Arthroscopic Anterior Cruciate Ligament Reconstruction in Ghana: A 2-Year Outcome Assessment

Abstract

Objective: The goal of this study was to evaluate the treatment outcomes of arthroscopic anterior cruciate ligament reconstruction among patients at the Komfo Anokye Teaching Hospital, (KATH) in Ghana.Methods: A prospective cohort study. We enrolled consenting patients who underwent arthroscopic anterior cruciate ligament (ACL) reconstruction at the KATH over a 3-year period, from January 1, 2015 to December 31, 2018 and followed up each study participant for 2 years. Post-operative assessments were performed at 2, 6, 12, 24 weeks, 1year and at 2 years, to record outcome variables such as range of motion, pain, swelling and laxity of the affected knee as well as excessive discharge from the surgical site, suggestive ofinfection. Tegner Lysholm knee scores were obtained for each patient at 2-years following surgery. The follow-up was concluded in 2020.Results: Over the 3-year period, 40 primary arthroscopic ACL reconstructions were performed in 40 patients. Most of the patients were young adult males who sustained a tear of the anterior cruciate ligament following a fall from a standing height. Out of this number, 31 had isolated ACL tear, 4 had ACL tear associated with LCL tear and 3 had ACL tear with associated meniscal tear. Two of the participants had ACL, PCL and LCL tear and a complex medial meniscal tear, with associated posterolateral corner rotatory instability. ACL reconstructions that were performed within 12 months following injury had higher mean Tegner Lysholm score of 7 (range of 5-9), than those carried out later than 12 months after injury. Overall, 37 of the patients (93%) had good to excellent outcome at 2 years post-operatively. Three of the patients who were competitive athletes before injury had returned to competitive sport within 1 year of surgery. There was one case of surgical site infection giving an infection rate of 2.5% and one case of graft rupture that requiredrevision ACL reconstruction.Conclusion: Arthroscopic ACL reconstruction is feasible at the study site with low complication rate and provides good to excellent outcome in 93% of patients. The procedure is generally safe and effective in restoring knee function following an ACL tear. Patientreported outcomes are superior when reconstruction is performed within 12 months of injury compared to later reconstructions.