Arthroscopic Anterior Cruciate Ligament Research Articles

Lateral femoral tunnel preparation and graft fixation for anterior cruciate ligament reconstruction-A discussion.

This article provides a discussion and commentary around the recent advances in arthroscopic anterior cruciate ligament reconstruction (ACLR), with a focus on the aspects of lateral femoral tunnel preparation and graft fixation techniques. The paper explores and comments on a recently published review by Dai et al, titled "Research progress on preparation of lateral femoral tunnel and graft fixation in ACLR", while providing insight into its relevance within the field of ACLR, and recommendations for future research.

Outcomes from different aspects indicate the all-inside technique may serve as an ideal option for anterior cruciate ligament reconstruction.

To evaluate the postoperative outcomes of the all-inside technique in arthroscopic anterior cruciate ligament reconstruction (ACLR). Patients who underwent ACLR using the all-inside technique between 2018 and 2021 were retrospectively assessed. All patients were followed up for at least 2 years. Functional recovery and pain relief were assessed using the International Knee Documentation Committee (IKDC) score, Lysholm score, Knee Injury and Osteoarthritis Outcome Score (KOOS) and visual analogue scale (VAS). Instrumented laxity was assessed via side-to-side difference using the Kneelax3 arthrometer. Graft maturity was estimated using the signal-to-noise quotient value based on magnetic resonance imaging (MRI). Adverse events during and after the surgery were recorded. A total of 78 patients were included in this study, with a mean age of 28.1 ± 7.6 years. The IKDC (p < 0.001), Lysholm (p < 0.001) and KOOS (p < 0.001 for all subgroups) scores at the final follow-up were significantly higher than those before the surgery. The VAS scores (p < 0.05) were significantly lower than those before surgery. The side-to-side difference results indicated that 50 patients had a difference of less than 3 mm, indicating a tight graft, whereas only 1 patient had a difference of >5 mm, indicating a loose graft. The median signal-to-noise quotient of the graft on MRI was 1.4 (P25, P75: 1.0, 2.0). No intraoperative adverse events were observed. Postoperative adverse events included three cases of infection, three cases of graft rerupture, two cases of cyclops lesion and one case of surgical intervention for a meniscal tear. ACLR using the all-inside technique offers promising results in patients with ACL rupture. Level IV.

ACL Reconstruction with Peroneus Longus Autograft Using Endobutton &amp; Bioabsorbable Interference Screw and Brace Free Rehabilitation

Objective: To assess the functional outcome of arthroscopic anterior cruciate ligament (ACL) reconstruction with Peroneus longus tendon autografts using endobutton and interference screw at one-year follow-up post- operatively and brace-free rehabilitation. Material and Methods: A prospective study included 53 patients with clinical and radiological ACL deficiency. Arthroscopic ACL reconstruction was performed using Peroneus Longus double bundle autografts with sub- sequent brace-free rehabilitation. Pre- and postoperative assessment at one-year follow-up utilized the International Knee Documentation Committee (IKDC) score. Graft length and diameter were measured perioperatively, and donor site morbidity was evaluated using The American Orthopedic Foot and Ankle Score (AOFAS). Results: The study included 51 (94.4%) males and 2 (3.7%) females, mean age 27.3±7.2 years. Majority were left-sided procedures (64.8%). Peroneus Longus graft mean length and diameter were 116.8±5.3mm and 8.2±0.2mm respectively. At one-year follow-up, ankle joint movement at the graft site was preserved (mean AOFAS 98±0.8). There was a significant improvement in IKDC score postoperatively (p &lt; 0.05). Conclusions: ACL reconstruction with Peroneus longus autograft offers knee stability and facilitates early rehabilitation. Utilizing endobutton and bioabsorbable interference screw fixation supports graft strength until sufficient graft-to-bone healing occurs. Patients regain pre-injury activity levels, including stair climbing, sitting cross-legged, and squatting without difficulty.

Comparison of genicular nerve block with adductor canal block for postoperative pain management in patients undergoing arthroscopic knee ligament reconstruction: A randomised controlled trial.

