Correlation between radiological and clinical findings after anterior cruciate ligament reconstruction

Abstract

INTRODUCTION: In the last two decades, the gold standard for anterior cruciate ligament reconstruction is the bone-patellar tendon-bone graft procedure. Correct position of the bone-patellar tendon-bone graft significantly affects the postoperative knee stability. The aim of this study was to establish if and how clinically measured knee stability is associated with radiographic position of bone-patellar tendon-bone graft in the femoral and tibial bones. MATERIAL AND METHODS: The prospective study included 39 patients, 30 men and 9 women. We analyzed and compared results of clinical and radiographic examinations prior to and 2 years following surgery. RESULTS: The mean arthrometric difference between the anterior tibial movement prior to surgery was 11.2 mm and 2.4 mm (p < 0.05) after surgery. The preoperative Tegner and Lysholm score was 1.49, and postoperative 8.23 (p < 0.05). The preoperative Lysholm-Gillquist scale was 51.56 and postoperative 97.74 (p < 0.05). The International Knee Documentation Committee (IKDC) scores were as follows: grade A in 32 patients (84.6%), grade B in 5 patients (12.8%), and grade C in 1 patient (2.6%). By comparison of IKDC scores and radiographic parameters (M1-M10) of anterior-posterior and profile views, a statistical significance was found only between IKDC and M9 index (sagittal femoral index OR'/RR' x 100). DISCUSSION: By using bone-patellar tendon-bone grafts, it is not possible to entirely achieve anatomical positions. Correct graft position within the bone tunnels is of great significance concerning knee stability after anterior cruciate ligament reconstruction. CONCLUSION: Correlation between radiological and clinical findings after anterior cruciate ligament reconstruction in our 39 patients shows that only the position of the graft affects the clinical outcome. Posterior graft location provides better clinical outcome and knee stability. On the other hand, anterior location is associated with worse postoperative IKDC scores, unstable knee and worse clinical outcome.