Abstract
PurposeThe anterior cruciate ligament (ACL) reconstruction via a contralateral bone-tendon-bone (C-BTB) autograft was introduced to encourage early return to sports. The purpose of this study is to evaluate whether primary contralateral BTB ACL reconstruction can be adapted for early return-to-sports modification by investigating the chronological changes of muscle strength after surgery.MethodsFifteen patients who had underwent C-BTB ACL reconstruction were compared with a matched group of 15 patients of ipsilateral BTB (I-BTB) ACL reconstruction. The clinical outcomes of the time of return-to-sports, Tegner activity scale and the rate of second ACL injuries, the tibial anterior translation measurement, and knee extension and flexion muscle strength were assessed.ResultsWithin 12 months after surgery, 14 of 15 patients from both groups returned to preinjury sports. The median time to return to sports after surgery was 6.5 months in the C-BTB group and 8.0 months in the I-BTB group (p = 0.021). No significant difference was noted with regard to the Tegner activity scale, reinjury rate or mean instrumental anterior tibial translation. The quadriceps muscle strength in the ACL-reconstructed knee compared with the opposite knee in both groups at 5 months after surgery was 120.6% in the C-BTB group and 70.0% in the I-BTB group (p < 0.001). However, the quadriceps muscle strength of the non-reconstructed limb, which instructed the graft harvested knee in the C-BTB and the intact knee in the I-BTB group, compared with that of the preoperative uninjured limb, was 74.5% in the C-BTB group and 118.7% in the I-BTB group (p = 0.0021) 5 months after surgery. Moreover, the quadriceps muscle strength of the reconstructed knee compared with the preoperative normal limb was 88.8% and 81.5% in the C-BTB and I-BTB groups, respectively (p = 0.38).ConclusionsACL reconstruction via the C-BTB autograft indicated better quadriceps muscle strength from early stage after surgery compared with I-BTB ACL reconstruction. However, the ostensible rapid symmetrical muscle strength recovery was attributed to strength deficits compared to the preoperative condition at the donor site limb and ACL-reconstructed limb.Level of evidenceLevel: Level: 4.
Highlights
Recovery from anterior cruciate ligament (ACL) injuries in athletes, especially at pre-injury levels, is often difficult
The purpose of the study was to evaluate whether primary contralateral BTB ACL reconstruction can be adapted for early return-to-sports modification by investigating the chronological changes of muscle strength after surgery
Concerning the occurrence rates of second ACL injuries, graft reinjury was 6.7% (1/15) in both groups, and the contralateral ACL injury was 6.7% (1/15) in the ipsilateral BTB (I-BTB) group, with none of the patients in the contralateral bone-tendon-bone (C-BTB) group deploying this injury within the follow-up period (Table 2)
Summary
Recovery from anterior cruciate ligament (ACL) injuries in athletes, especially at pre-injury levels, is often difficult. Only 63% of the Sanada et al J EXP ORTOP (2021) 8:86 patients re-engage in their preinjury sports, and only 44% among competitive athletes did [1] It takes 6–13 months for these patients and athletes to return to sports after ACL reconstruction [9]. The main concept of the procedure is to secure better quadriceps muscle strength by harvesting a bone-patellar tendon-bone graft from the unaffected limb, which divides the duplicative antagonistic effects of reconstruction and graft harvesting maneuvers on one limb into two separate knees This earlier return-to-sports strategy is supported by the biological healing advantage of BTB autografts, which mature faster than hamstring grafts [6]
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