New Anterior Cruciate Ligament Reconstrucion Using Harmstring Tendon Grafts - Clinical Part

Abstract

PURPOSE OF THE STUDY The authors present the clinical use of the new instrumentation set for the anterior cruciate ligament (ACL) reconstruction using the hamstring tendons (HS). The positionning of the femoral tunnel and the fixation of the graft play an important role for the results of the surgery. The aim of the study was to confirm the proposed surgical technique and the methods of the graft fixation, especially from the point of view of the clinical midterm results at the evaluation up to eight years after the surgery. MATERIAL AND METHODS The clinical evaluation comprises 58 patients operated from 2007 to 2014 using the new instrumentation set. There were 9 men and 49 women included in the sample. The mean age was 34.6 years (range 18 - 58 yrs), namely 36.7 in women and 32.4 years in men.The evaluation was performed pre-opeatively and at 3 and 6 months, 1, 3, 5 and 8 years post-operatively. All the patients were followed based on the same criteria - clinical range of motion (ROM), stability of the knee - instrumentation Lachman test utilizing Rolimeter, subjective IKDC score and pain VAS scale for the harvesting site. The ocurrence and the rate of post-operative complications were monitored. RESULTS The integration and the ingrowth of the graft were achieved in all cases, the full ROM was gained as well, no pathological instability was observed. The fixation of the HS graft in the bone was confirmed by post-op X ray at 3 months after the surgery. The clinical evaluation showed the following mean differences in the pre-op and final post-op findings. The average pre-operative laxity using the Lachmann test was 9.7 mm (range 6 - 12 mm), at 3 months 1.8 mm (1.4 - 2.1 mm), at 6 months 1.6 mm (1.2 - 2.2 mm), at 1 year 1.6 mm (1.1 - 2.3 mm), at 3 years the stability was 1.7 mm (1.2 mm - 2.4 mm), at 5 years 2.3 mm (1.2 - 3.6 mm) and at 8 years after surgery it was 2.5 mm (1.2 - 3.9 mm). None of the patitents included in the study showed pathological instability that would be considered an indication for revision. In the evaluation of the subjective IKDC score, the pre-operative average was 56, with the range of 42 - 66, at 3 months post-operatively 79 (69 - 85), at 6 months 88 (74 - 92), at 1 year 95 (88 - 100), at 3 years 96 (89 - 100), at 5 years 94 (87 - 100), and at 8 years 92 (84 - 98). No severe complications were observed. CONCLUSIONS The method provided sufficient post-operative stability of the knee joint. Fixation of the femoral screw satisfied the demands laid on it. Regarding the pain perception, the method was considered positive, the level of pain involved in the procedure was low. No severe complications or technical mistakes occurred during the surgical procedures. The new instrumentation set developed for the ACL reconstruction offers an easy technique and comfortof use.