Genicular nerve block (GNB) is beneficial in early ambulation and faster patient discharge since it selectively blocks articular branches and is motor-sparing. This study aimed to compare the analgesic efficacy of ultrasound (US)-guided GNB with adductor canal block (ACB) in patients undergoing arthroscopic anterior cruciate ligament reconstruction (ACLR). This randomised, double-blind study was conducted on 38 adults undergoing arthroscopic ACLR. Patients in Group GNB (n = 19) received US-guided GNB with 3 ml of 0.25% bupivacaine and 2 mg dexamethasone. Patients in Group ACB (n = 19) received US-guided ACB with 20 ml of 0.25% bupivacaine with 6 mg dexamethasone. Postoperative rescue analgesia was provided by intravenous Patient Controlled Analgesia (PCA) with morphine. The primary outcome was Numerical Rating Scale (NRS) pain scores over 24 h. The secondary outcome was the duration of analgesia and 24-h morphine consumption. The Chi-square test was used to test the statistical significance between categorical variables. Independent t-test or Mann-Whitney U test was used to compare continuous variables. NRS scores at rest and physical activity at 24 h were similar in both the groups (P = 0.429 and P = 0.101, respectively). The mean time to rescue analgesia was comparable in both groups (Group GNB: 820.79 [483.65] min [95% confidence interval {CI}: 603.31-1038.27] and Group ACB: 858.95 [460.06] min [95% CI: 652.08, 1065.82], P = 0.805), and the mean 24-h morphine consumption was also comparable in both groups (P = 1.000). US-guided GNB has an analgesic efficacy similar to US-guided ACB for patients undergoing arthroscopic ACLR.

Good clinical outcomes of anterior cruciate ligament reconstruction in patients over 60 years of age.

To evaluate the clinical outcomes following arthroscopic anterior cruciate ligament (ACL) reconstruction (ACLR) in patients over 60 years and to investigate the potential impact of preoperative osteoarthritis (OA) on these outcomes. A retrospective study included ACL-injured patients over 60 years who underwent primary arthroscopic ACLR between 2010 and 2020. The Lysholm score and the International Knee Documentation Committee (IKDC) score were assessed preoperatively and at the final follow-up. The Tegner activity scale was performed to evaluate patients' activity levels. Data on return to sports, patient satisfaction, subsequent injuriesand complications were collected. Preoperative radiographs were used to grade OA according to the Kellgrene-Lawrenceclassification. Correlation analysis between OA and clinical outcomes was performed. The rates of achieving the minimal clinically significant differenceand patient-acceptable symptoms statewere documented. A total of 37 patients were included in this study. The mean age at surgery was 62.3 ± 2.3 years, with a mean follow-up of 6.3 ± 3.2 years (range: 2.1-12.4). Patients showed statistically significant (all p < 0.001) improvements in the mean IKDC (38.9 ± 9.4-66.8 ± 12.5), Lysholm (48.8 ± 15.4-83.0 ± 12.8)and Tegner (1-3) scores. Fourteen patients (37.8%) returned to sports. No correlation was observed between the degree of preoperative OA and clinical outcomes (n.s.). Patients over 60 years with symptomatic ACL-deficient knees could benefit from ACLR, even when mild to moderate OA is present preoperatively. Level IV.

The Influence of Tunnel Parameters and Graft Inclination Angle on Clinical and Radiological Outcome at Long-term Follow-up after Arthroscopic Anterior Cruciate Ligament Reconstruction.

