Revision Anterior Cruciate Ligament Reconstruction Using a 2-Stage Technique With Bone Grafting of the Tibial Tunnel

Background: Revision anterior cruciate ligament surgery is often considered a salvage procedure with limited goals. However, this limitation need not be the case. Similar to primary reconstruction, the goal should be to choose an appropriate graft and place it in an anatomical position in a good qua...

Ausführliche Beschreibung

Gespeichert in:
Bibliographische Detailangaben
Veröffentlicht in:The American journal of sports medicine 2005-11, Vol.33 (11), p.1701-1709
Hauptverfasser: Thomas, Neil P., Kankate, Raghu, Wandless, Felicity, Pandit, Hemant
Format: Artikel
Sprache:eng
Schlagworte:
Online-Zugang:Volltext
Tags: Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
container_end_page 1709
container_issue 11
container_start_page 1701
container_title The American journal of sports medicine
container_volume 33
creator Thomas, Neil P.
Kankate, Raghu
Wandless, Felicity
Pandit, Hemant
description Background: Revision anterior cruciate ligament surgery is often considered a salvage procedure with limited goals. However, this limitation need not be the case. Similar to primary reconstruction, the goal should be to choose an appropriate graft and place it in an anatomical position in a good quality bone. The issue of good quality bone seems to have been ignored. Hypothesis: A 2-stage anterior cruciate ligament revision reconstruction with bone grafting of the tibial tunnel and the use of a different femoral tunnel will produce measured knee laxity and International Knee Documentation Committee scores similar to a primary anterior cruciate ligament reconstruction. Study Design: Case control study; Level of evidence, 3. Methods: This prospective study involved 49 consecutive 2-stage anterior cruciate ligament revisions (group R) performed by a single surgeon from 1993 to 2000. Two-stage revision surgery was performed if the tibial tunnel from a previous reconstruction surgery would overlap (either partially or fully) the correctly placed revision tunnel. The first stage consisted of removal of the old graft and interfering metalwork, together with bone grafting of the tibial tunnel. After ensuring adequate bone graft incorporation using computed tomography scan, the second stage revision was undertaken. This stage comprised harvesting the autograft, its anatomical placement, and its adequate fixation. The results were compared with the results of a matched group of patients with primary anterior cruciate ligament reconstruction (group P). Results: In group R, as meniscal and chondral lesions were more common, the International Knee Documentation Committee scores were lower than those of group P (61.2 for group R and 72.8 for group P; P = .006). Objective laxity measurement was similar in both groups (1.36 mm for group R and 1.2 mm for group P; P = .25). Conclusion: This study establishes that the laxity measurements achieved with a 2-stage revision anterior cruciate ligament reconstruction can be similar to those achieved after primary anterior cruciate ligament reconstruction, although the International Knee Documentation Committee rating is lower. Keywords: revision anterior cruciate ligament (ACL) reconstruction bone grafting clinical outcome
doi_str_mv 10.1177/0363546505276759
format Article
fullrecord <record><control><sourceid>gale_proqu</sourceid><recordid>TN_cdi_proquest_miscellaneous_68696496</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A138654839</galeid><sage_id>10.1177_0363546505276759</sage_id><sourcerecordid>A138654839</sourcerecordid><originalsourceid>FETCH-LOGICAL-c594t-181c63628645004f9353cbf1e233eb4cba295e4f2e1911d62a72bd4155cf782b3</originalsourceid><addsrcrecordid>eNqF0s1r2zAUAHAzNta0232nITa6sYM7fViSfczClg0ChS5lRyErz46CLbeSvI__fjIJtCkrQweB9HtPT4-XZa8IviBEyo-YCcYLwTGnUkhePclmhHOaMyb402w2XefT_Ul2GsIOY0ykKJ9nJ0TginFWzLJ4BT9tsINDcxfB28GjhR-N1RHQyra6BxfRFZjBhZjO4ySvg3Ut0ojm36NuAa3BbJ29HQH9sHGLPg0O0NLrJk5saFDcJmNrqzu0Hp2D7kX2rNFdgJeH_Sy7_vJ5vfiary6X3xbzVW54VcSclMQIJmgpCo5x0Uwlm7ohQBmDujC1phWHoqFAKkI2gmpJ602ROmAaWdKanWXv9nlv_JDKC1H1NhjoOu1gGIMSpahEUYn_QiJZRUkhE3zzAO6G0bv0CUWJxJIxShJ6-xgilSz5lAgndbFXre5AWdcM0WuT1gZ6m_oNjU3nc8JKwYuSVSngw1FAMhF-x1aPIahyuTq2-b-sGboOWlCpy4vLY4_33vghBA-NuvG21_6PIlhNo6YejloKeX345Vj3sLkLOMxWAucHoIPRXeO1MzbcOZlaJfG9WkMapnutevzh93u_te32l_WgQq-7LpXBlN4FxlJcyo4J-wvb-vBc</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1978514730</pqid></control><display><type>article</type><title>Revision