scholarly journals Anterior cruciate ligament reconstruction and rehabilitation: predictors of functional outcome

Joints ◽  
2015 ◽  
Vol 03 (04) ◽  
pp. 179-185 ◽  
Author(s):  
Francesco Della Villa ◽  
Margherita Ricci ◽  
Francesco Perdisa ◽  
Giuseppe Filardo ◽  
Jacopo Gamberini ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Recovery Of Function ◽  
Cruciate Ligament ◽  
Young Patients ◽  
Activity Level ◽  
Full Recovery ◽  
Surgical Reconstruction ◽  
Isokinetic Test ◽  
Anterior Cruciate

Surgical reconstruction of an injured anterior cruciate ligament (ACL) leads to full recovery of function and sports activity in a high percentage of cases. The aim of the present study was to analyze variables related to the patient, the surgical technique and the post-surgical rehabilitation methods, seeking to identify predictors of outcome and recovery time after ACL reconstruction.One hundred and four patients (81 M, 23 F) undergoing a step-based rehabilitation protocol after ACL reconstruction were evaluated. 43.2% of them had an isolated ACL lesion, whereas 56.8% had one or more concurrent injuries. Data relating to personal characteristics, surgery and post-operative management were collected and analyzed for correlation. Clinical outcome was evaluated with IKDC subjective score and the Tegner score, and the time to reach full recovery was noted as well.Young patients with a higher pre-injury Tegner activity level or who practice sport at professional level, no concurrent capsular lesions and no postoperative knee bracing had better clinical results and took shorter time to recover. Also, a higher percentage of on-thefield rehabilitation sessions, and absence of significant muscle strength deficits at the first knee isokinetic test emerged as rehabilitation-related factors leading to a better post-surgical outcome.Personal, surgical and rehabilitation factors should be considered in order to optimize patient management and maximize the expected results. Further studies are needed to find the strongest factors in different patients. Level of evidence: Level IV, retrospective study.

scholarly journals Functional outcome of an arthroscopic anatomical single bundle anterior Cruciate Ligament (ACL) reconstruction using Semi-tendinosus graft with fixation using Endo-button on femoral side and Suture Disc on Tibial side- A prospective clinical study

2017 ◽  
Vol 3 (6) ◽  
pp. 1175
Author(s):  
Vinod Jagtap ◽  
Namdev Gorgile ◽  
Yash Shah ◽  
Vikas Rokade ◽  
Girish Bartakke
Keyword(s):  
Anterior Cruciate Ligament ◽  
Functional Outcome ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Hamstring Tendon ◽  
Activity Level ◽  
Surgical Reconstruction ◽  
Prospective Clinical Study ◽  
Single Bundle ◽  
Anterior Cruciate

<p class="abstract"><strong>Background:</strong> Injury to the anterior cruciate ligament (ACL) is one of the most frequent injuries of the knee during different sports activities. Arthroscopic surgical reconstruction is the current standard of care for treatment of ACL injuries in young and active patients. The widespread adoption of ACL reconstruction over primary repair was based on early perception of the limited healing capacity of the ACL. Hamstring tendon is most favoured graft for ACL reconstruction. We wanted to study the outcomes particular method of fixation for fixing the hamstring tendon.</p><p class="abstract"><strong>Methods:</strong> In this study 30 patient with ACL injury were treated arthroscopically for the fixation of graft in bone tunnel we use endobutton for femur and suture disc for tibia as suspensor implant and prospective assessment of functional outcome using Tegner Lysholm knee scoring system.<strong></strong></p><p class="abstract"><strong>Results:</strong> The preoperative activity level could be maintained in 70% of the patients. The Lysholm score showed very good and good results in 80%. Functional and stability results in about 70% of the patients.</p><strong>Conclusions:</strong>This surgical technique can be recommended for the active patient with ACL deficiency. The functional outcome of anterior cruciate ligament reconstruction with quadrupled semitendinosus tendon autograft using Endobutton and suture disc is good. This method of fixation will help the graft to facilitate graft tunnel healing and also maintain its strength until there is a good graft to bone healing occurs completely.