Objective To study the influence of various tunnel parameters and graft inclination angle (GIA) on the clinical and radiological outcome after anterior cruciate ligament reconstruction (ACLR) at long-term follow-up. Methods In this retrospective study, 80 patients with isolated anterior cruciate ligament (ACL) injury treated by single bundle ACLR using bone patellar tendon bone (BPTB) and hamstring (HT) autografts were evaluated clinically and radiologically at their long-term follow-up. The study population were divided into two groups based on ideal and nonideal tunnel parameters as well as ideal and nonideal GIA. The various tunnel parameters and GIA were interpreted with clinical and radiological outcome at long-term follow-up. Results Eighty patients, 36 (45%) using BPTB and 44 (55%) using HT autografts, were available to complete the study. Patients with ideal coronal tibial tunnel angle (CTTA) and coronal femoral tunnel angle (CFTA) show superior clinical outcome (pivot shift test) than nonideal CTTA and CFTA, which was found to be statistically significant ( p -value < 0.038 and 0.024, respectively). Similarly, patients with ideal coronal tibial tunnel position (CTTP) show superior clinical outcome (International Knee Documentation Committee - IKDC objective) over nonideal CTTP ( p -value < 0.017). All other tunnel parameters and GIA were not found to have influence on clinical outcome. None of the tunnel parameters have influenced osteoarthritis (OA) change. There was no progression of OA change in the study population at long-term follow-up after ACLR. Conclusion Ideal coronal tunnel parameters produced a better clinical outcome at long-term follow-up after ACLR. There was no progression of OA change at long-term follow-up after isolated ACLR.

Current methods of perioperative analgesia for arthroscopic anterior cruciate ligament reconstruction: a literature review

Arthroscopic knee joint surgery is becoming routine in modern orthopedics. Its advantages include minimal invasiveness, lower infection risk, and early rehabilitation. Despite the minimized surgical trauma, the postoperative period after some arthroscopic operations involving cruciate ligament surgery occurs with relatively severe pain syndrome. This warrants the search for novel pain relief methods for patients that meet all modern trends. This review presents data from randomized clinical studies and meta-analyses on the use of various anesthesias in arthroscopic cruciate ligament repair and discusses methods of prolonged postoperative analgesia. The limited number of studies on this issue and lack of systematic recommendations require prospective studies.

The minimum effective concentration (MEC90) of bupivacaine for an ultrasound-guided suprainguinal fascia iliaca compartment block for analgesia in knee surgery: a dose-finding study.

In recent years, the suprainguinal fascia iliaca compartment block (SFICB) has become more common in clinical practice. This assessor-blinded dose-finding study aimed to determine the minimum effective concentration (MEC90, MEC95) of bupivacaine for a single-injection SFICB in patients undergoing arthroscopic anterior cruciate ligament repair. This prospective study was conducted at a tertiary hospital (postoperative recovery room and ward). The SFICB was performed as a postsurgical intervention after spinal anesthesia. Seventy patients were allocated using the biased-coin design up-and-down sequential method. The ultrasound-guided SFICB was performed using different bupivacaine concentrations, and standard multimodal analgesia was administered to all patients. Block success was defined as the absence of pain or presence of only tactile sensation during the pinprick test conducted on the anterior and lateral regions of the mid-thigh six hours postoperatively. According to isotonic regression and bootstrap CIs, the MEC90 value of bupivacaine for a successful SFICB was 0.123% (95% CI [0.098, 0.191]) and the MEC95 value was 0.188% (95% CI [0.113, 0.223]). Our study showed that the MEC90 and MEC95 values for bupivacaine administered via an SFICB for analgesia were 0.123% and 0.188%, respectively. One advantage of using lower concentrations of bupivacaine is the associated reduction in quadriceps weakness.

Incidence of Septic Arthritis After Vancomycin Soaking of the Graft During Arthroscopic Anatomic Anterior Talofibular Ligament and Calcaneofibular Ligament Reconstruction

