DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20185335

Study of arthroscopic anterior cruciate ligament reconstruction using single bundle hamstring auto-graft by trans-portal technique

Pranav D. Shah, Jayant D. Thipse, Mahesh M. Mulay

Abstract


Background: Anterior cruciate ligament (ACL) tear is a serious injury that results in immediate knee instability, lengthy rehabilitation and increased risk of early onset knee osteoarthritis. The goal of anatomic reconstruction is to place the ACL graft at a more anatomic location on both tibia and femur. The purposes of the study were to evaluate the outcome of trans-portal arthroscopic ACL reconstruction clinically and radiologically and to compare the results with reported studies.

Methods: 52 patients with complete tear of the ACL were treated with arthroscopic ACL reconstruction. The patients were regularly followed up at 4, 8, 12 and 24 weeks whereby laxity, pain and range of motion were assessed.

Results: There were 43 male and 9 females with the mean age being 30.38 years. Left sided injury was more common seen in 31 patients (59.62%) where domestic twist injury caused most of the ACL tears. Only 4 cases (7.69%) had isolated ACL tears and lateral meniscus was the most common associated injury found in 25 patients (48.07%) Average operative time was 113 minutes. Pain was the most common post-op complication seen in 16 patients (30.76%) while laxity was noted in 4 patients. Average flexion of 111.44 degrees was reached at 6 months. 37 cases (71.15%) had excellent post-op outcome at 6 months as per the modified cincinnati rating system.

Conclusions: ACL reconstruction using the arthroscopic trans-portal technique provides good post-op knee stability and satisfactory range of motion.


Keywords


Knee, Arthroscopy, Modified cincinnati rating system, ACL reconstruction

Full Text:

PDF

References


Yang JH, Chang M, Kwak DS, Wang JH. Volume & Contact Surface Area Analysis of Bony Tunnels in Single & Double Bundle Anterior Cruciate Ligament Reconstruction Using Autograft Tendons: In vivo Three-dimensional imaging analysis. Clin Orthop Surg. 2014;6:290-7.

Mahnik A, Mahnik S, Dimnjakovic D, Curic S, Smoljanovic T, Bojanic I. Current practice variations in the management of anterior cruciate ligament injuries in Croatia. World J Orthop. 2013;4(4):309-15.

Mirzatolooei F. Comparison of short-term clinical outcomes between trans-tibial and trans-portal Transfix femoral fixation in hamstring ACL reconstruction. Acta Orthop Traumatol Turc. 2012;46(5):361-6.

Alenton-Geli E, Samitier G, Alvarez P. Anteromedial portal versus transtibial drilling techniques in ACL reconstruction: a blinded cross-sectional study at two-to five-year follow-up. Int Orthop 2010;34(5):747-54.

Koutras G, Papadopoulos P, Terzidis IP. Short term functional and clinical outcomes after ACL reconstruction with Hamstrings Autograft: transtibial versus anteromedial portal technique. Knee Surg Sports Traumatol Arthroscopy. 2013;21(8): 1904-9.

Ku Kim M, Cheol Lee B, Park JH. Anatomic single bundle anterior cruciate ligament reconstruction by the two anteromedial portal method: the comparison of trans-portal and transtibial techniques. Knee Surg Relate Res. 2011;23(4):213-9.

Mardani-Kivi M, Madadi F, Keyhani S. Anteromedial portal vs. transtibial techniques for drilling femoral tunnel in ACL reconstruction using 4-strand hamstring tendon: a cross-sectional study with 1-year follow-up. Med Sci Monit. 2012;18(4):674-9.

Rahr-Wagner L, Thillemann TM. Increased risk of revision after antero-medial compared with transtibial drilling of the femoral tunnel during primary anterior cruciate ligament reconstruction: results from the Danish knee ligament reconstruction register. Arthroscopy. 2013;29(1):98-105.

Canale ST, Beaty JH. Campbell’s operative orthopaedics. 12thedition.Philadelphia, PA: Elsevier-Mosby; 2013;3:2433.

Wiesel S. Operative techniques in Orthopaedics. 4th edition. New York: Springer; 2011. Vol. 1, p-248:344-8.

Noyes FR, Barber SD, Mooar LA. A rationale for assessing sports activity levels and limitations in knee disorders. Clin Orthop Relat Res. 1989;246:238-49.

Marx RG, Jones EC, Allen AA, Altchek DW, O'Brien SJ, Rodeo SA, et al. Reliability, validity and responsiveness of four knee outcome scales for athletic patients. J Bone Joint Surg Am. 2001;83:1459-69.

Natri A. Anterior cruciate ligament (ACL) Injuries. Epidemiology, injury mechanisms, treatment and rehabilitation. Thesis. University of Tampere, Finland. 1996.

Kobayashi A, Higuchi H. Muscle performance after anterior cruciate ligament reconstruction. Int Orthop. 2004;28:48-51.

Eriksson K, Hamberg P. Semitendinosus muscle in anterior cruciate ligament surgery: Morphology and function. Arthroscopy. 2001;17:808-17.

Yasuda K, Tsujino J. Graft side morbidity with autogenous semitendinosus and gracilis tendons. Am J Sports Med. 1995;23:706-14.

Li RC, Maffulli N, Hsu YC, Chan KM. Isokinetic strength of the quadriceps and hamstrings and functional ability of anterior cruciate deficient knees in recreational athletes. Br J Sports Med. 1996;30:161-4.

Papastergiou SG, Koukoulias NE. Meniscal tears in the ACL-deficient knee: correlation between meniscal tears and the timing of ACL reconstruction. Knee Surg Sports Traumatol Arthrosc. 2007;15(12):1438-44.

Aglietti P, Buzzi R, Giron F. Arthroscopic-assisted anterior cruciate ligament reconstruction with the central third patellar tendon. Knee Surg Sports Traumatol Arthrosc. 1997;5:138-44.

Beynon BD, Johnson RJ. Treatment of anterior cruciate injuries. Am J Sports Med. 2005;33:1579-602.

Cohen M, Amaro JT, Ejnisman B. Anterior cruciate ligament reconstruction after 10 to 15 years: association between meniscectomy and osteoarthritis. Arthroscopy. 2007;23:629-34.

Jomha N, Borton D, Clingeleffer A. Long-term osteoarthritic changes in anterior cruciate ligament reconstructed knees. Clin Orthop Rel Res. 1999;358:188-93.

Lohmander LS, Roos H. Knee ligament injury, surgery and osteoarthritis. Truth or consequences? Acta Orthop Scand. 1994;65:605-9.

Lohmander LS, Englund PM. The long-term consequences of anterior cruciate ligament and meniscus injuries. Am J Sports Med. 2007;35:1756-69.