The Role of Patient Characteristics in the Success of Nonoperative Treatment of Anterior Cruciate Ligament Injuries

2020 ◽  
Vol 48 (7) ◽  
pp. 1657-1664 ◽  
Author(s):  
Jelle P. van der List ◽  
Frans J.A. Hagemans ◽  
Dirk Jan Hofstee ◽  
Freerk J. Jonkers
Keyword(s):  
Anterior Cruciate Ligament ◽  
Multivariate Analysis ◽  
Physical Therapy ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Patient Characteristics ◽  
Nonoperative Treatment ◽  
Activity Level ◽  
Acl Injuries ◽  
Anterior Cruciate

Background: Anterior cruciate ligament (ACL) tears can either be treated nonoperatively with physical therapy and then treated operatively if persistent instability is present, or be directly treated operatively. Advantages of early ACL reconstruction surgery include shorter time from injury to surgery and potentially fewer meniscal injuries, but performing early ACL reconstruction in all patients results in surgery in patients who might not need ACL reconstruction. It is important to assess in which patients nonoperative treatment is successful and which patients will require ACL reconstruction and thus might be better treated surgically in an earlier phase. Purpose: To identify patient characteristics that predict the success of nonoperative treatment. Study Design: Cohort study (Prognosis); Level of evidence, 2. Methods: All patients with complete ACL injuries who were evaluated between 2014 and 2017 at our clinic were included. The minimum follow-up was 2 years. The initial treatment and ultimate ACL reconstruction were reviewed. Univariate analysis was performed using Mann-Whitney U tests and chi-square tests and multivariate analysis using binary logistic regression. Results: A total of 448 patients were included with a median age of 26 years and median Tegner level of 7 and mean Tegner level of 6.4. At initial consultation, 210 patients (47%) were treated nonoperatively with physical therapy and 126 of these patients (60%) ultimately required ACL reconstruction. Nonoperative treatment failed in 88.9% of patients <25 years of age, 56.0% of patients 25 to 40 years, and 32.9% of patients >40 years ( P < .001); and 41.9% of patients with Tegner level 3 to 6, and 82.8% of patients with Tegner level 7 to 10. Age <25 years (odds ratio [OR], 7.4; P < .001) and higher Tegner levels (OR, 4.2; P < .001) were predictive of failing nonoperative treatment in multivariate analysis. Patients in the failed nonoperative group had longer time from diagnosis to surgery than the direct reconstruction group (6.2 vs 2.2 months; P < .001), and more frequently had new meniscal injuries (17.4% vs 3.1%; P < .001) at surgery. Conclusion: Nonoperative treatment of ACL injuries failed in 60% of patients and was highly correlated with age and activity level. In patients aged 25 years or younger or participating in higher-impact sports, early ACL reconstruction should be considered to prevent longer delay between injury and surgery, as well as new meniscal injuries.

scholarly journals Gait Analysis and Knee Kinematics in Patients with Anterior Cruciate Ligament Rupture: Before and After Reconstruction

2020 ◽  
Vol 10 (10) ◽  
pp. 3378
Author(s):  
Dmitry Skvortsov ◽  
Sergey Kaurkin ◽  
Alexander Akhpashev ◽  
Aljona Altukhova ◽  
Alexander Troitskiy ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Gait Analysis ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Surgical Reconstruction ◽  
Control Group ◽  
Cycle Duration ◽  
Post Surgery ◽  
Before And After ◽  
Anterior Cruciate

The objective of the study was to evaluate the clinical, functional, and biomechanical symptoms in patients with anterior cruciate ligament (ACL) rupture before and after ACL reconstruction. The study enrolled 20 patients and 20 healthy subjects as controls. Walking biomechanics was assessed at three time points: before surgery and three months and a year or more after surgical reconstruction. Impact loads on both sides differed significantly from the respective values before surgery (p<0.05). Walking cycle duration decreased with time after surgery. On both sides (affected and unaffected), hip movement amplitudes were significantly smaller than in control (p<0.05). They remained so in the follow-up periods after the reconstruction. Before ACL reconstruction, the amplitude of the main flexion of the knee was significantly reduced both on the affected and unaffected sides. The amplitude gradually increased after the reconstruction, and a year post-surgery, it reached, on the operated side, the same values as in the control group. Complete functional recovery of the knee joint was not achieved within a year after the ACL surgical reconstruction. The remaining changes, however, were not clinically pronounced and could only be detected by instrumental gait analysis. The compensatory processes developed bilaterally, in both the hip and knee joints.