Background: Vancomycin soaking of the graft during arthroscopic anterior cruciate ligament reconstruction has been shown to be effective in reducing the rate of postoperative infection. Purpose/Hypothesis: The present study aimed to (1) analyze the effect of vancomycin-soaked grafts during arthroscopic anatomic reconstruction of the anterior talofibular ligament (ATFL) and the calcaneofibular ligament (CFL) on the incidence of infection and (2) evaluate the influence of infection on functional outcomes and identify the risk factors of infection. It was hypothesized that vancomycin soaking of the graft would reduce the postoperative infection rate. Study Design: Cohort study; Level of evidence, 3. Methods: Consecutive patients at 2 centers who underwent ATFL/CFL reconstruction between December 2011 and July 2022 were included. All patients had undergone anterolateral arthroscopic debridement of the ankle and anatomic ATFL/CFL reconstruction with a gracilis tendon autograft. Vancomycin soaking of the graft was begun in both centers in January 2021. Complications, functional scores, return to sports (RTS) rates, and the level of return were compared between patients with and without vancomycin-soaked grafts and between patients with and without infection. Results: Overall, 182 patients (48% men; mean age, 34 ± 11.9 years) were included, with a mean follow-up of 23 ± 16.1 months. The rate of postoperative infection was significantly lower in the group with vancomycin soaking versus without (0/92 [0%] vs 8/90 [8.9%]; P = .001). At the final follow-up, there were 26 complications (14.3%): 8 infections, 6 recurrent tears, and 12 peripheral neuropathies. The infections developed after a mean of 17 ± 11 days. The functional scores were excellent at the final follow-up (American Orthopaedic Foot and Ankle Society [AOFAS] Ankle-Hindfoot Score, 86.5 ± 18.7; Karlsson score, 85 ± 18.3). Patients with infection had significantly decreased AOFAS scores (52.8 ± 27.6 vs 83.3 ± 21.5; P = .003), Karlsson scores (57 ± 27.7 vs 83.6 ± 20; P = .006), and RTS rates (25% vs 77%; P = .005) versus patients without infection. Conclusion: Vancomycin-soaked grafts for arthroscopic anatomic ATFL/CFL reconstruction decreased the rate of postoperative infection. Infection led to a deterioration in results. Vancomycin-soaking of the graft did not have a negative effect on functional results.

Epidural administration of ropivacaine and midazolam is superior to intra-articular administration as postoperative analgesia after isolated arthroscopic anterior cruciate ligament reconstruction with hamstrings autograft: a randomized controlled clinical trial

ObjectiveReconstructive surgery of the anterior cruciate ligament (ACL) is quite common, previous studies have documented that adequate pain control in the early phases of the postoperative period translates into early mobility and a rapid start of rehabilitation. Therefore, the search for new strategies for postoperative pain control is justified. The aim of this study was to compare intra-articular to the epidural administration of ropivacaine and midazolam as postoperative analgesia after arthroscopic ACL reconstruction with hamstring autograft (HA). Material and methodsDouble-blinded, prospective randomized clinical trial included 108 consecutive patients aged from 18 to 50 years that had undergone arthroscopic ACL reconstruction with HA. The patients were randomly assigned to 2 groups. The first group received intraarticular ropivacaine and midazolam. The second group received epidural ropivacaine and midazolam. The need for rescue analgesia, the postoperative pain experienced, side effects and complications of the analgesic drugs were evaluated. ResultsThe intra-articular group received statistically significantly higher mean doses of rescue analgesia on the first two days (2.8 ​± ​1.0 vs. 1.3 ​± ​0.6 in the epidural group; p ​= ​0.001). Visual Analogue Scale scores at flexion were statistically significantly higher in the intra-articular group over the entire study period. The intra-articular group also reported a statistically significantly lower range-of-motion 87 ​± ​15 vs. 102 ​± ​11 in the epidural group (p ​= ​0.001). ConclusionsEpidural administration of ropivacaine combined with midazolam in patients undergoing primary ACL reconstruction with HA was clinically and significantly better relative to rescue analgesia and the intensity of pain in the first 48 postoperative hours when compared to intraarticular administration. There was no difference in terms of adverse effects and complications. Level of evidence2.

Aspirin is as effective as low molecular weight heparins in preventing symptomatic venous thromboembolism following arthroscopic anterior cruciate ligament reconstruction

