POST-OPERATIVE COMPLICATIONS FOLLOWING ARTHROSCOPIC ACL RECONSTRUCTION USING VARIOUS GRAFTS; A PROSPECTIVE STUDY

Anterior cruciate ligament tear is a common occurrence and with advent of arthroscopic ligament reconstruction, the surgery is minimally invasive with good functional outcomes. The aim of this study is to evaluate the post-operative complications following arthroscopic ACLreconstruction. In this study we tried to analyse the post-operative complications in patients with arthroscopic ACL reconstructions using various autografts. The autografts used in this study were Bone patellar tendon bone graft, hamstring graft and peroneus graft. 26 patients were included in the study. 2 patients lost to follow up. The study result comprised of 24 patients. there were 45.8% of the patients who were below the age of 25 years whereas 54.2% patients were older than 25 years. Only 3 females were recruited in the present study, accounting for 12.5% of the total patients of the study. Majority 87.5% were males. Majority of the recruited patients were having right sided knee injury (54.2%) whereas remaining (45.8%) were having left sided injury. Majority of the patients were treated using hamstring and peroneus grafts (41.7%). 16.7% patients were treated with BPTB graft. There were 16.7% patients who developed deep infection after the surgery. Out of these, 30% were with hamstring grafts and 25% were with BPTB graft. 41.7% patients didn't develop any complications afterwards. 12.5% patients complained of post-operative knee pain. 16.7% patients reported occurrence of supercial infection. There are no signicant differences among complications for different grafts used in this study. The study concluded that arthroscopic ACL reconstruction is a safe surgical procedure with no signicant differences for various autograft options in terms of complications. The study is limited by small sample size and short follow up.

EVALUATION OF ARTHROSCOPIC ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION USING BONE-PATELLAR TENDON-BONE GRAFT

AIM- Anterior cruciate ligament (ACL) is most common injured ligament in the knee joint. Surgical management of ACL rupture is technically demanding as improper reconstruction can lead to an unstable joint. The aim of present study was to nd out the outcome of Arthroscopic reconstruction of ACLusing Bone patellar tendon bone (BPTB) graft. METHOD – It is a retrospective observational study where arthroscopic reconstruction of ACLwas done over a period of 5 years. IKDC score was applied to nd out the outcome of surgery. Strict post operative rehabilitation regime was followed. RESULT- After evaluation of 25 cases, 60% (15cases) showed very good outcome, 36%(9 cases) showed good outcome and 4% (1 case) showed poor outcome. Implant related local irritation is seen in 2 patients and low grade infection was seen in 1 patient. CONCLUSION – Majority of the patients were satised with the result so it is purposeful to perform ACL reconstruction arthroscopically using BPTB graft.

The Effect of Patient Sex and Graft Type on Postoperative Functional Outcomes After Primary ACL Reconstruction

Background: Graft choice in anterior cruciate ligament reconstruction (ACLR) and postoperative rehabilitation may affect strength recovery differently in men than women and therefore affect a timely and successful return to sport. Purpose: To compare knee extensor and flexor strength between men and women who underwent isolated ACLR with either patellar tendon or hamstring tendon (HST) autografts. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 166 patients (87 women, 79 men) with primary unilateral and uncomplicated ACLRs were recruited for participation. A total of 100 patients had bone–patellar tendon–bone (BPTB) autografts and 66 had HST autografts. At 6 months postoperatively, all patients completed the Tegner activity scale and International Knee Documentation Committee Subjective Knee Evaluation as well as underwent bilateral isokinetic (90 deg/s) tests of the knee extensor and flexor groups. Outcomes were recorded in a single session as part of a return-to-sport test battery. Surgical notes were obtained to determine the type of autograft and nerve block used at the time of ACLR. Results: There was a significant sex × graft type interaction for mass-normalized knee flexor torque ( P = .017). Female patients with an HST graft had a significantly lower knee flexor torque compared with female patients with a BPTB graft (0.592 ± 0.49 N·m/kg vs 0.910 ± 0.24 N·m/kg; Cohen d [95% CI] = 0.91 [0.45, 1.36]). They also had a significantly lower knee flexor torque when compared with male patients with an HST graft (0.592 ± 0.49 N·m/kg vs 0.937 ± 0.35 N·m/kg; Cohen d [95% CI]= 0.88 [0.45, 1.31]). There were significant main effects for graft type with knee flexion ( P = .001) and extension ( P = .008) symmetry. Patients with a BPTB graft demonstrated lower knee extensor symmetry (65.7% ± 17.0%) and greater knee flexor symmetry (98.7% ± 18.0%) compared with patients with an HST graft (extension: 77.1% ± 32%, Cohen d [95% CI] = 0.47 [0.16, 0.79]; flexion: 82.9% ± 33.3%, Cohen d [95% CI] = 0.63 [0.31, 0.95]). We also observed a significant main effect for sex ( P = .028) and graft type ( P = .048) for mass-normalized knee extensor strength. Female participants and patients of either sex with BPTB grafts had lower knee extensor strength compared with male participants and patients with HST grafts, respectively. Conclusion: At approximately 6 months after ACLR, female patients reconstructed with HST autografts demonstrated weaker HST strength compared with female patients with a BPTB autograft. There were no differences in HST strength between graft types in male patients. Female patients appear to be recovering HST strength differently than male patients when using an HST autograft. These findings may have implications in surgical planning, postoperative rehabilitation, and return-to-sport decision making.

