Elsevier

The Knee

Volume 10, Issue 4, December 2003, Pages 329-333
The Knee

Medium term follow up of endoscopically assisted BPTB ACL reconstruction using a two-incision technique –: Return to sporting activity

https://doi.org/10.1016/S0968-0160(02)00077-7Get rights and content

Abstract

We report our findings of a prospective outcome study of a series of 50 patients with chronic ACL injury undergoing arthroscopically assisted bone–patellar–tendon–bone ACL reconstruction. Patients underwent reconstruction if they had instability precluding participation in sport at the desired level and were reviewed at a mean of 62 months. Clinical examination was carried out pre and post operatively. Assessment was augmented by KT 1000 measurement, Tegner activity score and Lysholm score. Surgery was considered a failure if the Pivot Shift test was 2+(jerk) or symptoms of instability persisted. By these criteria 48 patients were successfully treated. Our results show a good medium term outcome for this reconstructive method. We had a 94% return to sporting activity but at a lower than expected activity level. Clinical examination showed an improvement and we recorded excellent or good results on Lysholm score in all these patients.

Introduction

The ACL is a major stabiliser of the knee joint and is most commonly injured during sporting activity. The evolution of reconstruction of the ACL deficient knee has taken a fascinating course over the last 30 years [1], [2]. This has encompassed variations in graft materials [3], [4], [5], operative techniques (including open and semi-open arthroscopically assisted and fully arthroscopic techniques) [6], [7], graft fixation methods and rehabilitation protocols [8], [9], [10]. The rationale for ACL reconstruction has included the relief of knee instability, while maintaining full movement and prevention of meniscal damage [11]. There have been many papers that show the short-term effectiveness of the reconstruction procedure [12], [13], [14], [15]. There have been several retrospective [7], [16], [17], [18], [19] but far fewer prospective medium and long-term studies [20], [21]. The aim of this study is to evaluate the outcomes and return to sport following ACL reconstruction by a two-incision technique using bone–patellar–tendon–bone autograft.

Section snippets

Patients and methods

This was a prospective study of chronic (>12 weeks) ACL injuries treated by reconstruction. Seventy-nine consecutive patients with chronic ACL injuries were treated between June 1989 and May 1994 at the Homerton Hospital and the Wellington Hospital. Patients underwent reconstruction if they had instability precluding participation in sport at the desired level or in normal daily activity. Patients who had undergone acute, sub-acute or revision surgery were excluded. All patients had

Results

There were 79 consecutive chronic ACL knee injuries. Of these patients, 16 (20%) were lost to follow-up and 13 (16%) were traced but unavailable for clinical review. Follow up was at a mean of 62 months (range 48–95 months). Our clinical review group consisted of 18 female and 32 male with a mean age at operation of 30 years (range 17–51). Two patients had suffered injury at work and home, whilst the remainder had suffered their injuries through sporting activity. There were 22 left and 28

Discussion

This paper reports our experience in the reconstruction of the chronic ACL injury using a standard two-incision technique. The current literature is full of papers exploring the details of surgical technique, including operative procedure and graft materials, often as comparison studies. Unfortunately, there is a wide spectrum of variables (graft, surgical technique, rehabilitation, follow-up) in each paper, which makes direct comparison of outcomes difficult. In those with medium to long-term

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