Use Caution When Assessing Preoperative Leg-Length Discrepancy in Pediatric Patients With Anterior Cruciate Ligament Injuries

2020 ◽  
Vol 48 (12) ◽  
pp. 2948-2953
Author(s):  
Madison R. Heath ◽  
Alexandra H. Aitchison ◽  
Lindsay M. Schlichte ◽  
Christine Goodbody ◽  
Frank A. Cordasco ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Intraclass Correlation ◽  
Case Series ◽  
Surgical Reconstruction ◽  
Radiographic Examination ◽  
Leg Length ◽  
Level Of Evidence ◽  
Anterior Cruciate

Background: Pre- and postoperative standing hip-to-ankle radiographs are critical for monitoring potential postoperative growth arrest and resultant deformities after pediatric anterior cruciate ligament (ACL) reconstruction. Purpose: To determine the prevalence of apparent preoperative leg-length discrepancies (LLDs) that resolve at the first postoperative radiographic examination in patients undergoing ACL reconstruction in order to understand what proportion of the noted preoperative deformities may have been inaccurate. Study Design: Case series; Level of evidence, 4. Methods: A retrospective review of prospectively collected preoperative and first postoperative full-length hip-to-ankle radiographs was performed in a cohort of skeletally immature patients who had an acute ACL injury and underwent subsequent surgical reconstruction. Leg length measurements for both the injured and the uninjured legs were obtained for comparison. Results: A total of 112 patients (mean age, 12.7 ± 1.7 years) were included (79 boys and 33 girls). Leg-length measurement interrater reliability among 3 raters for 25 randomly chosen images was nearly perfect (intraclass correlation coefficient, 0.996; 95% CI, 0.994-0.998). At baseline, there was no apparent preoperative LLD (<5 mm) in 48% (n = 54) of participants, while 37% (n = 41) displayed a small apparent LLD (5 to <10 mm), 12% (n = 13) displayed a moderate apparent LLD (10 to <15 mm), and 4% (n = 4) displayed a large apparent LLD (≥15 mm). Of the patients with an apparent preoperative LLD, 66% (n = 38) of them tore their ACL on the leg measuring shorter. At first postoperative radiographs, 48% (n = 28) of patients with an apparent preoperative LLD showed resolution to no LLD: 46% (n = 19) of patients with a small apparent preoperative LLD, 54% (n = 7) of patients with a moderate apparent LLD, and 50% (n = 2) of patients with a large apparent LLD. Conclusion: A high percentage of patients (48%) with apparent preoperative LLDs showed resolution to no LLDs by their first postoperative imaging, indicating that preoperative hip-to-ankle radiographs display some false LLDs in patients with recent ACL tears who are unable to fully extend their injured leg and bear weight.

Surgical Management of Simultaneous Anterior Cruciate Ligament and Patellar Tendon Ruptures: A Systematic Review

2017 ◽  
Vol 31 (09) ◽  
pp. 875-883 ◽  
Author(s):  
Carlos Meheux ◽  
Robert Jack ◽  
Patrick McCulloch ◽  
David Lintner ◽  
Joshua Harris
Keyword(s):  
Systematic Review ◽  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Activity Level ◽  
Two Stage ◽  
One Stage ◽  
Significant Difference ◽  
Anterior Cruciate ◽  
The One

AbstractThis study performs a systematic review to determine (1) if a significant difference exists in return to preinjury activity level between one- and two-stage treatment of combined anterior cruciate ligament (ACL) and patellar tendon (PT) tears; and (2) if a significant difference exists in the number of postoperative complications between the two differing surgical treatment approaches. A systematic review was performed using Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines and registered on PROSPERO. MEDLINE, Cochrane Central Register of Controlled Trials, SCOPUS, and Sport Discus were searched for English language level I–IV evidence studies on either one- (simultaneous) or two-stage (sequential) surgical treatment of simultaneously sustained ipsilateral ACL and PT tears. The approach to initial evaluation, diagnosis, treatment, and outcomes were qualitatively analyzed. Methodological quality assessment of all included studies was completed using the Methodological Index for Non-randomized Studies (MINORS). The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) tool was used to assess quality of evidence and provide strength of recommendation. Statistical analyses were done using Fischer's exact test. Eleven articles (18 patients; 83% males; mean age, 31.1 ± 10.1 years; mean follow-up, 2.2 ± 1.7 years; and mean MINORS 7.8/16) were analyzed. Eight patients had a one-stage procedure (primary PT repair and ACL reconstruction), and 10 patients underwent a two-stage procedure (primary PT repair first followed by ACL reconstruction) with mean 28 ± 45.7 weeks (5 weeks–3 years) between surgeries. The rate for return to preinjury activity level after surgery was not significantly different between one- (88%) and two-stage (100%) (p = 0.444). There was a significantly higher complication rate (p = 0.023) in the one-stage (stiffness, instability, and patella baja) versus two-stage surgery (no complications). There was no significant difference in return to preinjury activity level between one- and two-stage PT repair and ACL reconstruction. However, the one-stage combined surgery had a significantly higher complication rate compared with two-stage surgery. The level of evidence is IV.