Anterior Cruciate Ligament Reconstruction Using a 2-Stage Technique With Bone Grafting of the Tibial Tunnel</title><source>MEDLINE</source><source>SAGE Journals</source><source>Alma/SFX Local Collection</source><creator>Thomas, Neil P. ; Kankate, Raghu ; Wandless, Felicity ; Pandit, Hemant</creator><creatorcontrib>Thomas, Neil P. ; Kankate, Raghu ; Wandless, Felicity ; Pandit, Hemant</creatorcontrib><description>Background: Revision anterior cruciate ligament surgery is often considered a salvage procedure with limited goals. However, this limitation need not be the case. Similar to primary reconstruction, the goal should be to choose an appropriate graft and place it in an anatomical position in a good quality bone. The issue of good quality bone seems to have been ignored. Hypothesis: A 2-stage anterior cruciate ligament revision reconstruction with bone grafting of the tibial tunnel and the use of a different femoral tunnel will produce measured knee laxity and International Knee Documentation Committee scores similar to a primary anterior cruciate ligament reconstruction. Study Design: Case control study; Level of evidence, 3. Methods: This prospective study involved 49 consecutive 2-stage anterior cruciate ligament revisions (group R) performed by a single surgeon from 1993 to 2000. Two-stage revision surgery was performed if the tibial tunnel from a previous reconstruction surgery would overlap (either partially or fully) the correctly placed revision tunnel. The first stage consisted of removal of the old graft and interfering metalwork, together with bone grafting of the tibial tunnel. After ensuring adequate bone graft incorporation using computed tomography scan, the second stage revision was undertaken. This stage comprised harvesting the autograft, its anatomical placement, and its adequate fixation. The results were compared with the results of a matched group of patients with primary anterior cruciate ligament reconstruction (group P). Results: In group R, as meniscal and chondral lesions were more common, the International Knee Documentation Committee scores were lower than those of group P (61.2 for group R and 72.8 for group P; P = .006). Objective laxity measurement was similar in both groups (1.36 mm for group R and 1.2 mm for group P; P = .25). Conclusion: This study establishes that the laxity measurements achieved with a 2-stage revision anterior cruciate ligament reconstruction can be similar to those achieved after primary anterior cruciate ligament reconstruction, although the International Knee Documentation Committee rating is lower. Keywords: revision anterior cruciate ligament (ACL) reconstruction bone grafting clinical outcome</description><identifier>ISSN: 0363-5465</identifier><identifier>EISSN: 1552-3365</identifier><identifier>DOI: 10.1177/0363546505276759</identifier><identifier>PMID: 16093534</identifier><identifier>CODEN: AJSMDO</identifier><language>eng</language><publisher>Los Angeles, CA: American Orthopaedic Society for Sports Medicine</publisher><subject>Adult ; Anterior cruciate ligament ; Anterior Cruciate Ligament - surgery ; Anterior Cruciate Ligament Injuries ; Biological and medical sciences ; Bone transplantation ; Bone-grafting ; Care and treatment ; Case-Control Studies ; Clinical trials ; Documentation ; Female ; Femur - surgery ; Fundamental and applied biological sciences. Psychology ; Health aspects ; Humans ; Injuries ; Joint Instability ; Knee ; Ligaments ; Male ; Medical sciences ; Orthopedic Procedures - methods ; Prospective Studies ; Reconstructive Surgical Procedures - methods ; Reoperation ; Skin &amp; tissue grafts ; Sport (general aspects) ; Sports injuries ; Sports medicine ; Studies ; Surgery ; Tibia - surgery ; Tibia - transplantation ; Traumas. Diseases due to physical agents ; Treatment Outcome ; Vertebrates: body movement. Posture. Locomotion. Flight. Swimming. Physical exercise. Rest. Sports</subject><ispartof>The American journal of sports medicine, 2005-11, Vol.33 (11), p.1701-1709</ispartof><rights>2005 American Orthopaedic Society for Sports Medicine</rights><rights>2005 INIST-CNRS</rights><rights>COPYRIGHT 2005 Sage Publications, Inc.