The Anterior Cruciate ligament (ACL) is the primary stabilizer of the knee and prevents the knee against anterior translation. It is also important in counteracting rotational and valgus stress. Anterior Cruciate Ligament (ACL) reconstruction is an established and widely practiced surgical procedure with proven efficacy and a low morbidity profile. The arthroscopically aided approach has the advantages of smaller skin and capsular incisions, improved viewing of the intercondylar notch for placement of the tunnel and attachment sites, less postoperative pain, fewer adhesions, earlier motion, and easier rehabilitation. The advantages with semitendinosus grafts are availability of a greater sectional area and unaffected integrity of the extensor mechanism. Moreover tensile strength of quadrupled hamstring is found to be even better than a normal ACL. The rate of complications like extension loss, anterior knee pain and surgical site infections was also lower than other procedures like in BPTB grafts. Cortical suspension devices have the necessary biomechanical properties with regard to ultimate failure strength, displacement, and stiffness for initial fixation of soft tissue in the femoral tunnel for ACL reconstruction. The aperture fixation methods like the interference screws allows for early firm fixation and heal with tight bone-tendon interface.
Objectives: To evaluate functional outcome of arthroscopy assisted ACL reconstruction with quadrupled semitendinosus tendon graft using Endobutton and Bioabsorbable interference screw.
Methodology: The study results included 120 patients (serving soldiers) admitted with clinical and radiological deficiency of ACL during march 2015 to march 2018, in Department of Orthopaedics, Armed Forces Medical College, Pune. Study aims to assess the functional outcome of arthroscopy assisted anterior cruciate ligament reconstruction with quadrupled semitendinosus tendon graft using Endobutton and Bioabsorbable interference screw in terms of range of motion, postoperative knee stability, graft site morbidity, subjective knee functions and prospective assessment of functional outcome using Tegner Lysholm knee scoring system.
Results: All the patients included in the study were serving male soldiers. The analysis of the studied cases revealed that the most common affected age group was between 18 to 24 years (n=41, 34.2%) and the mean age was 30.53 ± 7.24 years. Majority of patients (n=76, 64.4%) were operated more than 6 months after injury. Sports/BPET (Battle Physical Efficiency Test) injuries was the most common mode of injury (n=79, 65.8%). The mean size of graft used was 8.2±0.39.Post-operatively at 02 year follow up, 08 case (6.7%) had a positive Pivot shift test with a "Glide" (Grade-I), whereas remaining 112 cases (93.3%) had a negative Pivot shift test. None of the patients had grade III laxity. The mean postoperative rolimeter measurement at 02 year follow up was 3.86±1.06 SD. The mean postoperative Lysholm score improved from pre-operative score of 66±5.2 to 88.70±5.54. The overall satisfactory result (excellent + good) at 02 year follow up was 95%. Out of this, 111(92.5) patients had returned to preinjury level of activity i.e., military training activity. In this study, 9 patients had Superficial Infection, 6 patients had Joint effusion in immediate post operative period, 9 patients had knee pain, 7 patients had sense of giving away during exertional activities and 19 patients had Thigh muscle wasting (2-3cm)
Conclusion: ACL injuries are common in younger age group individuals. Sports related injury and RTA are the most common modes of injury. Arthroscopy assisted ACL reconstruction using Semitendinosus tendon autograft provides a stable knee, reduces postoperative morbidity and enables early rehabilitation. Graft fixation using endobutton and and Bioabsorbable interference screw will help the graft to facilitate graft tunnel healing and also maintain its strength until there is a good graft to bone healing occurs. It allows the patients to return to preinjury level of activity, allows the patient to squat, sit crossed leg and climb stairs without difficulty. Degeneration of the articular surfaces rarely occurs and the re-operation rates are minimal.