Revision ACL reconstruction using quadriceps or hamstring autografts leads to similar results after 4 years: good objective stability but low rate of return to pre-injury sport level (original) (raw)
Related papers
Long-term follow-up of ACL reconstruction with hamstring autograft
Knee Surgery, Sports Traumatology, Arthroscopy, 2014
Purpose To investigate the differences in the incidence and severity of knee osteoarthritis (OA), joint space narrowing, knee laxity, and knee flexion and extension strength between an anterior cruciate ligament (ACL)reconstructed knee and the contralateral non-reconstructed limb. Methods Retrospective case series of patients from a single surgeon that had an ACL reconstruction with a semitendinosus/gracilis autograft more than 12 years ago. Outcome measures included radiographic analysis, International Knee Documentation Committee Subjective Knee Evaluation Form (IKDC), KT-1000, Tegner Activity Level Scale, Lysholm Knee Score, ACL quality of life score (ACL-QOL) and knee flexor/extensor strength. Results Seventy-four patients consented and sixty-eight (43 male, 25 female) were included for analysis. Average age (SD) at the time of surgery was 31.2 (±9.1) years. At follow-up of 14.6 (1.9) years, 9 % had re-ruptured their ACL, whereas 5 % ruptured the contralateral ACL. Reconstructed knees had a greater incidence and severity of OA (P \ 0.01). Medial meniscus surgery was a strong predictor of OA. Seventy-five per cent scored a normal or nearly normal knee on the IKDC. The mean Lysholm score was 75.8 % and Tegner Activity Level Scale scores decreased (P \ 0.001) from the time of surgery. Knee extension strength was greater in the contralateral knee at speeds of 60°/s (P = 0.014) and 150°/s (P = 0.012). Conclusions Reconstructed knees have a greater incidence and severity of OA than non-reconstructed knees, which suggests degenerative changes are secondary to ACL rupture. Medial meniscus surgery is a strong predictor of OA. Despite this, 75 % of patients reported good outcomes.
Acta Orthopaedica Belgica
Recently there has been growing interest in the quadriceps tendon (QUAD) as a valid option for reconstruction of the anterior cruciate ligament (ACLR). The aims of the study is to compare the out- comes achieved in anatomic ACLR involving QUAD vs. Hamstring (HT) autografts. A total of 52 consecutive patients underwent an ACLR, 25 patients with QUAD graft and 27 with HT graft. The same surgical technique, fixation method and postoperative protocol were used in both groups. The following parameters were evaluated: functional status (Lysholm, Tegner, subjective IKDC scores), joint stability (Lachman and pivot shift tests), surgical reoperation rate, complications, degree of satisfaction and return to previous level of activity. Descriptive statistics were analysed using the Student’s t-test. Forty four patients were evaluated (20 QUAD, 24 HT), with a mean follow-up of 27.4 months. Two patients were re-operated in the QUAD group (including one ACL revision), and one patient in the HT gr...
Ortopedia, traumatologia, rehabilitacja, 2007
BACKGROUND The purpose of this paper is to present a protocol of rehabilitation after ACL reconstruction using a hamstring autograft in the first month after surgery. The program enables the patient to return early to everyday activities (school, sedentary work) without crutches or a stabilizer. MATERIAL AND METHODS The program has been developed in accordance with rehabilitation protocols employed at Karolinska Institute in Sweden and Prof. Shelbourne's Clinic in the USA. The study group included 31 patients (18 men and 13 women). RESULTS Patients rehabilitated in the Department according to our program achieved stable gait patterns and were able to step up and down within four to seven weeks. CONCLUSIONS Early patient mobilization after ACL reconstruction is possible and does not cause any negative effects provided that the patient, doctor and physiotherapist cooperate very closely.
BAC K G R O U N D Anterior cruciate ligament (ACL) inj ur ies are successfully r econstructed arthroscopically especially in young and active patients. The main purposes of these reconstructions are to achieve a stable and functional knee joint. Recently most frequently used autogenous graft types are mainly bone- patellar tendon- bone and quadruple hamstring tendon. The various advantages and disadvantages and their superiorities to each other are still debated. For this purpose we have compared the general symptomatology, stability, proprioception and functional results of ACL reconstruction operations that we used these graft types. M ET H O D S Twenty ACL reconstructed patients in two groups with 10 subjects each were included in our study. In one group ACL reconstruct ions were made with bone - patellar tendon one and in the other group with quadruple hamstring tendon. Anterior knee pain, thigh atrophy, stability, proprioception, Lysholm and Tegner activity level scores were ev...