scholarly journals Incidence of Second Anterior Cruciate Ligament Tears (1990-2000) and Associated Factors in a Specific Geographic Locale

2017 ◽  
Vol 45 (7) ◽  
pp. 1567-1573 ◽  
Author(s):  
Nathan D. Schilaty ◽  
Nathaniel A. Bates ◽  
Thomas L. Sanders ◽  
Aaron J. Krych ◽  
Michael J. Stuart ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Patellar Tendon ◽  
Cruciate Ligament ◽  
Population Based ◽  
Contralateral Side ◽  
Activity Level ◽  
Acl Injuries ◽  
Acl Tear ◽  
Anterior Cruciate

Background: Second anterior cruciate ligament (ACL) tears after reconstruction occur at a reported rate of 20% to 30%. This high frequency indicates that there may be factors that predispose an athlete to graft failure and ACL tears of the contralateral knee. Purpose: To determine the incidence of second ACL injuries in a geographic population-based cohort over a 10-year observation period. Study Design: Descriptive epidemiological study. Methods: International Classification of Diseases, 9th Revision (ICD-9) codes relevant to the diagnosis of an ACL tear and the procedure code for ACL reconstruction were searched across the Rochester Epidemiology Project, a multidisciplinary county database, between the years of 1990 and 2000. This cohort of patients was tracked for subsequent ACL injuries through December 31, 2015. The authors identified 1041 patients with acute, isolated ACL tears. These patients were stratified by primary and secondary tears, sex, age, activity level, side of injury, sex by side of injury, and graft type. Results: Of the 1041 unique patients with a diagnosed ACL tear in Olmsted County, Minnesota, from 1990 to 2000, there were 66 (6.0%) second ACL tears; 66.7% of these tears occurred on the contralateral side. A second ACL injury was influenced by graft type ( P < .0001), election of ACL reconstruction ( P = .0060), and sex by side of injury ( P = .0072). Nonparametric analysis of graft disruption by graft type demonstrated a higher prevalence of second ACL tears with allografts compared with hamstring ( P = .0499) or patellar tendon autografts ( P = .0012). Conclusion: The incidence of second ACL tears in this population-based cohort was 6.0%, with 66.7% of these tears occurring on the contralateral side from the original injury. There was a high population incidence of second ACL injuries in female patients younger than age 20 years. The utilization of patellar tendon autografts significantly reduced the risk of second ACL injuries compared with allografts or hamstring autografts in this cohort.

scholarly journals A study on functional outcome of arthroscopic anatomical reconstruction of anterior cruciate ligament using quadrupled hamstring graft

2017 ◽  
Vol 3 (4) ◽  
pp. 854
Author(s):  
Jagdeesh P. C. ◽  
Suhail R. Shaikh
Keyword(s):  
Anterior Cruciate Ligament ◽  
Functional Outcome ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Scoring Systems ◽  
Activity Level ◽  
Anatomical Reconstruction ◽  
Proper Patient Selection ◽  
Anterior Cruciate ◽  
Hamstrings Tendon