</rights><rights>Copyright Sage Publications Ltd. Nov 2005</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c594t-181c63628645004f9353cbf1e233eb4cba295e4f2e1911d62a72bd4155cf782b3</citedby><cites>FETCH-LOGICAL-c594t-181c63628645004f9353cbf1e233eb4cba295e4f2e1911d62a72bd4155cf782b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/0363546505276759$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/0363546505276759$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,776,780,21798,27901,27902,43597,43598</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&amp;idt=17213709$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/16093534$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Thomas, Neil P.</creatorcontrib><creatorcontrib>Kankate, Raghu</creatorcontrib><creatorcontrib>Wandless, Felicity</creatorcontrib><creatorcontrib>Pandit, Hemant</creatorcontrib><title>Revision Anterior Cruciate Ligament Reconstruction Using a 2-Stage Technique With Bone Grafting of the Tibial Tunnel</title><title>The American journal of sports medicine</title><addtitle>Am J Sports Med</addtitle><description>Background: Revision anterior cruciate ligament surgery is often considered a salvage procedure with limited goals. However, this limitation need not be the case. Similar to primary reconstruction, the goal should be to choose an appropriate graft and place it in an anatomical position in a good quality bone. The issue of good quality bone seems to have been ignored. Hypothesis: A 2-stage anterior cruciate ligament revision reconstruction with bone grafting of the tibial tunnel and the use of a different femoral tunnel will produce measured knee laxity and International Knee Documentation Committee scores similar to a primary anterior cruciate ligament reconstruction. Study Design: Case control study; Level of evidence, 3. Methods: This prospective study involved 49 consecutive 2-stage anterior cruciate ligament revisions (group R) performed by a single surgeon from 1993 to 2000. Two-stage revision surgery was performed if the tibial tunnel from a previous reconstruction surgery would overlap (either partially or fully) the correctly placed revision tunnel. The first stage consisted of removal of the old graft and interfering metalwork, together with bone grafting of the tibial tunnel. After ensuring adequate bone graft incorporation using computed tomography scan, the second stage revision was undertaken. This stage comprised harvesting the autograft, its anatomical placement, and its adequate fixation. The results were compared with the results of a matched group of patients with primary anterior cruciate ligament reconstruction (group P). Results: In group R, as meniscal and chondral lesions were more common, the International Knee Documentation Committee scores were lower than those of group P (61.2 for group R and 72.8 for group P; P = .006). Objective laxity measurement was similar in both groups (1.36 mm for group R and 1.2 mm for group P; P = .25). Conclusion: This study establishes that the laxity measurements achieved with a 2-stage revision anterior cruciate ligament reconstruction can be similar to those achieved after primary anterior cruciate ligament reconstruction, although the International Knee Documentation Committee rating is lower. Keywords: revision anterior cruciate ligament (ACL) reconstruction bone grafting clinical outcome</description><subject>Adult</subject><subject>Anterior cruciate ligament</subject><subject>Anterior Cruciate Ligament - surgery</subject><subject>Anterior Cruciate Ligament Injuries</subject><subject>Biological and medical sciences</subject><subject>Bone transplantation</subject><subject>Bone-grafting</subject><subject>Care and treatment</subject><subject>Case-Control Studies</subject><subject>Clinical trials</subject><subject>Documentation</subject><subject>Female</subject><subject>Femur - surgery</subject><subject>Fundamental and applied biological sciences. Psychology</subject><subject>Health aspects</subject><subject>Humans</subject><subject>Injuries</subject><subject>Joint Instability</subject><subject>Knee</subject><subject>Ligaments</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Orthopedic Procedures - methods</subject><subject>Prospective Studies</subject><subject>Reconstructive Surgical Procedures - methods</subject><subject>Reoperation</subject><subject>Skin &amp; tissue grafts</subject><subject>Sport (general aspects)</subject><subject>Sports injuries</subject><subject>Sports medicine</subject><subject>Studies</subject><subject>Surgery</subject><subject>Tibia - surgery</subject><subject>Tibia - transplantation</subject><subject>Traumas. Diseases