Knee Surgery, Sports Traumatology, Arthroscopy, 2012
Purpose Several studies have suggested that drilling the femoral tunnel through an anteromedial arthroscopic portal during anterior cruciate ligament reconstruction allows more anatomic placement of the graft. However, no studies have investigated whether the anteromedial approach results in better outcomes compared to the traditional transtibial drilling approach when a hamstring autograft is used. The purpose of the present study is to investigate short-term functional and clinical outcome differences between male patients recovering from anterior cruciate ligament reconstruction with a hamstring autograft using the transtibial femoral tunnel drilling approach versus the anteromedial approach. Methods Lysholm score, functional test and isokinetic data were collected at 3 and 6 months after surgery in 51 male patients who received a standardized rehabilitation in a large outpatient facility. Multivariate and univariate analyses of variance were used to assess group, time and interaction effects. Results All outcomes except isokinetic knee flexion at 180°/s improved from 3 to 6 months for both groups (p B 0.05). The anteromedial approach group had better Lysholm scores at 3 months (p B 0.05) and better performance in the timed lateral movement functional tests at 3 and 6 months (p B 0.05). No other comparisons were significant (n.s). Conclusions Both groups had comparable outcomes on most measures. The differences in the Lysholm score and lateral movement functional tests may suggest a quicker return of function and performance for the anteromedial approach group. Clinicians should take into consideration the surgical technique as they progress patients recovering from ACL reconstruction through the different phases of the rehabilitation protocol. Level of evidence Therapeutic study, Level II.
Inferior results after revision ACL reconstructions: a comparison with primary ACL reconstructions
Knee Surgery, Sports Traumatology, Arthroscopy, 2013
Purpose Anterior cruciate ligament (ACL) ruptures are common, especially among young athletes, and such injuries may have considerable impact on both sport careers and everyday life. ACL reconstructions are successful for most patients, but some suffer from persistent giving-way symptoms and/or re-ruptures requiring revision surgery. The aim of this study was to evaluate the results after revision ACL reconstructions and compare them with the results in a control group consisting of primary ACL reconstructions. Methods This retrospective study included 56 patients undergoing revision ACL reconstruction and 52 patients receiving primary ACL reconstructions. The follow-up evaluation included clinical examination, instrumented laxity testing, testing of muscle strength, Tegner activity score, Lysholm score, Knee injury and osteoarthritis outcome score (KOOS) and radiological grading of osteoarthritis. Results The median time from the last ACL reconstruction to follow-up was 90 months in the revision ACL reconstruction group and 96 months in the primary ACL reconstruction group. The revision group had significantly inferior KOOS and Lysholm scores compared with the primary group. Patients in the revision group also showed greater laxity measured with the pivot shift test, a larger reduction in the Tegner activity score, reduced muscle strength in the injured knee, and more severe radiological osteoarthritis; however, no difference in anterior-posterior translation was found. Conclusion Inferior results were found on several of the testing parameters in the revision group compared with the primary group. Patients should receive this information prior to revision ACL reconstructions. Level of evidence III.
Clinical Orthopaedics and Related Research®, 2017
Background Athletes often are cleared to return to activities 6 months after anterior cruciate ligament (ACL) reconstruction; however, knee function measures continue to improve up to 2 years after surgery. Interventions beyond standard care may facilitate successful return to preinjury activities and improve functional outcomes. Perturbation training has been used in nonoperative ACL injury and preoperative ACL reconstruction rehabilitation, but has not been examined in postoperative ACL reconstruction rehabilitation, specifically return to sport rehabilitation. Questions/Purposes The purpose of this study was to determine whether there were differences at 1 and 2 years after ACL reconstruction between the male SAP (strengthening, agility, and secondary prevention) and SAP+PERT (SAP protocol with the addition of perturbation training) groups with respect to (1) quadriceps strength and single-legged hop limb symmetry; (2) patient-reported knee outcome scores; (3) the proportion who achieve selfreported normal knee function; and (4) the time from surgery to passing return to sport criteria. Methods Forty men who had completed ACL reconstruction rehabilitation and met enrollment criteria (3-9 months after ACL reconstruction, [ 80% quadriceps strength limb symmetry, no pain, full ROM, minimal effusion) were randomized into the SAP or SAP+PERT groups of the Anterior Cruciate Ligament-Specialised Post-Operative Return to Sports trial (ACL-SPORTS), a single-blind randomized clinical study of secondary prevention and return to sport. Quadriceps strength, singlelegged hopping, the International Knee Documentation Committee (IKDC) 2000 subjective knee form, Knee Injury and Osteoarthritis Outcome Score (KOOS)-sports and recreation, and KOOS-quality-of-life subscales were collected 1 and 2 years after surgery by investigators
