COMPARISON OF THE ACL RECONSTRUCTION WITH QUADRUPLED HAMSTRING TENDONS VIA ARTHROTOMY VERSUS ARTHROSCOPY. MINIMUM 2,5 YEARS FOLLOW-UP

Abstract

Aims: The purpose of the paper is to compare results of reconstruction of ACL with quadrupled ST and GR tendons via arthrotomy in the study group and arthroscopy in the control group.

Methods: Treatment results of the consecutive cohort of 26 patients in the study group treated by arthrotomy were compared to the results of the consecutive cohort of 22 patients in the control group treated by arthroscopy operated between September 2002 and December 2003 by the same operating team. The patient’s age varied from 17 to 46 years (mean 24,5y) in the study group and 18 to 48 years (mean 23,7y) in the control group, with minimum follow-ups longer than 30 months. For the evaluation clinical examination, Lysholm& Gillquist and Marshall scales and KT-1000 assessment were used. For the proximal fixation endo-button plate and for the distal screw-post fixation were applied. There were no differences in graft harvesting, graft preparation and rehabilitation protocol in both groups.

Results: There were 3 traumatic graft failures in the study group. Mean gained Lysholm& Gillquist score in the study group was 31,42(+−4,68SD) and mean gained Marshall score was 12,18(+−2,27SD). 57.69% of the patients in the study group returned to the sport and work without any limitation on the preoperative level, additional 30.76% has only minor limitation in sport or work. There was 1 case of superficial infection and 1 deep infection in the study group. Both infections resolved without sequels. MM lesions in 10 cases (38,46%) and no LM lesions were found intraoperatively.

There were 2 traumatic and 1 unclear graft failures in the control group. Mean gained Lysholm& Gillquist score was 34,35(+−8,86SD) and mean gained Marshall score was 12,33(+−2,88SD). 45,46% of the patients in the control group returned to the unlimited sport and work on the preoperative level, additional 36,37% has minor limitation in sport or work and 1 patient despite stable knee was unable to return to the work. There was 1 case of deep vein thrombosis of the operated leg and 1 neuroma in the arthroscopy portal area in the control group. MM lesions in 12 cases (54,5%) and LM lesions in 5 cases (22,7%) were found intraoperatively.

The average KT-1000 side-to-side difference in the study group was 2,88 mm and in the control group 2,73 mm.

Conclusions: Mid-time follow-up reveals good to very good clinical outcome in both groups with no statistically significant differences. It looks interesting why the better average return to sport ratio was gained in the study group. 2 cases of infection discourage this approach except necessity additional cartilage repair. Differences in meniscal injuries rate might also advocate for arthroscopy as more capable in diagnose and treatment.