ObjectiveThe optimal agent for thromboprophylaxis following arthroscopic anterior cruciate ligament reconstruction (ACLR) remains unclear, particularly in patients with a low baseline risk for venous thromboembolism (VTE). This retrospective cohort study aims to compare the effectiveness and safety of aspirin versus low molecular weight heparins (LMWHs) in this specific patient population.MethodsWe analyzed data from patients who underwent ACLR between March 2016 and March 2021, focusing on those with a low risk for VTE. High-risk individuals, identified by factors such as cardiac disease, pulmonary disease, diabetes mellitus, previous VTE, inflammatory bowel disease, active cancer, and a BMI > 40, were excluded (n = 33). Our approach included a thorough review of medical charts, surgical reports, and pre-operative assessments, complemented by telephone follow-up conducted over a 3-month period by a single investigator. We assessed the incidence of symptomatic VTE, including deep vein thrombosis and pulmonary thromboembolism, as the primary outcome. The secondary outcomes included to complications related to the surgery and thromboprophylaxis. Statistical analysis included descriptive statistics, univariate logistic regression models, and calculations of incidence rates.ResultIn our study, 761 patients (761 knees) were included, with 458 (60.18%) receiving aspirin and 303 (39.82%) receiving LMWH. The two groups showed no significant differences in demographic factors except for age. The incidence of VTE was reported at 1.31% (10 individuals). Specifically, five patients in the aspirin group (1.09%) and five patients in the LMWH group (1.65%) developed a symptomatic VTE event (p = 0.53). Additionally, the two groups did not significantly differ in terms of other complications, such as hemarthrosis or surgical site infection (p > 0.05). Logistic regression analysis revealed no statistically significant difference in VTE risk between the two groups.ConclusionThis study, focusing on isolated ACLR in patients with a low baseline risk for venous thromboembolism, demonstrated that aspirin is equally effective as low molecular weight heparins for VTE prophylaxis following this surgery.Level of EvidenceIII

Femoral-Obturator-Sciatic (FOS) Nerve Block as an Anesthetic Triad for Arthroscopic ACL Reconstruction: Is This the Magic Trick We Were Missing?

Arthroscopic anterior cruciate ligament (ACL) reconstruction with hamstring grafting is a common orthopedic procedure that is associated with moderate-to-severe pain. Peripheral nerve blockade as an anesthetic technique is an appealing option in the era of modern anesthesia. The aim of this narrative review is to document the efficacy and safety of the combination of femoral, obturator, and sciatic (FOS) nerve blocks as an exclusive method for anesthesia in patients undergoing ACL reconstruction. An electronic search of the literature published up to October 2023 was conducted in the Medline, Embase, Cochrane, Web of Science, and Google Scholar databases to find studies on ACL reconstruction and peripheral obturator nerve block. Overall, 8 prospective studies-with a total of 315 patients-published between 2007 and 2022 were included in this review. Ultrasound-guided peripheral FOS nerve blockade is an effective anesthetic technique for ACL reconstruction, offering good perioperative pain management, minimal opioid consumption, and an excellent safety profile. Further well-designed prospective studies are needed to determine the best approach for obturator nerve blockade and the appropriate type and dosage of local anesthetic.

Arthroscopic Anterior Cruciate Ligament Reconstruction Learning Curve: Analysis of Operating Time and Clinical Outcomes.

Technical proficiency for arthroscopic anterior cruciate ligament reconstruction (ACLR) is complex and requires learning and practice. Achieving an appropriate level of competency with this surgery is important for patient safety and satisfactory surgical outcomes. There is limited literature about the learning curve in ACLR in Africa. This study aimed to demonstrate the learning curve associated with ACLR. This retrospective study on arthroscopic ACLR was conducted between January 2020 and June 2023 with a minimum of 12 months follow-up. The primary outcome measure was operation time, whereas the secondary outcome measures were functional outcome and postoperative complications. One hundred fifty-nine ACLR met the inclusion criteria and were analysed. The mean age of the patients was 31.47 ± 9.50 years. There were 148 (93.1%) males and 11 (6.9%) females. The median operation time was 50 min (45-190 min). There was progressively decreasing operation time with increasing number of cases done until after the first 19 cases. The mean operating time for the first 19 cases was 143.89 ± 32.84 min, whereas the mean operating time for the later 140 cases was 53.81 ± 9.72 min (P = 0.000). The operation time for arthroscopic ACLR progressively decreased until after the first 19 cases. There was, however, no significant difference in the clinical outcome between the cases done during the learning curve and those done at proficiency.