International Journal of Orthopedics Sciences, 2020
Background: Our study aim is to assess the functional outcome of arthroscopy assisted anatomical reconstruction of ACL with autologous hamstring graft using IKDC score. Methodology: Our study is a prospective observational study conducted in 40 patients, all patients between age group of 20-40 yrs, both male and females with ACL injury, admitted to Yashoda Superspeciality hospital, between April 2016 and May 2017 (14 months) and fulfilling inclusion and exclusion criteria, treated surgically with Arthroscopic anatomic ACL reconstruction using autologous hamstring graft were included as the subjects for study. Case selection was done according to. Results: A total of 40 patients, 32 male and 8 female with 26 right knee and 14 left knee involvement with ACL tear were operated. The IKDC score reflected highly significant improvement in the stability, mainly rotational and anterior stability when preoperative score were compared with the score of most recent follow up i.e. 6 months. Pre-operative mean of 44.43+3.630 SD and Post-operative mean was 88.53+3.994 SD. The average Pre-operative mean was 44.525 and average Post-operative mean was 88.525, with an average mean increase in score was 44, with significant P value < 0.01 using IKDC score. Interpretation and conclusion: Anatomical ACL reconstruction is excellent technique for treating patients with ACL tear who are especially involved in the activities which involve pivoting most of the times in their life time for e.g. Athletes.
IP innovative publication pvt. ltd, 2019
Introduction: Selection of graft for primary anterior cruciate ligament reconstruction have long been a topic of controversy. Among the vast range of graft options, hamstring autograft is most commonly used and quadriceps tendon autograft is less common. Purpose: To compare the functional outcomes in quadriceps tendon graft and quadruple hamstring graft in primary anterior cruciate ligament reconstruction. Materials and Methods: Thirty patients with post traumatic anterior cruciate ligament injury were taken into study. All 30 patients were randomised and two group were made. Group H Included 15 patients in which ACL reconstruction was done using quadruple hamstring graft and Group Q included 15 patients in which ACL reconstruction was done using quadriceps tendon graft. All patients were prospectively analysed. In post-operative period all patients were treated with standardized rehabilitation protocol and were evaluated at 6 weeks, 3 months and 6months by Lysholm knee score, quadriceps weakness, extension lag, quadriceps wasting, anterior drawer test, Lachman test and pivot shift test and compared. Results: Mean difference in extensor lag between both groups was 1.07(p value 4.48), - 0.22(p value 3.59) and - 0.32(p value 2.28) at first, second and third follow-up but was not significant. Mean difference in quadriceps strength between both groups was 4.10(p value 0.172), 2.04(p value 0.955) and - 2.46(p value 0.218) at first, second and third follow-up but was not significant. Mean difference in quadriceps wasting between both groups was - 0.29(p value 0.380), - 0.33(p value 0.349) and - 0.26(p value 0.217) at first, second and third follow-up but was not significant. Mean difference in Lysholm knee score between both groups was 4.10(p value 0.172), 2.04(p value 0.955) and - 2.46 (p value 0.218) at first, second and third follow up but was not significant. No significant difference was found in both groups. Conclusion: All the patients in whom ACL reconstruction were done showed good results irrespective of the choice of graft. The results showed no clinically significant difference at different follow-ups. Considering the small number of the study of short follow up, we recommend the study at larger scale for longer follow up to evaluate the results of both the procedures.
Functional outcomes of ACL reconstruction using hamstring auto graft
The Professional Medical Journal, 2019
Objectives: The knee joint is made of two cruciate ligaments. One is anterior cruciate ligament (ACL) which is weaker when it comes to comparison with the other cruciate ligament known as posterior cruciate ligament (PCL). ACL tears are most common and frequently neglected. ACL tear is affecting 70% of the population and this high incidence reflects the significance of the problem. Reason of restoration of a torn ACL is to provide knee stability, knee motion in a safe wide range and to prevent osetoarthritis OA. The gold standard for ACL auto-graft reconstruction is bone patella-tendon bone (BTB) which is still questioned by many researchers as this technique followed subjects suffered from knee pain. So aim is to use and to access outcomes of hamstring auto-graft for reconstruction ACL by using Tegner’s score. Study Design: Cross sectional study. Setting: Private based hospital, Faisalabad. Period: January 2017 to January 2019. Material and Methods: It was comprised of in comprised...