scholarly journals Outcomes of single bundle arthroscopic anterior cruciate ligament reconstruction in a limited resource setting

2020 ◽  
pp. jisakos-2020-000500
Author(s):  
Binod Sherchan ◽  
Saroj Rai ◽  
Nira Tamang ◽  
Siddhartha Dhungana ◽  
Laxmi Kanta Sharma ◽  
...  
Keyword(s):  
Graft Failure ◽  
Ligament Reconstruction ◽  
Pivot Shift ◽  
Cruciate Ligament ◽  
Pivot Shift Test ◽  
Cruciate Ligament Reconstruction ◽  
Lachman Test ◽  
Urban Group ◽  
Anterior Cruciate ◽  
Rural Group

ObjectivesDespite various challenges, orthopaedic sports surgeons are still providing the arthroscopic service in low-income and middle-income countries like Nepal; however, it is hardly being reported. The main purpose of this study was to compare the clinical outcomes and complications of patients undergoing arthroscopic anterior cruciate ligament reconstruction (ACLR) in the urban group and that of the rural group.MethodsWe evaluated a total of 194 patients, including 98 patients in the urban group and 96 patients in the rural group, undergoing arthroscopic ACLR between August 2015 and February 2018, and had completed a minimum of 2-year follow-up. Subjective evaluations were performed using the Tegner-Lysolm score and International Knee Documentation Committee (IKDC) subjective knee evaluation form. Laxity assessments were performed using the Lachman test and the Pivot-shift test. Functional evaluation included the range of motion, single-leg hop test and overall IKDC score. Radiological assessment was performed according to the IKDC guidelines. SPSS was used for data analysis.ResultsThere was statistically significant differences in the subjective assessments between 2 groups. No statistically significant differences existed between 2 groups in terms of laxity and functional assessments. However, the proportion of laxity, in terms of Lachman test and Pivot-shift test, was higher in the young and active individuals and the proportion of abnormal and severely abnormal in all parameters of functional outcomes was higher in the older female in the rural group. Graft failure occurred in 19 (17.6%) knees in the urban group and 17 (16.8%) knees in the rural group. Graft failure in the urban group was higher in young and active male patients, whereas failure in the rural group was more in female patients. Similarly, overall infection occurred in 13 (6.2%) knees, including 5 (2.3%) deep infections and 8 (3.8%) superficial infections.ConclusionWe advised similar rehabilitation protocol for all the patients; however, the outcomes were significantly lower in patients living in rural areas as they are found to have poor compliance with the rehabilitation protocol. The overall graft failure rate was 17.2%; however, the reoperation rate was higher in the urban group than the rural group. The rate of deep infection was higher in the rural group as compared with the urban group.Level of evidenceLevel III, retrospective comparative study.

EVALUATE THE RESULTS OF ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION WITH THE USE OF AUTOGENOUS PATELLAR LIGAMENT AT HUE UNIVERSITY HOSPITAL

2011 ◽  
pp. 105-115
Author(s):  
Nghi Thanh Nhan Le ◽  
Huu Toan Bui
Keyword(s):  
Anterior Cruciate Ligament ◽  
Ligament Reconstruction ◽  
Pivot Shift ◽  
Cruciate Ligament ◽  
University Hospital ◽  
Patellar Ligament ◽  
Pivot Shift Test ◽  
Cruciate Ligament Reconstruction ◽  
Lachman Test ◽  
Anterior Cruciate

Background: Anterior cruciate ligament (ACL) play the importance role in stability of knee. Our purpose was to report the stability and functional outcomes for a prospective series of patients with ACL injuries treated with reconstruction of use of autogenous patellar ligament. Methods: A prospective study of 30 patients with ACL ruptures treated with arthroscopically assisted reconstruction with autogenous patellar ligament was initiated from May 2008 to December 2010 at Hue University Hospital. Lachman test, anterior draw test, pivot shift test, functional Lysholm scores were obtained at each visit, including preoperatively and at the third and sixth month of follow-up visit. Results: Thirty patients (male : female = 2.3; with a mean age of thirty years) enrolled in the study. Twenty one knees had an isolated ACL tear, nine also had an associated PCL tear and/or meniscus injuries. Lachman test was positive in 100% of cases, draw test was positive in 86% and pivot-shift test was positive in 93%. Mean value of knee function according to Lysholm score was 56 points. Twenty-six patients were followed-up in six months. Lachman test was positive in 15% of all cases, draw test was positive in 7% and pivot-shift test was positive in 7%. Lysholm outcomes scores were improved to 89 points. Conclusions: Bone patellar tendon bone graft was a useful and safety technique for anterior cruciate ligament reconstruction.

