- Jianquan Wang
- Peking University Third Hospital, Beijing, China
- Kai Wang
- Qinghai Provincial People’s Hospital, Xining, Qinghai Province, China
- Fei Wang
- The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
- Hong Wang
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
- Weiming Wang
- Xinhua Hospital Affiliated to Dalian University, Dalian, Liaoning Province, China
- Meng Wu
- The Second Hospital of Lanzhou University, Lanzhou, Gansu Province, China
- Yayi Xia
- The Second Hospital of Lanzhou University, Lanzhou, Gansu Province, China
- Gengyan Xing
- The Third Medical Center of the Chinese People's Liberation Army General Hospital, Beijing, China
- Weidong Xu
- Changhai Hospital, Naval Medical University, Shanghai, China
- Youjia Xu
- The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
- Kun Yin
- The Second Hospital of Shanxi Medical University, Taiyuan, Shanxi Province, China
- Hongbo You
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
- Jia-Kuo Yu
- Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
- Patrick Yung
- Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
- Hui Zhang
- Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
- Xinghuo Zhang
- Beijing Luhe Hospital Affiliated to Capital Medical University, Beijing, China
- Xintao Zhang
- Peking University Shenzhen Hospital, Shenzhen, Guangzhou Province, China
- Chunli Zhang
- Qionghai People’s Hospital, Qionghai, Hainan Province, China
- Wentao Zhang
- The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangzhou Province, China
- Weiguo Zhang
- The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning Province, China
- Yufei Zhang
- The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning Province, China
- Keyuan Zhang
- The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang Uyghur Autonomous Region, China
- Yadong Zhang
- The Fourth Medical Center of the General Hospital of the People's Liberation Army, Beijing, China
- Lei Zhang
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Qichun Zhao
- The First Affiliated Hospital of the University of Science and Technology of China, Hefei, Anhui Province, China
- Jiapeng Zheng
- Southeast Hospital Affiliated to Xiamen University, Zhangzhou, Fujian Province, China
- Jingbin Zhou
- China National Institute of Sports Medicine, Beijing, China
- Liwu Zhou
- General Hospital of the Eastern Theater Command of the People's Liberation Army, Nanjing, Jiangsu Province, China
- Yongsheng Xu
- Inner Mongolia Autonomous Region People's Hospital, Hohhot, Inner Mongolia Autonomous Region, China
- Journal volume & issue
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Vol. 48
pp. 163 – 175
Abstract
Background: In the recent decade, there has been substantial progress in the technologies and philosophies associated with diagnosing and treating anterior cruciate ligament (ACL) injuries in China. The therapeutic efficacy of ACL reconstruction in re-establishing the stability of the knee joint has garnered widespread acknowledgment. However, the path toward standardizing diagnostic and treatment protocols remains to be further developed and refined. Objective: In this context, the Chinese Association of Orthopaedic Surgeons (CAOS) and the Chinese Society of Sports Medicine (CSSM) collaboratively developed an expert consensus on diagnosing and treating ACL injury, aiming to enhance medical quality through refining professional standards. Methods: The consensus drafting team invited experts across the Greater China region, including the mainland, Hong Kong, Macau, and Taiwan, to formulate and review the consensus using a modified Delphi method as a standardization approach. As members of the CSSM Lower Limb Study Group and the CAOS Arthroscopy and Sports Medicine Study Group, invited experts concentrated on two pivotal issues: “Graft Selection” and “Clinical Outcome Evaluation” during the second part of the consensus development. Results: This focused discussion ultimately led to a strong consensus on nine specific consensus terms. Conclusion: The consensus clearly states that ACL reconstruction has no definitive “gold standard” graft choice. Autografts have advantages in healing capability but are limited in availability and have potential donor site morbidities; allografts reduce surgical trauma but incur additional costs, and there are concerns about slow healing, quality control issues, and a higher failure rate in young athletes; synthetic ligaments allow for early rehabilitation and fast return to sport, but the surgery is technically demanding and incurs additional costs. When choosing a graft, one should comprehensively consider the graft's characteristics, the doctor's technical ability, and the patient's needs. When evaluating clinical outcomes, it is essential to ensure an adequate sample size and follow-up rate, and the research should include patient subjective scoring, joint function and stability, complications, surgical failure, and the return to sport results. Medium and long-term follow-ups should not overlook the assessment of knee osteoarthritis.
