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Background: Approximately 100,000 anterior cruciate ligament (ACL) reconstructions are performed in the USA each year. Interference screw fixation is considered the standard for rigid fixation of the graft and provides higher fixation strength compared with other devices such as staples or buttons. The present study summarizes the latest evidence comparing the effectiveness of the available classes of interference screws for fixation of ACL grafts., Sources: A comprehensive search of the CINAHL, PubMed, Google Scholar, Embase Biomedical databases and the Cochrane Central Registry of Controlled Trials was performed in March 2013. Twelve studies met our inclusion criteria., Areas of Agreement: Most studies showed no intergroup difference in terms of outcomes measured with validated clinical scores such as IKDC (International Knee Documentation Committee), Lysholm score and Tegner activity level. There was no significant difference regarding range of motion. Knee stability as evaluated with pivot shift and KT arthrometer showed a significant difference only in one study, favouring metallic interference screws. Tunnel widening is much more evident and marked patients who underwent ACL reconstruction with bioabsorbable screws, with no influence on the final clinical results achieved. Complication rates between the two screw classes were similar. The average modified Coleman methodology score was 74.67. AREAS OF UNCERTAINTY/RESEARCH NEED: The data comparing the outcomes achieved by two different materials for fixation, bioabsorbable and metallic, to be used during single-bundle ACL reconstruction, showed no significant difference in the final patient outcomes, in terms of clinical scores, clinical evaluation and imaging.

Introduction: Following knee surgery, rehabilitation can dramatically affect the postoperative course and the final outcomes of the procedure. We systematically reviewed the current literature comparing clinical outcomes of home-based and outpatient supervised rehabilitation protocols following knee surgery., Sources of Data: We searched Medline, CINAHL, Embase, Google Scholar, The Cochrane Library and SPORTDiscus. The reference lists of the previously selected articles were then examined by hand. Only studies comparing clinical outcomes of patients who had undergone knee surgery followed by different rehabilitation programs were selected. Then the methodological quality of each article was evaluated using the Coleman methodology score (CMS), a 10-criterion scoring list assessing the methodological quality of the selected studies., Areas of Agreement: Eighteen studies were evaluated in the present review. Three were retrospective studies. The remaining 15 studies were prospective randomized clinical trials. The supervised and home-based protocols did not show an overall significant difference in the outcomes achieved within the studies reviewed. The mean CMS was 77.2., Areas of Controversy: The heterogeneity of the rehabilitation protocols used in the studies reviewed makes it difficult to draw definite conclusion on the subject., Growing Points: Supervision and location does not seem to directly determine the final outcomes. Numerous variables, including comorbidities and motivation, could influence the results and deserve to be accounted for in future investigations., Research: Better designed studies are needed to show a clear superiority of one rehabilitation approach over another and its applicability to the various surgical procedures involving the knee.