Abstract
BackgroundIn anterior cruciate ligament (ACL) reconstruction, the clinical outcome and level of post-operative pain are important factors. To date there have been no studies evaluating differences in post-operative pain between single bundle and double bundle ACL reconstruction with a hamstring graft.Hypothesis/purposeWe hypothesized that post-operative pain in single bundle ACL reconstruction would be less than in double bundle ACL reconstruction. This study was to compare post-operative pain between patients undergoing single bundle versus double bundle ACL reconstruction.Study designCohort study.MethodsThis was a retrospective study comparing post-operative pain scores between single bundle and double bundle ACL reconstruction. Each patient was given our standard regimen of oral diclofenac (25 mg/tab) three times per day and paracetamol (500 mg/tab) six times per day for 1 day post-operatively. If the patient complained of moderate to severe pain (pain numeric rating scale (PNRS) > 3), 3 mg of morphine was injected intravenously every 3 h for 24 h and 1 mg of morphine as a rescue medication every 1 h for 24 h. PNRS and morphine consumption were recorded at 4-h intervals for 24 h.Results209 patients were included in this study of whom 102 and 107 patients received single bundle and double bundle ACL reconstruction, respectively. The average post-operative pain scores of the single bundle group were lower at all time points. Linear mixed effect regression analyses showed that the single bungle group had lower post-operative pain than the double bundle group after adjusting for confounders (beta = − 0.45; 95% CI = − 0.838, − 0.062) but there was no statistically significant difference between numbers of bundle ACL reconstruction with regard to morphine consumption.ConclusionSingle bundle ACL reconstruction had significantly lower post-operative pain scores than double bundle ACL reconstruction.Clinical relevanceDouble bundle ACL reconstruction results in higher post-operative pain, which may slow the start of rehabilitation and reduce patient satisfaction. In middle-aged adult patients with low-demand activities, we suggest performing a single bundle ACL reconstruction.
Highlights
The reported pain levels following arthroscopic anterior cruciate ligament (ACL) surgery depend on various factors such as pre-operative pain toleration [1,2,3,4], associated intraarticular knee pathologies and operative procedure [2, 5], but regardless of the particulars, such pain is an obstacle to beginning early post-operative rehabilitation and affects the satisfaction of the patient concerning their operation.In ACL reconstruction, there are two widely used autograft types, bone-patellar-tendon-bone (BPTB) and semitendinosus-gracilis (STG)
209 patients were included in this study of whom 102 and 107 patients received single bundle and double bundle ACL reconstruction, respectively
Linear mixed effect regression analyses showed that the single bungle group had lower post-operative pain than the double bundle group after adjusting for confounders but there was no statistically significant difference between numbers of bundle ACL reconstruction with regard to morphine consumption
Summary
The reported pain levels following arthroscopic anterior cruciate ligament (ACL) surgery depend on various factors such as pre-operative pain toleration [1,2,3,4], associated intraarticular knee pathologies and operative procedure [2, 5], but regardless of the particulars, such pain is an obstacle to beginning early post-operative rehabilitation and affects the satisfaction of the patient concerning their operation.In ACL reconstruction, there are two widely used autograft types, bone-patellar-tendon-bone (BPTB) and semitendinosus-gracilis (STG). There are many studies comparing the clinical and functional outcomes (Lysholm scores, Tegner scores, subjective International Knee Documentation Committee (IKDC) between single bundle and double bundle grafts in ACL reconstruction which have reported no significant differences between the two groups [7,8,9]. Because of these results, differences in the level of post-operative pain between the two methods becomes an important factor in making the decision about which type of ACL reconstruction the patient wishes. This study was to compare post-operative pain between patients undergoing single bundle versus double bundle ACL reconstruction
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