Comparative analysis of five-year outcomes of anterior cruciate ligament tears repaired with different techniques

Abstract

Introduction Primary repair of the anterior cruciate ligament (ACL) torn from the femur and the synovial membrane being intact can be an indication for two competing methods including dynamic intraligamentary stabilization (DIS) as the saving method and resection of the stump and primary autoplasty as a more traumatic option.The purpose was to evaluate the five-year results of DIS in comparison with early ACL reconstruction of the knee joint.Material and methods A review and statistical analysis of outcomes of 72 patients with ACL injuries (47 males and 25 females) were performed. The patients aged between 18 and 45 years (30.9 ± 8.5), with the length of time from injury ranging from 3 to 21 days (10.6 ± 5.0) and the Tegner activity score of 5 (1–9; 5.8 ± 0.9) prior to injury. DIS was performed for the first group of patients (n = 39) who arthroscopically were diagnosed with ACL torn off the femur with the synovial membrane preserved. Early ACL repair was performed for the controls (second group, n = 33).Results VAS scored 1.4 ± 0.8 in group I and 1.9 ± 0.8 in group II at 6 months, p = 0.004. Patient satisfaction scored 8.0 ± 0.8 in group I and 7.4 ± 0.8 in group II at 12 months, p = 0.003. Tegner activity level scored 6.5 ± 0.9 in group I and 6.3 ± 0.8 in group II at 12 months, p = 0.014. The Lysholm knee score measured 91.1 ± 2.2 in group I and 88.6 ± 3.5 in group II at 12 months, p = 0.001. Five-year dynamic observation showed relapses of anterior-medial instability of the knee joint in 10 patients (13.9 %), with 4 patients in group I (10.3 %) and 6 patients in group II (18.2 %).Discussion Outcomes of proximal ACL tears with intact synovium can be as good as with ACL repair. Removal of the torn cruciate ligament with the synovium being intact and grafting may be an unnecessary and aggressive approach.Conclusion Dynamic intraligamentous stabilization as compared to early ACL repair shows a faster recovery of physical activity at a short term and less relapses of knee joint instability at a long term.