OUTCOME OF TREATMENT FOLLOWING PRIMARY ARTHROSCOPIC REPAIR OF BUCKET HANDLE MENISCUS TEARS IN ADULTS

AimsWe studied the outcomes following arthroscopic primary repair of bucket handle meniscus tears to determine the incidence of re-tears and the functional outcomes of these patients.MethodologyProspective cohort study. Over a 4-year period (2016 to 2020), 35 adult patients presented with a bucket handle tear of the meniscus. Arthroscopic meniscal repair was performed using either the all inside technique or a combination of all-inside and inside-out techniques. 15 patients also underwent simultaneous arthroscopic anterior cruciate ligament reconstruction. Functional knee scores were assessed using IKDC and Lysholm scores.ResultsMean patient age at surgery was 27 years (range, 17 to 53years). Medial meniscus was torn in 20 and lateral in 15 cases. Zone of tear was white on white in 19, red on white in 9 and red on red in 7 cases. Average delay from injury to surgery was 4 months. At a mean follow-up of 4.5 years, the meniscus repair failed in 3 patients (8.5 %). Outcome following re-tear was meniscus excision. Average IKDC scores in patients with intact repair were 74.04 against 56.67 in patients with a failed repair (p&lt; 0.0001). Similarly, Lyshlom scores were 88.96 and 67.333, respectively (p&lt;0.0001).ConclusionThe survivorship of primary repair of bucket handle meniscus tears in our series was 91.5% at medium term follow-up. Functional outcomes were significantly poor in patients with a failed repair compared to those with an intact repair.

Is fixation with a U-shaped staple necessary in anterior cruciate ligament reconstruction?

Aims: This study aimed to compare the clinical and functional outcomes of patients who underwent anterior cruciate ligament reconstruction using a quadruple hamstring autograft with and without U-shaped staple fixation and tibial tunnel BioScrew fixation. Methods: Patients who underwent arthroscopic anterior cruciate ligament (ACL) reconstruction by a single surgeon between August 2020 and June 2022 were retrospectively analyzed. The time to return to sports after surgery and the evaluation of preoperative and postoperative Lysholm Knee scores, International Knee Documentation Committee (IKDC) scores, VAS scores, and thigh diameters, were conducted. Statistical analysis of the study data was performed using SPSS 29.0 (IBM InCorp, USA). Results: A total of 100 patients (77% male) who underwent arthroscopic ACL reconstruction were included in the analysis. There was no significant difference in Lysholm knee scores and IKDC scores between patients undergoing fixation with or without staples. However, VAS scores were significantly lower in the non staple group. Conclusion: The present study found that fixation with a staple in addition to tibial BioScrew fixation of the autograft in the tibial tunnel resulted in more pain in the patients, and there was no significant difference in clinical and functional outcomes between the staple and non staple groups.

Short-term results of combined anterior cruciate ligament and anterolateral ligament reconstruction using a novel hamstrings graft construct in obese patients: a pilot study

Abstract Background Elevated body mass index (BMI) was associated with increased complication rates including failures in arthroscopic anterior cruciate ligament (ACL) reconstruction surgery. We present our short-term results of our technique used for ACL reconstruction in obese patients with the aim to reduce chances for graft failure and improve outcomes. Patients and methods We present our case series of obese patients (BMI &gt; 30) operated for ACL reconstruction during the period from January 2017 to January 2022 using a dedicated technique for ACL reconstruction. We are using hamstring tendons prepared in a single construct to reconstruct both the intra-articular ACL and the anterolateral ligament. All patients received the same surgical technique and associated injuries were operated on according to their indications and guidelines. All patients completed the subjective knee evaluation form of the International Knee Documentation Committee at the time of the procedure and at the last follow-up visit and assessment of knee laxity was performed using a KT-1000 arthrometer before the surgery and at the last follow-up. Results Twenty patients underwent anterior cruciate ligament reconstruction (ACLR) using this technique during the study period, with average follow-up period of 1 year. All cases were males, mean BMI was 32.2 (30.4–36.2), 18 cases were operated on using ipsilateral Semitendinosus and Gracilis grafts, 2 cases were operated on using contralateral knee hamstrings. All cases were instructed nonweight bearing for 6 weeks after surgery and received the same standard accelerated rehabilitation protocol. Two cases developed postoperative superficial wound infection at the graft harvest site that resolved with conservative treatment of oral antibiotics and wound care. The mean postoperative International Knee Documentation Committee score improved from 45.195 to 79.245 (P&lt;0.001), and the mean KT-1000 arthrometer differential improved from 11.8 to 2.77 (P&lt;0.001) and pivot shift tests were negative in the postoperative exam for all the cases. Conclusion ACLR in obese patients should be approached with care, our technique can offer a feasible solution to obtain an acceptable outcome, Further work is required to provide insight on the long-term outcome of ACLR in obese patients.

