AIM:Anterior cruciate ligament reconstruction (ACLR) in patients over 50 years has traditionally been considered controversial due to concerns about graft failure, limited healing potential, and the risk of degenerative progression. However, with increasing life expectancy and higher physical activity in older adults, the demand for ACLR in this population has grown, and the role of graft selection remains unclear. The aim of this study was to evaluate the influence of graft choice on clinical outcomes, graft survival, and re-rupture rates after ACLR in patients aged 50 years and older. It was hypothesized that (1) ACLR in this population would result in low re-rupture rates and satisfactory functional outcomes, and (2) no significant differences would be observed among different graft types. EVIDENCE REVIEW:A systematic literature search of PubMed, Embase, and the Cochrane Library was performed from database inception to July 20, 2025, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Eligible studies included skeletally mature patients ≥50 years undergoing primary ACLR with different grafts (hamstring tendon [HT], bone-patellar tendon-bone [BPTB], quadriceps tendon [QT], allograft, or synthetic). Outcomes of interest included graft re-rupture, Lysholm score, and International Knee Documentation Committee (IKDC) subjective score. Random-effects meta-analyses were conducted to pool results, and subgroup analyses were performed by graft type. FINDINGS:Twenty-one studies including a total of 1093 patients were analyzed. The overall weighted mean age at surgery was 55.88 years (95% confidence interval [CI], 54.6-57.2). The majority of patients underwent HT reconstruction (n = 744-68.1%), followed by QT (n = 142-12.9%), BPTB (n = 81-7.4%), allograft (n = 110-10.1%), and synthetic grafts (ligament augmentation and reconstruction system [LARS]; n = 16-1.5%). The overall re-rupture rate was 0.3% (95% CI, 0.0-1.4), with no statistically significant differences among graft types (p > 0.05), ranging from 0.0% for BPTB/QT to 1.8% for allograft/LARS. The pooled mean Lysholm score was 91.2 (95% CI, 89.5-92.9), and the pooled mean IKDC score was 81.4 (95% CI, 77.9-84.9), showing no statistically significant graft-related differences. Odds ratio analysis confirmed no increased risk of re-rupture across graft types. CONCLUSIONS:ACL reconstruction in patients aged 50 years and older is associated with excellent functional outcomes and very low re-rupture rates. No statistically significant differences were observed among graft types. These findings should be interpreted with caution due to limited data for some graft categories and the heterogeneity of the available evidence. Graft selection should be individualized based on patient characteristics and surgeon expertise rather than chronological age. STUDY DESIGN:Systematic review and meta-analysis; level of evidence, III.
Statistische Fragilität beschreibt, wie stabil oder instabil die Ergebnisse klinischer Studien gegenüber kleinen Änderungen einzelner Datenpunkte sind. Gerade in der Arthroskopie und Gelenkchirurgie, in der viele Studien auf kleinen Stichproben und seltenen Ereignissen basieren, kann bereits der Wechsel weniger Patient:innenergebnisse dazu führen, dass statistische Signifikanz verloren geht. Der Fragility-Index sowie seine Weiterentwicklungen für kontinuierliche und nichtsignifikante Endpunkte erlauben eine intuitive Einschätzung dieser Robustheit und ergänzen klassische Kennzahlen wie p-Wert und Konfidenzintervalle. In diesem Übersichtsartikel werden die Konzepte der statistischen Fragilität, ihre Berechnung für binäre und kontinuierliche Variablen sowie ihre Bedeutung für die Interpretation gelenkchirurgischer Studien dargestellt.
Although intermittent catheterisation (IC) has been established as the standard method of bladder emptying in cases of neurogenic bladder dysfunction since the 1960s, there are still many uncertainties in everyday nursing practice regarding the specific implementation of IC. It, therefore, seemed necessary to standardise the IC procedure and develop specific recommendations for performing IC based on an interprofessional, interdisciplinary consensus process. In 2014, an interprofessional, interdisciplinary working group developed initial Clinical Practice Guidelines (CPG) in accordance with the rules of the Association of the Scientific Medical Societies in Germany (AWMF) based on the evidence level of a structured consensus process. The methods used to develop the CPG and the professional associations involved are described in detail. These CPG have been consistently refined and have been available as update 3.0 since 2026. The CPG describes in detail the topics of indications for IC, definitions, detailed descriptions of the various catheter characteristics, specific implementation of IC including disinfection of hands and meatus urethrae, management of complications such as urinary tract infections (UTIs) or autonomic dysreflexia, and options for UTI prophylaxis, and provides specific recommendations for action. This CPG, based on consensus-based evidence, has proven itself in clinical and everyday use for over 10 years. Due to the regular further development of the CPG, the guideline will also be able to meet future challenges such as changing demographic conditions of our patients with an increase in older patients with complex medical situations and increased use of permanent urinary catheter drainage or increased cost pressure in the healthcare system, even in developed countries. Consensus-based CPGs are an important component of evidence-based medicine, especially in situations where there are few randomised-controlled trials and none are expected in the future. Such CPGs can also address aspects that are likely to become even more important in the future, such as sustainability and environmental issues.
Background: Management of tracheobronchial secretions is an integral part of clinical work in many specialist areas, contributing to respiratory stability and survival of the patients. This study aimed at recording the practice of secretion management among doctors, respiratory therapists, specialist nurses and other health professions in German-speaking countries and to derive measures from the results to improve patient care. Methods: An online survey with 15 closed and two open-ended questions was designed to collect information regarding the profession and working environment of the respondents as well as the practice of secretion management in their primary working environment. The survey was distributed to members of the German Interdisciplinary Society for Out-of-Hospital Ventilation and Intensive Care e.V. (DIGAB), the German Society for Neurorehabilitation e.V. (DGNR), the German Society for Respiratory Therapy e.V. (DGA) and the German Society for Pulmonology and Mechanical Ventilation e.V. (DGP). Findings: The invitation to participate in the survey was distributed to 1695 members of the DIGAB, DGNR, DGA and DGP. Two-hundred fifty-eight health professionals including doctors, respiratory therapists, nurses, pediatric nurses, speech and language therapists and physiotherapists mostly working in Germany (97 %) completed the survey. One-Hundred eighty-eight (73 %) worked in hospitals or rehabilitation facilities and seventy (27 %) in an in-community setting. The spectrum of diagnostic and therapeutic methods used for management of tracheobronchial secretions on a daily or routine basis differed between hospitals or rehabilitation facilities and the in-community setting, between ICUs, weaning units and wards with specialization in ENNR, between in-community intensive care in the home of the patients and in residential communities, and between respondents treating only children, both children and adults, and only adults. Interpretation: A consensus on proceedings for the management of tracheobronchial secretions is required, which again requires further research into the differences regarding the practice of secretion management observed in this study. Standardized proceedings for the management of tracheobronchial secretions should be implemented by national treatment guidelines or local standard operating procedures.