Chronological Changes in Anterior Knee Stability after Anatomical Anterior Cruciate Ligament Reconstruction Using Bone–Patellar Tendon–Bone and Hamstring Grafts

The clinical outcomes of anterior cruciate ligament (ACL) reconstruction are typically evaluated at specific time points only. This study aimed to characterize the chronological changes in anterior knee stability after anatomical ACL reconstruction and to compare the anterior knee stability achieved with bone–patellar tendon–bone (BPTB) and hamstring tendon (HT) grafts. A total of 59 patients underwent anatomical rectangular tunnel ACL reconstruction using the BPTB graft and 23 patients underwent anatomical double-bundle ACL reconstruction using the HT graft. Anterior knee stability was quantitatively assessed using the KneeLax 3 arthrometer at 6 months, 1 year, and 2 years after surgery using side-to-side differences. The values for anterior knee stability using the BPTB graft were 0.3 mm after 6 months, 0.2 mm after 1 year, and 0.2 mm after 2 years, and no significant differences were observed during the postoperative study period. Meanwhile, the values for anterior knee stability using the HT graft were −0.3 mm after 6 months, 0.5 mm after 1 year, and 1.2 mm after 2 years, and anterior knee stability decreased chronologically from 6 months up to 2 years. Regarding anterior stability, the HT graft showed significant laxity compared with the BPTB graft only after 2 years. No chronological changes in anterior stability were observed from 6 months up to 2 years after ACL reconstruction using the BPTB graft, whereas anterior laxity developed during the same period after ACL reconstruction using the HT graft. This is a Level IV, therapeutic case series study.

Hamstring Strength Recovery is Worse in Women than Men following ACL Reconstruction with Hamstring Autografts

Objectives: Graft choice in ACL reconstruction (ACLR) and post-operative rehabilitation may influence strength recovery and return to sports differently in men versus women. Persistent muscle weakness, impaired function, and poor patient reported outcomes are a concern for patients early after reconstruction and impact a timely and successful return to unrestricted physical activity without re-injury. However, little is known about the effect of graft choice and sex on short term ACLR recovery and return-to-play assessment. The purpose of this study was to compare knee extensor and flexor strength between male and female patients in isolated ACLR across both patellar tendon and hamstring autografts. Methods: A total of 166 patients with primary, unilateral and uncomplicated ACL reconstructions (22.6±9.9 years, 87 females, 5.94±.46 months post ACLR) were recruited for participation. There were 100 patients with bone patellar tendon bone (BPTB) autografts and 66 hamstring (HS) autografts. All patients completed the Tegner activity Scale and underwent bilateral isokinetic (90°/sec) tests of the knee extensor and flexor groups. Outcomes were recorded in a single session as part of a return-to-sport test battery. Strength was expressed as torque normalized to mass (Nm/kg) and limb-symmetry was expressed as a percentage of (involved/uninvolved)*100. Surgical Notes were obtained to determine the patient’s sex and type of autograft used at the time of ACLR. Strength measures were compared using 2x2 ANCOVAs (Sex by Graft Type) with the patient’s current activity level as a covariate. Post-hoc Cohen’s D effect sizes and 95% CI were calculated and statistical significance was defined as p-values of .05 or less. Results: There was a significant sex*graft type interaction for normalized knee flexor torque (P=.017) (Figure 1). Females with a HS graft (.592±.49 Nm/kg) had significantly less knee flexor torque compared to females with a BPTB graft (.910±.24 Nm/kg, Cohen’s d= .90[.45, 1.36]) and all males (HS: .937±.35, Cohen’s d=.87 [.45, 1.30]). There were significant main effects for graft type for knee flexor (P=.001) and extensor (P=.008) symmetry. Patients with a BPTB graft demonstrated less knee extensor symmetry (65.7±17%) and greater knee flexor symmetry (98.7±18%) compared to patients with a HS graft (Extension: 77.1±32%, Cohen’s d=.47[.16, .79]) (Flexion: 82.9±33%, Cohen’s d=.63[.31,.95]). We also observed a significant main effect for sex (P=.028) and graft type (P=.048) for normalized knee extensor strength. On average, males (1.67±.60 Nm/kg) demonstrated significantly greater normalized extensor torque than females (1.44±.75 Nm/kg, Cohen’s d= .34 [.03, .64]), and patients with a HS graft (1.66±.34 Nm/kg) demonstrated greater normalized extensor strength than those with a BPTB graft (1.45±.42 Nm/kg, Cohen’s d= .54 [.22, .85]). Conclusion: At approximately 6 months following ACLR, female patients reconstructed with hamstring autografts demonstrated weaker hamstring strength compared to females with a BPTB autograft. There were no differences in hamstring strength between graft types in males. Females appear to be recovering hamstring strength differently than males when using a hamstring autograft. These findings may have implications in surgical planning, post-operative rehabilitation and return to sports decision making. [Figure: see text]