scholarly journals Outcomes of Single Bundle Arthroscopic Anterior Cruciate Ligament Reconstruction in a Limited Resource Setting.

2020 ◽  
Author(s):  
Binod Sherchan ◽  
Saroj Rai ◽  
Siddhartha Dhungana ◽  
Nira Tamang ◽  
Laxmi Kanta Sharma ◽  
...  
Keyword(s):  
Graft Failure ◽  
Pivot Shift ◽  
Pivot Shift Test ◽  
Single Bundle ◽  
Functional Evaluation ◽  
Rehabilitation Protocol ◽  
Lachman Test ◽  
Urban Group ◽  
Resource Setting ◽  
Rural Group

Abstract Purpose: Despite various challenges, orthopaedic sports surgeons are still providing the arthroscopic service in developing countries like Nepal; however, it is hardly being reported. The main purpose of this study was to compare the clinical outcomes and complications of patients undergoing arthroscopic ACLR in the Urban group and that of the Rural group. Methods: We evaluated a total of 194 patients, including 98 patients in the Urban group and 96 patients in the Rural group, undergoing arthroscopic ACLR between August 2015 and February 2018. The subjective evaluations were performed using the Tegner-Lysolm score and International Knee Documentation Committee (IKDC) form. The laxity assessments were performed using the Lachman test and the Pivot-shift test. The functional evaluation included the ROM, single-leg hop test, and overall IKDC score. Radiological assessment was performed according to the IKDC guidelines. SPSS was used for data analysis. Results: There was statistically significant differences in the subjective assessments between 2 groups. No statistically significant differences existed between 2 groups in terms of Laxity and Functional assessments. However, the proportion of laxity, in terms of Lachman test and Pivot-shift test, was higher in the young and active individuals and the proportion of abnormal and severely-abnormal in all parameters of functional outcomes was higher in the older female in the Rural group. Graft failure occurred in 19(17.6%) knees in the Urban group and 17(16.8%) knees in the Rural group. Graft failure in the urban group was higher in young and active male patients, whereas failure in the Rural group was more in female patients. Similarly, overall infection occurred in 13 (6.2%) knees, including 5 (2.3%) deep infections and 8 (3.8%) superficial infections. Conclusion: We advised the similar rehabilitation protocol for all the patients; however, the outcomes were significantly lower in patients living in rural areas as they are found to have poor compliance with the rehabilitation protocol. The overall graft failure rate was 17.2%; however, the reoperation rate was higher in the Urban group than the Rural group. The rate of deep infection was higher in the Rural group as compared to the Urban group.

scholarly journals Revision anterior cruciate ligament reconstruction due to knee instability

2007 ◽  
Vol 60 (11-12) ◽  
pp. 587-592 ◽  
Author(s):  
Miroslav Milankov ◽  
Aleksandar Milicic ◽  
Dragan Savic ◽  
Milan Stankovic ◽  
Srdjan Ninkovic ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Ligament Reconstruction ◽  
Pivot Shift ◽  
Cruciate Ligament ◽  
Pivot Shift Test ◽  
Cruciate Ligament Reconstruction ◽  
The Mean ◽  
Anterior Cruciate ◽  
Sports Activities

