Abstract
ObjectiveThe aim of the study was to: 1) evaluate the differences in pre-post operative knee functioning, mechanical stability, isokinetic knee muscle strength in simultaneous arthroscopic patients after having undergone an anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL) with hamstring tendons reconstruction, 2) compare the results of ACL/PCL patients with the control group.DesignControlled Laboratory Study.Materials and MethodsResults of 11 ACL/PCL patients had been matched with 22 uninjured control participants (CP). Prior to surgery, and minimum 2 years after it, functional assessment (Lysholm and IKDC 2000), mechanical knee joint stability evaluation (Lachman and “drawer” test) and isokinetic tests (bilateral knee muscle examination) had been performed. Different rehabilitation exercises had been used: isometric, passive exercises, exercises increasing the range of motion and proprioception, strength exercises and specific functional exercises.ResultsAfter arthroscopy no significant differences had been found between the injured and uninjured leg in all isokinetic parameters in ACL/PCL patients. However, ACL/PCL patients had still shown significantly lower values of strength in relative isokinetic knee flexors (p = 0.0065) and extensors (p = 0.0171) compared to the CP. There were no differences between groups regarding absolute isokinetic strength and flexors/extensors ratio. There was statistically significant progress in IKDC 2000 (p = 0.0044) and Lysholm (p = 0.0044) scales prior to (44 and 60 points respectively) and after the reconstruction (61 for IKDC 2000 and 94 points for Lysholm).ConclusionsAlthough harvesting tendons of semitendinosus and/or gracilis from the healthy extremity diminishes muscle strength of knee flexors in comparison to the CP, flexor strength had improved. Statistically significant improvement of the knee extensor function may indicate that the recreation of joint mechanical stability is required for restoring normal muscle strength. Without restoring normal muscle function and strength, surgical intervention alone may not be sufficient enough to ensure expected improvement of the articular function.
Highlights
Damage to two or more ligaments within the knee joint leads to significant impairment of the articular function
Significant improvement of the knee extensor function may indicate that the recreation of joint mechanical stability is required for restoring normal muscle strength
Numerous authors have described various, predominantly arthroscopic, techniques used in the combined multiligament surgical reconstruction of the knee joint when restoring its mechanical stability [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17]; fewer of them have revealed the outcomes of such techniques being applied in surgical treatment of complex instability [7,8,9,11,13,14,17], and even fewer have conducted prospective studies with pre- and post-operative assessment [7,8,9] based on mechanical stability and knee joint subjective functional evaluation
Summary
Damage to two or more ligaments within the knee joint leads to significant impairment of the articular function. Doi:10.1371/journal.pone.0082462.t001 evaluation of mechanical knee stability with subjective and objective functional joint assessment. Graft materials are another topic widely discussed in relevant publications [16]. There are no objective studies confirming the that graft harvesting from an unaffected limb does not impair muscle strength of relevant muscle groups, or lead to functional impairment of the limb [14]. Based on this knowledge, a hypothesis has been developed, stating that hamstring harvesting from both the injured and intact leg does not lead to flexor weakening. The second hypothesis of the present study is that good results could be achieved in the majority of patients by the implementation of our standardized surgical approach and postoperative protocol
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