<p class="abstract"><strong>Background:</strong> Various techniques and graft types are now available for the reconstruction of ACL. Opinions differ among experts with regard to the ideal technique and graft type to be used. Arthroscopic anatomical ACL reconstruction using quadrupled hamstring autograft with fixation in the femoral tunnel using tightrope and in the tibial tunnel with interference screw is a relatively new technique. Purpose of this study is to analyze the postoperative outcome in our experience with this procedure.</p><p class="abstract"><strong>Methods:</strong> This was a prospective study of patients with ACL injury who underwent Arthroscopic anatomical ACL reconstruction using quadrupled hamstrings autograft. All patients were operated upon by the same surgeon and had the same rehabilitation protocol. They were followed up for six months at regular intervals using IKDC, LGS scoring systems, tegner activity scale and a subjective questionnaire.<strong></strong></p><p class="abstract"><strong>Results:</strong> About 95% of the patients had a favorable outcome as per three scoring systems. (IKDC, Lysholm score, subjective questionnaire) all three scoring system had a very high correlation around 90% of individuals were able to return to their pre injury activity level.</p><p class="abstract"><strong>Conclusions:</strong> We conclude that the functional outcome of arthroscopic anatomical anterior cruciate ligament reconstruction using quadrupled hamstrings tendon autograft is excellent to good (95%). With proper patient selection and rehabilitation full occupational and recreational activities can be expected for most of the patients within four to six months of the procedure.</p>

scholarly journals Comparison of hamstring and patellar tendon grafts in anterior cruciate ligament reconstruction: A prospective randomized study

2017 ◽  
Vol 46 (2) ◽  
pp. 785-791 ◽  
Author(s):  
Katarzyna Stańczak ◽  
Marzenna Zielińska ◽  
Marek Synder ◽  
Marcin Domżalski ◽  
Michał Polguj ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Patellar Tendon ◽  
Cruciate Ligament ◽  
Randomized Study ◽  
Activity Level ◽  
Prospective Randomized Study ◽  
Kujala Score ◽  
Anterior Cruciate

Objective This prospective randomized study was performed to compare the outcomes of two operative methods of anterior cruciate ligament (ACL) reconstruction based on either bone–patellar tendon–bone (BTB) grafts or hamstring tendon (HT) grafts. Methods Among 100 patients, 96 completed the full follow-up period and were included in the final analysis (48 in the BTB group and 48 in the HT group). The patients were evaluated preoperatively and 1, 3, 6, and 12 months after ACL reconstruction. The Kujala score, Tegner score, and Knee injury and Osteoarthritis Outcome Score (KOOS) were among the parameters used to evaluate the patients. Results Both groups were comparable in terms of sex, age, and body mass index. None of the analyzed scores were significantly different between the BTB and HT groups at either the initial or last visit. Both groups demonstrated improvement at the 12-year follow-up according to the Kujala score and most categories of the KOOS. The Tegner activity level score showed significant improvement in the HT but not BTB group. Conclusion Patients undergoing ACL reconstruction with BTB and HT grafts show comparable improvement in functional results after 1 year of rehabilitation.

scholarly journals Result of arthroscopic anterior cruciate ligament reconstruction in patients aged 50 years and older in Viet Duc University Hospital

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Đình Toàn Dương ◽  
Lê Vinh Đoàn
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Pivot Shift ◽  
Cruciate Ligament ◽  
University Hospital ◽  
Knee Joints ◽  
Joint Effusion ◽  
Surgical Reconstruction ◽  
Joint Movement ◽  
Anterior Cruciate