Ceramic Bone Graft Substitutes do not reduce donor-site morbidity in ACL reconstruction surgeries: a pilot study

Introduction:Anterior knee pain is a major problem following Bone-patellar-tendon-bone graft (BPTB) use in anterior cruciate ligament (ACL) reconstruction. We hypothesized that filling the donor defect sites with bone-graft substitute would reduce the anterior knee symptoms in ACL reconstruction surgeries.Material and Methods: Patients operated for ACL-deficient knee between March 2012 and August 2013 using BPTB graft were divided into two treatment groups. The patellar and tibial donor-site bony defects were filled-up with Hydroxyapatite–Bioglass (HAP:BG) blocks in the study group (n = 15) and no filler was used in the control group (n = 16). At 2 years, the clinical improvement was assessed using International Knee Documentation Committee (IKDC) score and donor-site morbidity was assessed by questionnaires and specific tests related to anterior knee pain symptoms.Results: Donor-site tenderness was present in 40% patients in the study group and 37.5% patients in the control group (p = 0.59). Pain upon kneeling was present in 33.3% patients in the study group and 37.5% patients in the control group (p = 0.55). Walking in kneeling position elicited pain in 40% patients in the study group and 43.8% in the control group (p = 0.56). The mean visual analogue score for knee pain was 3.0 in the study group and 3.13 in the control group, with no statistically significant difference (p = 0.68). Unlike control group, where a persistent bony depression defect was observed at donor sites, no such defects were observed in the study group.Conclusion:Filling the defects of donor sites with HAP:BG blocks do not reduce the anterior knee symptoms in patients with ACL reconstruction using autogenous BPTB graft.

Anterior Cruciate Ligament Reconstruction Using a Bone–Patellar Tendon–Bone Graft With and Without a Ligament Augmentation Device: A 25-Year Follow-up of a Prospective Randomized Controlled Trial

Background: Various grafts and ligament augmentation devices (LADs) have been used in the search for optimal reconstruction of the anterior cruciate ligament (ACL). Purpose: To compare 25-year follow-up results after ACL reconstruction using a bone–patellar tendon–bone (BPTB) graft with or without the Kennedy LAD. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: One hundred patients undergoing ACL reconstruction between 1991 and 1993 were randomized into 2 groups: reconstruction using a BPTB graft alone (BPTB group, 51 patients) or a BPTB graft with the Kennedy LAD (LAD group, 49 patients). The 25-year follow-up evaluation included a clinical knee examination, patient-reported outcome measures, and an assessment of radiological osteoarthritis (OA) according to the Ahlbäck classification. Additional outcomes were reruptures and knee arthroplasty. Results: Ninety-three patients (93%) were available for the follow-up evaluation: 48 patients in the BPTB group and 45 in the LAD group. Through telephone calls, 26 patients were excluded from further investigation because of reruptures and arthroplasty in the knee of interest; 67 patients were further investigated. A total of 43 of 44 (98%) and 42 of 44 (95%) patients had negative or 1+ Lachman and pivot-shift test results, respectively. The mean Lysholm score was 85 for the BPTB group and 83 for the LAD group. All mean Knee injury and Osteoarthritis Outcome Score (KOOS) subscale values were ≥73. There were no statistically significant differences between groups in any of these outcomes or regarding the Tegner score, radiological classification of OA, or number of ACL reruptures. Signs of radiological OA were detected in all patients, and severe radiological OA (Ahlbäck grade III, IV, or V) was detected in 32% of patients in the BPTB group and 21% of patients in the LAD group ( P = .37). There were 12 patients in the BPTB group and 7 in the LAD group who had documented reruptures ( P = .40). One patient in the BPTB group and 6 in the LAD group underwent knee arthroplasty ( P = .054). Conclusion: In the present study, there were no statistically significant differences between groups in any of the outcomes. After 25 years, 19% of patients had reruptures, 27% had severe radiological OA, and 7% underwent knee arthroplasty.