Custom-made anterior cruciate ligament

Abstract

Rupture of the anterior cruciate ligament (ACL) of the knee is one of the most common ligament injuries. It is most common in young, athletic patients, and its short- and long-term repercussions result in functional disability. The increasing development of ligamentoplasty using the crow's foot tendons: the medial rectus and the semitendinosus (DIDT), compared with ligamentoplasty using the patellar tendon, considered to be the "Gold Standard", and the quadricipital tendon, has led the various surgical and rehabilitation teams to compare these three techniques. Our work is a retrospective study of 66 patients with chronic knee instability secondary to ACL rupture. 33 patients underwent ligamentoplasty using a semitendinosus medial rectus graft (DIDT), 21 patients were treated with a patellar tendon graft using the Kenneth-Jones (KJ) technique and 12 patients were treated using the quadricipital tendon technique.Rehabilitation was started at 24 hours post-operatively, with support allowed, according to a well-coded protocol. Comparing these 3 techniques, patients in the DIDT and TQ group showed a less marked pain profile than those in the "patellar tendon" group. In all three groups, there was a significant improvement in the postoperative Lysholm and Tegner scores compared with the preoperative scores; this improvement was significantly greater in the DIDT group than in the KJ group (94.6 vs. 86.2). The three techniques (QT, KJ and DIDT) gave comparable long-term results, although the early postoperative effects, which differed from one technique to another, could be an interesting criterion in choosing the type of ligamentoplasty. In summary, in sensory terms QT > DIDT > KJ, in aesthetic terms QT= DIDT > KJ, and in functional terms QT= DIDT = KJ. Measurement of preoperative and postoperative laximetry using a laximeter (KT-1000) represents an objective assessment of the outcome of surgery, which is necessary to demonstrate the superiority of one technique over another.