Introduction. The primary goal of anterior cruciate ligament reconstruction is to provide stability to the knee and regain full range of motion. Although great improvement has been achieved in surgical techniques and rehabilitation, some patients are not completely satisfied with the results of surgery and a revision anterior cruciate ligament reconstruction is necessary. Material and Methods. Revision arthroscopic anterior cruciate ligament reconstruction was carried out in eleven patients with bone-tendon-bone autografts. The surgery was performed in a standard manner and the graft was taken from the opposite knee. Eight men and three women were evaluated. The mean age of patients was 26 (17-34) years. Repeated instability of the knee was caused by injury in five patients, while six patients were unsatisfied with the position of the graft. Results. The follow up was 4,2 years (2-8) respectively. The mean Lysholm and Gillquist score after operation was 88 (65-90). Preoperative and postoperative tibial shift was 9mm (6-15) and 2mm (0-4), respectively. The preoperative pivot shift test was grade 2 and 3 in all patients. Postoperative pivot shift test was negative in seven patients, in three it was grade 1 and grade 2 in one patient. According to the IKDC scale, preoperative results were abnormal in three patients and in eight they were severely abnormal. Postoperative IKDC score was normal in five patients, in four nearly normal, and in one patient the score was still abnormal. Five patients continued to be active in sports activities, four patients decreased the level of sports activity and two stopped all sports activities. Conclusion. Success of revision anterior cruciate ligament reconstruction requires detailed preoperative evaluation of the repeated instability of the knee. The treatment plan is then decided upon. The patients must be preoperatively informed about the real possibilities of revision surgery. Only a mutual collaboration between the patient, physiatrist and a surgeon is a key for successful treatment and return to previous level of sports activities.

Anatomical anterior cruciate ligament reconstruction (ACLR) results in fewer rates of atraumatic graft rupture, and higher rates of rotatory knee stability: a meta-analysis

2020 ◽  
Vol 5 (6) ◽  
pp. 359-370
Author(s):  
Yousif Eliya ◽  
Khaled Nawar ◽  
Benjamin B Rothrauff ◽  
Bryson P Lesniak ◽  
Volker Musahl ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Failure Rate ◽  
Ligament Reconstruction ◽  
Pivot Shift ◽  
Cruciate Ligament ◽  
Meta Analysis ◽  
Knee Stability ◽  
Cruciate Ligament Reconstruction ◽  
Anterior Cruciate

ImportanceThis review highlights the differences in outcomes between anatomical and non-anatomical anterior cruciate ligament reconstruction (ACLR) techniques.ObjectiveTo compare clinical and functional outcomes between anatomical and non-anatomical ACLR techniques.Evidence reviewA search of MEDLINE, Embase and PubMed from 1 January 2000 to 24 October 2019 was conducted. Randomised and prospective primary ACLR studies using autograft and a minimum of 2 years of follow-up were included. The Anatomic Anterior Cruciate Ligament Reconstruction Checklist (AARSC) was used to categorise studies as anatomical. Outcomes analysed included failure rate, knee stability and functional outcomes. A meta-analysis using risk ratio and mean differences was conducted using a random effects model.FindingsThirty-six studies were included, representing 3710 patients with a follow-up range of 24–300 months. The overall failure rate was 96/1470 (6.5%) and 131/1952 (6.7%) in the anatomical group and non-anatomical group, respectively. The pooled results of the overall failure rate showed that there was no statistically significant difference between the anatomical and the non-anatomical groups (p=0.96). There were 37/60 (61.7%) and 29/67 (43.3%) traumatic failures in the anatomical and non-anatomical groups, respectively. The number of patients with the negative postoperative pivot-shift test was 995/1252 (79.5%) and 1140/1589 (71.1%) in the anatomical and non-anatomical groups, respectively. The pooled results indicated a statistically significant higher number of patients with a positive pivot shift in the non-anatomical group compared with the anatomical group (p=0.03).Conclusions and relevanceThis study demonstrated that the overall failure rate was similar between the anatomical and non-anatomical approaches. However, the anatomical ACLR demonstrated a significantly superior restoration of rotatory stability, as evidenced by a higher percentage with a negative postoperative pivot-shift test. Non-anatomical ACLR resulted in higher rates of atraumatic graft ruptures and persistent rotatory knee instability. Surgeons should consider anatomical ACLR when treating rotatory knee stability in patients.Level of evidenceII, systematic review and meta-analysis of level I and II studies.

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