Lachman Test on ACLR With Internal Bracing at Hasan Sadikin General Hospital Bandung

Abstract

Introduction: The growing popularity of recreational and competitive sport activities has contributed to an increased number of anterior cruciate ligament (ACL) injuries in the past three decades. Because of its varying success rates, anterior cruciate ligament reconstruction (ACLR) is considered the gold standard surgical treatment for ACL rupture. ACLR in hyperlaxity patients has unpredictable outcomes because of its flexibility, therefore utilizing an internal brace aims to obtain a rigid fixation such as the enthesis structure. Methods: This prospective case series study was done from August 2021 to March 2022. Laxity was assessed using Beighton score, and patients were divided into three groups based on clinical laxity and surgical management that performed. Group 1 was no laxity patients performed ACLR without internal bracing, group 2 was laxity patients performed ACLR without internal bracing and group 3 was laxity patients performed ACLR with internal bracing. We conducted ACLR on 34 patients with a mean age of 35±6.71 years old. Twenty four patients had laxity with Beighton score 4–9. Ten patients had no laxity with Beighton score 0-3. ACLR were done with internal bracing augmentation for 15 patients with laxity. ACLR without internal bracing were done for 19 patients. Post-surgery follow up were scheduled at 1 and 3 months using Lachman test. Patients with no anterior displacement is considered as negative Lachman test , while patients with 0-5 mm, 5-10 mm, and >10 mm of anterior displacement were considered as Lachman test grade 1, grade 2, and grade 3 respectively. Results: All patients completed 1 and 3 months post-operation follow-up using Lachman test. After 3 months follow-up, in group of patients with no laxity performed ACLR, negative Lachman test was found in 7 participants (70 %), and grade 1 was found in 3 participants (30 %). %) In group of laxity patients performed ACLR without internal bracing, negative Lachman test was found in 4 participants (44.4%), grade 1 in 2 participants (22.2%) and grade 2 in 3 participants (33.3%). Meanwhile in group of laxity patients performed ACLR with internal bracing, negative Lachman test was found in 12 participants (80%), grade 1 in 2 participants (13.3%) and grade 2 in 1 participant (6.7%). Negative Lachman test after 3 months follow up was found higher in patients performed ACLR with internal bracing. Discussion: Our results showed that patients who received ACLR with internal bracing recovered 80% of the time by the Lachman test after 3 months. Internal brace reduce graft failure and improve rehabilitation in ACLR. The limitation of this study was a subjective result performing Lachman test examination. A junior resident, senior resident and sport injury consultant may had different Lachman test valuation. Conclusion: The difference between preoperative and postoperative Lachman test results were statistically significant on laxity patients underwent anterior cruciate ligament reconstruction with internal bracing.