Abstract
Purpose Evaluate clinical effectiveness of anatomical reconstruction of the anterior cruciate ligament (ACL) and determine the perspectives for practical health care. Material and methods The review included 706 patients who underwent arthroscopic reconstruction of the ACL and graft interference screw fixation between 2010 and 2018. ACL reconstruction was performed using either anteromedial portal (n = 396, Group I) or an isometric transtibial tunnel technique (n = 310, Group II). Outcomes were evaluated clinically and radiographically using the 2000 International Knee Documentation Committee (2000 IKDC) Subjective Knee Evaluation Form, the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Tegner Lysholm scoring scale. Clinical and economic outcome measures included surgical time, rehabilitation and disability periods and period of recovery for sports performance. Results The knee anterior drawer test was equally negative and showed no significant differences in the groups. The Lachman test and the pivot shift test showed better results in Group I (p < 0.001). Contractures, atrophic femoral muscles (p < 0.05), synovitis (p < 0.01), vertical position of the femoral graft channels and pathologically extended bone channels with wind-wiper effect (p < 0.001) were more common among patients of Group II. Although knee function returned to normal, as rated with the 2000 IKDC Subjective Knee Evaluation Form, in 91.3 % of cases pathological changes in the knee (C) and severely impaired function (D) were 2.5 and 5 times less common in group I than in Group II (p < 0.05). Pain, symptoms and sport scores were significantly higher on the KOSS scale for Group I (p < 0.05). Surgical time was longer in patients of Group I (p < 0.05) who had shorter rehabilitation period (p < 0.05). Conclusion Anatomical reconstruction of ACL using anteromedial portal was shown to be a more reliable technique as compared to transtibial approach to ensure overall knee stability arranging adequate bone channels. The technique is capable to protect the graft from injury, reduce the likelihood of pain, synovitis, contractures, muscle atrophy, providing shorter rehabilitation, disability period and recovery for sport performance.
Highlights
The treatment of anterior cruciate ligament (ACL) rupture has significantly evolved over the past two decades with technological advances allowing anatomic reconstruction
Two basic principles of ACL reconstruction formulated more than 20 years ago involved an isometric technique using a transtibial approach through the tibial bone tunnel, and anatomical approach aimed at imitating the natural course of the native ligament fibers [1, 2]
Our findings suggested that anatomic ACL reconstruction was shown to be effective allowing to obtain good stability of the knee joint in 97.0 % of cases
Summary
The treatment of anterior cruciate ligament (ACL) rupture has significantly evolved over the past two decades with technological advances allowing anatomic reconstruction. Two basic principles of ACL reconstruction formulated more than 20 years ago involved an isometric technique using a transtibial approach through the tibial bone tunnel, and anatomical approach aimed at imitating the natural course of the native ligament fibers [1, 2]. Despite the large number of publications reporting multiple surgical and different operative techniques and approaches, a systematic review of the clinical effectiveness of anatomical reconstruction of ACL requires further justification [5, 6]. Several areas of controversy exist in ACL tear management with the lack of comparative research [6, 7] which have engaged surgeons and researchers in debates towards identifying an ideal isometric and anatomical approach for these patients
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