A Long-term Comparison of Outcome of Arthroscopic Anterior Cruciate Ligament Reconstruction Using Bioabsorbable Interference Screw and Endobutton on Femur.

Arthroscopic anterior cruciate ligament (ACL) reconstruction is a very commonly done procedure in recent times. There is a need for a long-term outcome study of ACL reconstruction with a comparison between different types of fixation techniques. The graft fixation methods vary from aperture fixation (interference screws) to suspensory fixation methods (endobutton). Failure of graft incorporation and the development of tunnel widening (TW) after ACL reconstruction have been frequently reported in the long term in present literature. TW especially complicates revision ACL surgery. This is a prospective non-randomized clinical study of arthroscopic ACL reconstruction comparing the functional results between aperture fixation and suspensory fixation. Two groups of 14 patients who underwent autogenous hamstring ACL reconstruction with a minimum of 2-year follow-up evaluation were included in the study. The first group underwent aperture fixation with bioabsorbable interference screw at tibial and femoral side. The second group underwent suspensory fixation with endobutton fixation on the femoral side and biointerference screw on the tibial side. Both group patients were examined clinically before surgery, and at 3 months, 6 months, 1 year, and at 2 years. They were compared for functional outcome with Tegner Lysholm knee score. There was a significant improvement in functional outcome in both the groups for base and at 3 months, also for 3 months and 6 months but for 6 months-1 year. Group 2 is almost significant. This improvement in outcome in Group 2 is consistent from 1 year to 2 years. In our prospective study comparing the outcomes of functional outcomes of ACL reconstruction with aperture fixation versus suspensory fixation on the femur, which was evaluated using Tegner Lysholm knee score over a period of 2 years, suspensory fixation was found to be better. However, further studies involving a larger series of cases are required for a better evaluation of the outcome.

Outcome of home-based rehabilitation program following arthroscopic anterior cruciate ligament reconstruction in nonathletic patient

Abstract Background: Rehabilitation following anterior cruciate ligament (ACL) reconstruction is thought to be important by almost all surgeons. It has even been considered by some to be as important as surgery itself. As the surgical procedure for these injuries evolved, so has the rehabilitation. A traditional approach to rehabilitation which focused on delayed weight bearing and mobilization is now being replaced by accelerated rehabilitation which advocates early weight bearing and results in early return to sports. Materials and Methods: This is a observational case-control comparative study conducted in our department from September 2019 to February 2021. About 30 cases of more than 20 years of age with comparable matching group are included in our study. Assessment of Lysholm score, International Knee Documentation Committee (IKDC) score, ACL quality of life score, and Tegner activity level is done. Functional assessment was carried out by Carioca test, one leg hop test, and Shuttle test. Assessment of clinical status is done by anterior drawer test, Lachman test, and Pivot shift test. Results: All patients participating in study although nonathletic had complaints of instability and giving away episodes of knee in their day to day activities and therefore were considered as candidates for surgery. Following an arthroscopic ACL reconstruction, they were given written home-based protocols with goals and exercises being explained to them at the time of discharge. All the patients participating in the study were able to return to their preinjury activity level as assessed by the Tegner activity scale at the final follow up. Their functional outcome as measured by Lysholm score, IKDC score, and ACL quality of life score was significantly lower when compared to an age, sex, and activity matched control group. The patients functional performance as assessed by one leg hop test, Carioca test, and Shuttle test was also below the level of what was seen in control groups. More than 90% patients had a stable knee as assessed by the anterior drawer test, Lachman test and pivot shift test (29 patients has anterior drawer of ≤5 mm, 27 patients had Lachmann test ≤5 mm and all 30 patients had pivot shift grades in absent or glide category). Conclusions: Home-based rehabilitation is an effective method of rehabilitation in low demand individuals following ACL reconstruction. In the future, adequately powered randomized controlled trials are needed to assess the usefulness of one rehabilitation protocol over other in these group of low demand patients.

