Comparison of Therapeutic Results of Open and Arthroscopic Surgery on Functional Level, Duration of Return to Daily Activity and Satisfaction with Treatment in Patients with ACL Rupture

Abstract

Bone-Patellar Tendon-Bone autograft (BPTB) and four-strand semitendinosus-gracilis (hamstring) graft are the most common methods for reconstructing anterior cruciate ligament but there is still controversy over the best method. The aim of this study was to compare the therapeutic results of two methods of BPTB and four-strand semitendinosus-gracilis (hamstring) grafts using arthroscopic treatment in patients with anterior cruciate ligament (ACL) rupture. This retrospective study was performed on 85 patients with ACL rupture aged 17-45 years who referred to Imam Khomeini Hospital in Ahwaz from the beginning of 2016 to the end of 2017 who had undergone two years of ACL reconstruction surgery, either by bone-patellar tendon-bone autograft (BPTB) (open surgery) (n=23) or four-strand hamstring autograft (semitendinosus-gracilis) (by arthroscopy) (n=25). Lysholm score was used for knee functional status assessment, Lachman test for tendon laxity, and pivot shift test for strength evaluation. The 36-Item Short-Form Health Survey questionnaire (SF-36) was also completed and compared at the last follow-up. Patients were also evaluated by type of daily activity (heavy or light activity). There was no significant difference between the two groups in the Lysholm score (P>0.05) and both groups were classified as “Good”. There was no significant difference between the frequency distribution of patients based on Lachman test results and pivot shift results (P>0.05). None of the patients in the two groups had any rupture within two years after treatment. Both groups had good satisfaction with treatment and quality of life and there was no statistically significant difference between the mean SF-36 scores (P>0.05). There was no significant difference between the two groups in the light and heavy activity groups. Although complication in short-term follow-up was more in patients undergoing open surgery, the functional level and treatment satisfaction in patients treated by open surgery (bone-patellar tendon-bone autograft) and arthroscopy (four-strand hamstring autograft) were not significantly different after two years. Therefore, according to the surgeon's diagnosis or the patient's choice, both methods can be selected; method with acceptable therapeutic outcomes in reconstructing the anterior cruciate ligament.