due to physical agents</subject><subject>Treatment Outcome</subject><subject>Vertebrates: body movement. Posture. Locomotion. Flight. Swimming. Physical exercise. Rest. Sports</subject><issn>0363-5465</issn><issn>1552-3365</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2005</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqF0s1r2zAUAHAzNta0232nITa6sYM7fViSfczClg0ChS5lRyErz46CLbeSvI__fjIJtCkrQweB9HtPT4-XZa8IviBEyo-YCcYLwTGnUkhePclmhHOaMyb402w2XefT_Ul2GsIOY0ykKJ9nJ0TginFWzLJ4BT9tsINDcxfB28GjhR-N1RHQyra6BxfRFZjBhZjO4ySvg3Ut0ojm36NuAa3BbJ29HQH9sHGLPg0O0NLrJk5saFDcJmNrqzu0Hp2D7kX2rNFdgJeH_Sy7_vJ5vfiary6X3xbzVW54VcSclMQIJmgpCo5x0Uwlm7ohQBmDujC1phWHoqFAKkI2gmpJ602ROmAaWdKanWXv9nlv_JDKC1H1NhjoOu1gGIMSpahEUYn_QiJZRUkhE3zzAO6G0bv0CUWJxJIxShJ6-xgilSz5lAgndbFXre5AWdcM0WuT1gZ6m_oNjU3nc8JKwYuSVSngw1FAMhF-x1aPIahyuTq2-b-sGboOWlCpy4vLY4_33vghBA-NuvG21_6PIlhNo6YejloKeX345Vj3sLkLOMxWAucHoIPRXeO1MzbcOZlaJfG9WkMapnutevzh93u_te32l_WgQq-7LpXBlN4FxlJcyo4J-wvb-vBc</recordid><startdate>20051101</startdate><enddate>20051101</enddate><creator>Thomas, Neil P.</creator><creator>Kankate, Raghu</creator><creator>Wandless, Felicity</creator><creator>Pandit, Hemant</creator><general>American Orthopaedic Society for Sports Medicine</general><general>SAGE Publications</general><general>Sage Publications, Inc</general><general>Sage Publications Ltd</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>8GL</scope><scope>7TS</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>U9A</scope><scope>7X8</scope></search><sort><creationdate>20051101</creationdate><title>Revision Anterior Cruciate Ligament Reconstruction Using a 2-Stage Technique With Bone Grafting of the Tibial Tunnel</title><author>Thomas, Neil P. ; Kankate, Raghu ; Wandless, Felicity ; Pandit, Hemant</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c594t-181c63628645004f9353cbf1e233eb4cba295e4f2e1911d62a72bd4155cf782b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2005</creationdate><topic>Adult</topic><topic>Anterior cruciate ligament</topic><topic>Anterior Cruciate Ligament - surgery</topic><topic>Anterior Cruciate Ligament Injuries</topic><topic>Biological and medical sciences</topic><topic>Bone transplantation</topic><topic>Bone-grafting</topic><topic>Care and treatment</topic><topic>Case-Control Studies</topic><topic>Clinical trials</topic><topic>Documentation</topic><topic>Female</topic><topic>Femur - surgery</topic><topic>Fundamental and applied biological sciences. Psychology</topic><topic>Health aspects</topic><topic>Humans</topic><topic>Injuries</topic><topic>Joint Instability</topic><topic>Knee</topic><topic>Ligaments</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Orthopedic Procedures - methods</topic><topic>Prospective Studies</topic><topic>Reconstructive Surgical Procedures - methods</topic><topic>Reoperation</topic><topic>Skin &amp; tissue grafts</topic><topic>Sport (general aspects)</topic><topic>Sports injuries</topic><topic>Sports medicine</topic><topic>Studies</topic><topic>Surgery</topic><topic>Tibia - surgery</topic><topic>Tibia - transplantation</topic><topic>Traumas. Diseases due to physical agents</topic><topic>Treatment Outcome</topic><topic>Vertebrates: body movement. Posture. Locomotion. Flight. Swimming. Physical exercise. Rest. Sports</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Thomas, Neil P.</creatorcontrib><creatorcontrib>Kankate, Raghu</creatorcontrib><creatorcontrib>Wandless, Felicity</creatorcontrib><creatorcontrib>Pandit, Hemant</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Gale In Context: High School</collection><collection>Physical Education Index</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>Nursing &amp; Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of sports medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Thomas, Neil P.