Correlation of Anthropometric Measurements with Hamstring Graft Size in Anterior Cruciate Ligament Reconstruction in Nepalese Population: A Prospective Observational Study

Background: The use of autologous hamstring tendon for arthroscopic Anterior Cruciate ligament (ACL) reconstruction is very common. The size of hamstring tendons varies significantly between individuals, and graft diameter is unpredictable. Anthropometric measurements may be a simple way to estimate hamstring tendon length and diameter. This study aims to determine the correlation between anthropometric measurements of patients with length and diameter of harvested hamstring autograft during ACL reconstruction.Methods: A prospective observational study was carried out after ethical approval. All patients who underwent arthroscopic ACL reconstruction from 1 March 2022 to 30 April 2023 in Birat Medical College Teaching Hospital were included. Fourty seven patients’ age, sex, height, weight and thigh length were recorded preoperatively. Hamstring tendons were harvested and length of the semitendinosus tendon and diameter of the quadrupled graft (doubled semitendinosus and doubled gracilis) was measured intraoperatively. We used Pearson’s correlation coefficient to observe the relationship between anthropometric measurements and graft variables.Results: Mean length of harvested semitendinosus tendon was 27.4 ± 1.8 cm and mean quadrupled hamstring autograft diameter was 7.4 ± 0.8 mm. A significant positive correlation between graft variables (semitendinosus tendon length and quadrupled hamstring autograft diameter) and patients’ height and thigh length was found.Regression equations for predicting Semitendinosus tendon length and quadrupled hamstring autograft diameter from thigh length in males and females are also derived.Conclusion: Height and thigh length of patients are useful parameters for predicting semitendinosus tendon length and quadrupled hamstring graft diameter before ACL reconstruction.

Semitendinosus Tendon Autograft Length and its Correlation with Anthropometric Measurements in Patients Undergoing Arthroscopic Anterior Cruciate Ligament Reconstruction using Hamstring Tendon Autograft in a Tertiary Care Centr

Introduction: There is limited data available regarding semitendinosus tendon length and its correlation with anthropometric parameters in Nepalese population. This study aims to find out mean semitendinosus tendon length in patients undergoing arthroscopic anterior cruciate ligament reconstruction and its correlation with patient’s height, femur length, and thigh girth. Methodology: An observational study was conducted following institutional review committee (IRC) approval (reference number: B&amp;BIRC-23-04). All Patients undergoing arthroscopic anterior cruciate ligament reconstruction using hamstring tendon autograft between January 1, 2021, and December 31, 2022, were included. Those who had premature rupture of semitendinosus tendon during graft harvest were excluded. Semitendinosus tendon autograft was harvested, and length was measured. Then, triplicated graft diameter was measured. If harvested gracillis, quadrupled or pentapled, combined semitendinosus and gracilis tendon autograft diameter was measured. Pearson’s correlation coefficient was used to evaluate correlation and student t test was used to test the significance. Results: Out of 102 included patients, 87(85.3%) were male and 15(14.7%) were female. Mean age of the patients was 30.5 ± 8.4 years. Semitendinosus tendon alone autograft was used in 26(25.5%) cases. and combined semitendinosus and gracillis tendon was used in 76(74.5%) cases. Mean semitendinosus tendon autograft length was 27.9±2.8 cm. There was significant positive correlation between semitendinosus tendon autograft length and patients’ height (r= 0.594, p=.000) and femur length (r=0.528, p=.000). Conclusion: Mean semitendinosus tendon autograft length in patients undergoing arthroscopic anterior cruciate ligament reconstruction is comparable to what reported in other international studies. Semitendinosus tendon length is significantly positively correlated with patients’ height and femur length.