In contrast to old time in today’s world of competitive sports and vehicular accidents twisting injuries to knee joints causing ligament and meniscal tears are a common occurrence. Being a prime stabilizer of the knee joint anterior cruciate ligament is truly “crucial” for normal functioning and stability of knee. It is responsible for prevention of forward displacement of tibia on the femur as well as prevention of hyperextension and excessive internal rotation of tibia. Additionally it acts as restraint on valgus and varus stress in all degrees of flexion and fine-tunes the screw home motion as the tibia approaches terminal extension. Rupture of ACL, unless properly reconstructed, can have catastrophic consequences for knee stability. The methods of reconstruction of a ruptured ACL include intra-articular reconstruction, extra-articular reconstruction and combined intra-articular and extra-articular reconstruction. With advances in arthroscopy intra-articular reconstruction is fast becoming procedure of choice due to less morbidity and prospect of an early mobilization. Recent studies have shown that four stranded semitendinosus tendon graft have similar strength and stiffness characteristics as that of normal anterior cruciate ligament. We conducted this study to evaluate the result of arthroscopic reconstruction of anterior cruciate ligament with quadrupled semitendinosus autograft and complications associated with this procedure.
Materials and Methods: After obtaining approval from institutional ethical committee we conducted a prospective study of 30 patients who had been admitted to our institute with pain, limp and instability due to anterior cruciate ligament rupture. Patients were enrolled on the basis of pre-defined inclusion criteria and any patient having any exclusion criteria was excluded from the study. X-Ray and MRI (if required) were done. Detailed history, thorough clinical examination and baseline investigations were done. All patients underwent ACL reconstruction by semitendinosus autograft. The outcome of arthroscopic reconstruction with quadrupled semitendinosus autograft and complications associated with this procedure were studied. The data was tabulated and analyzed using SPSS 16.0 version software.
Results: This study consisted of 30 patients having been diagnosed with anterior cruciate ligament rupture. There were 27 men and 3 women with a M: F ratio of 1: 0.11. The most common age group involved was 31-35 years (30%) followed by 20-25 years (26.67%) and 26-30 years (16.67%). Road traffic accidents (46.67%) and Sports injuries (43.33%) were the predominant causes of ACL rupture. Most patients (26.67%) presented within 6 months of injury. Associated meniscal injuries were seen in 11 (36.67%) patients and medial meniscus (20%) was found to be involved more commonly than lateral meniscus (16.67%). Majority of the patients received 9 mm graft (60%). Most of the patients were discharged from hospital within 1 week (53.33%) while 9 patients (30%) needed to be kept in hospital for up to 2 weeks. Only 5 patients (16.67%) required hospitalization beyond 2 weeks. Pre-operative Tenger- Lysholm score was poor in majority of the patients (73.33%). Post-operatively at the time of 6 months follow up majority of the patients (66.67%) had an excellent Tenger-Lysholm score. No major complications were encountered in any of our patients. Minor complication like wound infection at the graft site (2/30), wound edge necrosis (2/30), foot drop (1/30), chemical burn under the tourniquet (1/30) and synovitis (1/30) were seen in some patients. All these complication resolved with proper management and no residual complications were seen in any of the patients.
Conclusion: Arthroscopic reconstruction of ruptured anterior cruciate ligament by quadrupled semitendinosus autograft is associated with good functional results and excellent outcome. Minor complications associated with the procedure can be taken care of by appropriate management.