Abstract Introduction: A few years ago, arthroscopic became one of the most common treatments for anterior cruciate ligament (ACL) injury. Patients who are older than 50 years of age have problems of degenerative knee, ACL reconstruction indication in this group has many different perspectives. Materials and Methods: Retrospective and prospective descriptive study was conduted in the patients group over 50 years of age having ACL reconstruction in Viet Duc University Hospital from April 2017 to November 2018. Follow-up examination was in one, three and six months. Results: After 1 month, 96,2% of the patients had movement amplitude over 90 degrees, there were no cases of swelling knee, knee joint effusion or infection of the incision. After 3 months of surgery, all patients could flex their knee joints over 120 degrees, 93,2% of patients had negative the Lachmann sign, 91% of them had negative anterior draw test and negative Pivot shift sign ratio was 97,7%. Re-examination after 6 months of surgery showed that 83,9% patients had good or very good the Lysholm score, amplitude of joint movement means was 147 ± 11,8 degree. Conclusion: Our results suggest that individuals 50 years and older who have symptomatic instability from an absent or insufficient ACL can have good outcomes with surgical reconstruction if there are no contraindications. Key word: Laparoscopy surgery, anterior cruciate, over 50 years old. Tóm tắt Đặt vấn đề: Trong những năm gần đây, phẫu thuật nội soi đã trở thành phương pháp thường quy để điều trị đứt dây chằng chéo trước (DCCT) khớp gối cho người bệnh dưới 50 tuổi, có nhu cầu hoạt động thể lực. Tuy nhiên tổn thương dây chằng chéo trước (DCCT) ở lứa tuổi trên 50 thường kèm theo bệnh lý thoái hóa khớp gối, vì vậy chỉ định phẫu thuật nội soi tái tạo DCCT ở lứa tuổi này còn nhiều quan điểm khác nhau. Phương pháp nghiên cứu: Nghiên cứu mô tả hồi cứu kết hợp tiến cứu được tiến hành trên 56 người bệnh trên 50 tuổi, được phẫu thuật nội soi tái tạo DCCT tại Bệnh viện Hữu nghị Việt Đức từ tháng 4/2017 đến tháng 11/2018. 100% người bệnh được tái khám, đánh giá kết quả sau phẫu thuật 1, 3, 6 tháng. Kết quả: Sau 1 tháng phẫu thuật, 96,2% người bệnh có biên độ vận động > 900, không có trường hợp nào nhiễm trùng vết mổ. Sau phẫu thuật 3 tháng, tất cả người bệnh có biên độ gấp gối đạt trên 1200, duỗi hết gối, 93,2% người bệnh có dấu hiệu Lachmann âm tính, 91% có dấu hiệu rút ngăn kéo trước âm tính, tỷ lệ âm tính với dấu hiệu Pivot shift là 97,7%. Đánh giá lại sau 6 tháng điều trị có 83,9% người bệnh có điểm Lysholm ở mức tốt hoặc rất tốt, biên độ vận động khớp gối trung bình là 147 ± 11,8 độ. Kết luận: Kết quả của chúng tôi cho thấy rằng những người bệnh từ 50 tuổi trở lên có triệu chứng lâm sàng do tổn thương ACL có thể cho kết quả tốt với phẫu thuật nội soi tái tạo nếu không có chông chỉ định. Từ khóa: Phẫu thuật nội soi, dây chằng chéo trước, trên 50 tuổi.

Outcomes of Anterior Cruciate Ligament Reconstruction in Females Using Patellar–Tendon–Bone versus Hamstring Autografts: A Systematic Review and Meta-Analysis

2018 ◽  
Vol 32 (08) ◽  
pp. 770-787 ◽  
Author(s):  
Si Heng Sharon Tan ◽  
Bernard Puang Huh Lau ◽  
Lingaraj Krishna
Keyword(s):  
Anterior Cruciate Ligament ◽  
Clinical Outcomes ◽  
Acl Reconstruction ◽  
Patellar Tendon ◽  
Cruciate Ligament ◽  
Activity Level ◽  
Knee Score ◽  
Graft Rupture ◽  
Significant Difference ◽  
Anterior Cruciate

AbstractThe current review aims to compare the outcomes of anterior cruciate ligament (ACL) reconstruction in the female population after patellar–tendon–bone and hamstring grafts. The review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. All original randomized controlled trials and prospective cohort studies that compared clinical outcomes after female ACL reconstruction using hamstring versus patellar–tendon–bone grafts were included. All clinical outcomes reported by three or more studies were included. Fifteen publications, with 948 female patients, were included. Most outcomes were reported to have no significant graft differences by all studies that reported the outcome. These included all the outcomes for objective knee scores (International Knee Documentation Committee [IKDC] objective knee score), neuromuscular testing (quadriceps strength, hamstring strength, and single hop test), graft rupture or failure, and subjective knee scores (Lysholm score and IKDC subjective knee score). The pivot shift test, flexion deficit, and presence of crepitus were also reported to have no significant graft differences by all studies. Some studies reported a significant difference in anteroposterior laxity (Lachman's test and instrumented laxity), range of motion deficits (extension deficit), and sports and activity level (Tegner score). However, these statistically significant differences were noted to be clinically insignificant due to the normal population variation or standard error of measurement of these tools of evaluation. Patients reconstructed with patellar-tendon–bone grafts have a higher risk of kneeling pain. There was no significant difference in the incidence of crepitus. Most of the outcomes following female ACL reconstructions showed no clinically and statistically significant difference when either patellar–tendon–bone or hamstring autograft was used. These included outcomes for anteroposterior laxity, objective knee scores, neuromuscular testing, graft rupture or failure, subjective knee scores, sports and activity level, and crepitus. This a level II study.

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