Comparison of therapeutic results of open and arthroscopic surgery on functional level, duration of return to daily activity and satisfaction with treatment in patients with acl rupture

Abstract

Bone-Patellar Tendon-Bone autograft (BPTB) and four-strand semitendinosus-gracilis (hamstring) graft are the most common methods used for reconstructing anterior cruciate ligament (ACL) but there is still controversy over the best method. This study aimed to compare the therapeutic outcomes of two methods of BPTB and hamstring grafts using arthroscopic treatment in patients with ACL rupture. This was a retrospective study conducted on 85 patients with ACL rupture (age range: 17-45 years old) who referred to Imam Khomeini Hospital, Ahvaz, Iran between 2016 and 2017. The patients underwent ACL reconstruction surgery, either by bone-patellar tendon-bone autograft (BPTB) (open surgery) (n=23) or four-strand hamstring auto graft (semitendinosus-gracilis) (by arthroscopy) (n=25). Lysholm score was used for knee functional status assessment, Lachman test for tendon laxity, and pivot shift test for strength evaluation. The 36-Item Short-Form Health Survey questionnaire (SF-36) was also completed and compared at the last follow-up. Patients were evaluated by type of daily heavy or light activities. Two groups showed no signifiicant difference in the Lysholm score (P>0.05) and both groups were classifiied as “Good”. There was no signifiicant difference between the frequency distribution of patients based on the Lachman test and pivot shift scores (P>0.05). None of the patients in the two groups had any rupture within two years after treatment. Both groups had good satisfaction with treatment and quality of life and there was no statistically signifiicant difference between the mean SF-36 scores (P>0.05). Although complication in short-term follow-up was more in patients undergoing open surgery, the functional level and treatment satisfaction in patients treated by open surgery and arthroscopy were not signifiicantly different after two years.