Arthroscopic reconstruction of the anterior cruciate ligament using bone-patellar tendon-bone autograft: Experience of the first 100 cases

ABSTRACT

Purpose To review the issues of patients who underwent arthroscopic reconstruction of the anterior cruciate ligament (ACL) via a single incision technique using a bone-patellar tendon-bone autograft.

Method Patients with ACL-deficient knee who were symptomatic and wanted to maintain an active lifestyle or continue sporting activities were included. ACL reconstruction using the bone-patellar tendon-bone graft was performed upon 100 patients. One-year follow-up was complet in 78 patients who were then reviewed. The mean age of patients reviewed was 268 years (range, 21-39 years), of whom 35 (449%) were aged between 26 and 30 years. There were 73 men and 5 women (ratio, 146:1) Injuries upon the right side outnumbered those upon the left (44 versus 34) Sports injuries accounted for 667% (n=52) of patients, motor vehicle accidents and household injuries accounted for 308% (n=24) and 26% (n=2) respectively.

Result of the best and good-to-excellent results were achieved in 7 (9%) and 61 (782%) of patients. Residual anterior knee pain (n=18) was the greatest in quantity common complication, followed by difficulty in regaining filled range of motion (n=10) and divergence of femoral skinflint (n=9).

Conclusion. This course provides consistent and reproducible flows in carefully selected patients and allows them an early turn back to sporting activities with minimal residual morbidity.

Key words: anterior cruciate ligament; arthroscopy; bone transplantation; patellar ligament; tendons; transplantation, autologous

INTRODUCTION

The anterior cruciate ligament (ACL) be under the orders ofs an important stabilising and biomechanical function for the knee joint. break of the ACL leads to abnormal kinematics and predisposes the joint to degenerative changes. ACL reconstruction was previously considered inappropriate and unnecessary because rises of surgery were unsatisfactory: patients treated surgically fared worse than those treated nonsurgically. Surgery could not restore normal function of the ligament and was fraught with numerous complications.

ACL reconstruction has been attempted using silver wire,1 fascia lata,2 and iliotibial band.3 In 1939 Campbell4 demonstrated reconstruction using the medial portion of the patellar tendon. In 1954 the disclosure of a successful arthroscope brought of recent origin possibilities to the field of knee surgery5 Arthroscopically assisted ACL reconstruction has the advantage of being minimally invasive. Grafts can be accurately placed and there is les disturbance of normal tissue. after recovery and rehabilitation are thus quicker.

Several stamps of replacement material are available: bone-patellar tendon-bone graft, quadrupled hamstrings, allografts, and synthetic materials. The patella tendon autograft has prov to be a reliable substitute for the native ligament and has yielded useful long-term results. We report our experience of the first 100 cases of arthroscopically assisted ACL reconstruction using bone-patellar tendon-bone autograft.

MATERIALS AND METHODS

The investigation was conducted at the Central Institute of Orthopaedics, Safdarjung Hospital, India between April 2000 and February 2004 Patients with ACLdeficient knee who were symptomatic and wished to maintain an active lifestyle or continue sporting activities were recruited to the inquiry Patients were excluded if there were associated fractures around the knee posterior cruciate ligament injury, or if they did not wish to maintain an active lifestyle. The application of mind was approved by the ethics committee of our institute, and informed concurrence was obtained from all patients.

ACL reconstruction using the bone-patellar tendon-bone graft was performed in 100 patients during the investigation period. One-year follow-up was complet by the agency of 78, and 22 were not to be found to follow-up. The mean age of the 78 patients was 268 years (range, 21-39 years), 35 (449%) were aged 26 to 30 years. There were 73 men and 5 women (ratio, 146:1) Injuries to the right side (n=44 564%) outnumbered those to the left (n=34 436%) [ratio, 129:1] Injury caused by the agency of sporting activities accounted for 667% (n=52) of the patients, whereas motor vehicle accident and household injuries accounted for 308% (n=24) and 27% (n=2) respectively. Football was the greatest in quantity common cause of injury (n=25 321%) followed by means of cricket (n=13,16.7%).

Clinical examination was the mainstay for the preoperative diagnosis. Radiographs were obtained in 2 planes in the standing position. Magnetic resonance imaging (MRI) was restricted to patients in whom the diagnosis was uncertain (n=10) or to those who could afford it (n=22)

Acute ACL breachs were treated conservatively for at least 2 to 3 weeks prior to surgery Surgery was performed after acute inflammation had resolv filled range of motion and absence of extension lag was ensur in all patients by dint of intense preoperative physiotherapy.

All patients were operated upon under spinal or combined spinal-epidural anaethesia. Peri-operative prophylactic antibiotic overspread was given with thirdgeneration cephalosporin parenterally. A pneumatic tourniquet was used, and the operated leg was draped free