</au><au>Kankate, Raghu</au><au>Wandless, Felicity</au><au>Pandit, Hemant</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Revision Anterior Cruciate Ligament Reconstruction Using a 2-Stage Technique With Bone Grafting of the Tibial Tunnel</atitle><jtitle>The American journal of sports medicine</jtitle><addtitle>Am J Sports Med</addtitle><date>2005-11-01</date><risdate>2005</risdate><volume>33</volume><issue>11</issue><spage>1701</spage><epage>1709</epage><pages>1701-1709</pages><issn>0363-5465</issn><eissn>1552-3365</eissn><coden>AJSMDO</coden><abstract>Background: Revision anterior cruciate ligament surgery is often considered a salvage procedure with limited goals. However, this limitation need not be the case. Similar to primary reconstruction, the goal should be to choose an appropriate graft and place it in an anatomical position in a good quality bone. The issue of good quality bone seems to have been ignored. Hypothesis: A 2-stage anterior cruciate ligament revision reconstruction with bone grafting of the tibial tunnel and the use of a different femoral tunnel will produce measured knee laxity and International Knee Documentation Committee scores similar to a primary anterior cruciate ligament reconstruction. Study Design: Case control study; Level of evidence, 3. Methods: This prospective study involved 49 consecutive 2-stage anterior cruciate ligament revisions (group R) performed by a single surgeon from 1993 to 2000. Two-stage revision surgery was performed if the tibial tunnel from a previous reconstruction surgery would overlap (either partially or fully) the correctly placed revision tunnel. The first stage consisted of removal of the old graft and interfering metalwork, together with bone grafting of the tibial tunnel. After ensuring adequate bone graft incorporation using computed tomography scan, the second stage revision was undertaken. This stage comprised harvesting the autograft, its anatomical placement, and its adequate fixation. The results were compared with the results of a matched group of patients with primary anterior cruciate ligament reconstruction (group P). Results: In group R, as meniscal and chondral lesions were more common, the International Knee Documentation Committee scores were lower than those of group P (61.2 for group R and 72.8 for group P; P = .006). Objective laxity measurement was similar in both groups (1.36 mm for group R and 1.2 mm for group P; P = .25). Conclusion: This study establishes that the laxity measurements achieved with a 2-stage revision anterior cruciate ligament reconstruction can be similar to those achieved after primary anterior cruciate ligament reconstruction, although the International Knee Documentation Committee rating is lower. Keywords: revision anterior cruciate ligament (ACL) reconstruction bone grafting clinical outcome</abstract><cop>Los Angeles, CA</cop><pub>American Orthopaedic Society for Sports Medicine</pub><pmid>16093534</pmid><doi>10.1177/0363546505276759</doi><tpages>9</tpages></addata></record>
fulltext fulltext
identifier ISSN: 0363-5465
ispartof The American journal of sports medicine, 2005-11, Vol.33 (11), p.1701-1709
issn 0363-5465
1552-3365
language eng
recordid cdi_proquest_miscellaneous_68696496
source MEDLINE; SAGE Journals; Alma/SFX Local Collection
subjects Adult
Anterior cruciate ligament
Anterior Cruciate Ligament - surgery
Anterior Cruciate Ligament Injuries
Biological and medical sciences
Bone transplantation
Bone-grafting
Care and treatment
Case-Control Studies
Clinical trials
Documentation
Female
Femur - surgery
Fundamental and applied biological sciences. Psychology
Health aspects
Humans
Injuries
Joint Instability
Knee
Ligaments
Male
Medical sciences
Orthopedic Procedures - methods
Prospective Studies
Reconstructive Surgical Procedures - methods
Reoperation
Skin & tissue grafts
Sport (general aspects)
Sports injuries
Sports medicine
Studies
Surgery
Tibia - surgery
Tibia - transplantation
Traumas. Diseases due to physical agents
Treatment Outcome
Vertebrates: body movement. Posture. Locomotion. Flight. Swimming. Physical exercise. Rest. Sports
title Revision Anterior Cruciate Ligament Reconstruction Using a 2-Stage Technique With Bone Grafting of the Tibial Tunnel
url https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-14T18%3A08%3A54IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_proqu&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Revision%20Anterior%20Cruciate%20Ligament%20Reconstruction%20Using%20a%202-Stage%20Technique%20With%20Bone%20Grafting%20of%20the%20Tibial%20Tunnel&rft.jtitle=The%20American%20journal%20of%20sports%20medicine&rft.au=Thomas,%20Neil%20P.&rft.date=2005-11-01&rft.volume=33&rft.issue=11&rft.spage=1701&rft.epage=1709&rft.pages=1701-1709&rft.issn=0363-5465&rft.eissn=1552-3365&rft.coden=AJSMDO&rft_id=info:doi/10.1177/0363546505276759&rft_dat=%3Cgale_proqu%3EA138654839%3C/gale_proqu%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1978514730&rft_id=info:pmid/16093534&rft_galeid=A138654839&rft_sage_id=10.1177_0363546505276759&rfr_iscdi=true