Short-term effects of rituximab on flow-mediated dilatation may be mediated by intravenous glucocorticoids: Comment on the article by Gonzalez-Juanatey et al
✍ Scribed by Sandoo, Aamer ;Toms, Tracey ;Zanten, Jet Veldhuijzen van ;Carroll, Douglas ;Kitas, George
- Publisher
- John Wiley and Sons
- Year
- 2009
- Tongue
- English
- Weight
- 42 KB
- Volume
- 61
- Category
- Article
- ISSN
- 0004-3591
No coin nor oath required. For personal study only.
✦ Synopsis
We are pleased to note Dr. Dahlberg's interest in our recent article about muscle strength and functional performance in patients treated for ACL injuries. Despite the fact that surgical reconstruction of ACL tears is widely practiced, there is no evidence to date showing whether surgical or nonsurgical treatment is best for patients with an ACL injury (1). A majority of American orthopedic surgeons believe that ACL reconstruction reduces the rate of OA in ACL-deficient knees (2), although there is no evidence to suggest this (3). The Knee, Anterior cruciate ligament, NON-surgical versus surgical treatment (KANON) study is the first RCT comparing training and surgery with training only. This RCT (not yet published) was set up to provide answers to these important questions.
The patients in our cross-sectional report on muscle function were from the KANON study, but our present study and report is not part of this RCT. Muscle function as assessed in the present report is not an outcome included in the RCT. A limitation of our study was that 41% of the patients who were contacted for this followup outside of the RCT did not attend the assessment. We agree with Dr. Dahlberg that our study result showing no differences between the surgical and the nonsurgical treatment groups would have been more conclusive if all study subjects had participated. However, in our data analysis we adjusted for sex, the confounding factor that influenced muscle function. The presence of meniscal tears, contralateral ACL injury, or additional surgery did not influence our results and, therefore, we did not adjust for them.
Various methods of assessing neuromuscular function have shown that both legs are affected after a unilateral ACL injury, and using the uninjured leg as control may, therefore, conceal impairment (4). In our study, between 44% and 89% of subjects had normal muscle function in the single tests, and between 44% and 56% of subjects had normal muscle function in the test batteries, as measured with the Limb Symmetry Index. Therefore, the number of patients with abnormal muscle function may be even higher than reported in our study.
As stated, meniscal tears and meniscectomy are strong risk factors for knee OA. The ACL is the most commonly injured ligament in the knee, but isolated ACL tears are uncommon. For example, associated injuries to the menisci, other ligaments, and joint cartilage are often observed, and it is likely that these associated injuries significantly contribute to the risk of future OA after an ACL injury (3). The relative contribution of different factors, such as sex, postinjury physical activity, body mass index, heredity, meniscal injury, and poor muscle function on OA development after ACL injury is not well understood. We agree with Dr. Dahlberg that future research to determine how these factors contribute to OA development is highly important and relevant.