Transportal single bundle ACL reconstruction with quadruple hamstring graft using suspensory femoral and hybrid tibial fixation: A prospective study

Design: Prospective Study Design.

Methods: Patients admitted to the department of Orthopaedics, Bhagat Phool Singh Government medical college, Khanpur Kalan, Sonipat and fulfilling the inclusion criteria of age group 20-45 years without pre-existing arthritis and clinical and radiological evidence of anterior cruciate ligament tear were included in the study who were followed upto six months. Preoperatively Lysholm score and IKDC score was evaluated of each patient and post operatively Lysholm score and IKDC score were calculated at 2 weeks, 8 weeks, 12 weeks and 24 weeks.

Results and conclusion: All patients were taken for single bundle ACL reconstruction using suspensory femoral and hybrid tibial fixation. The Lysholm and Knee Scoring Scale consists of eight parameters for evaluation. The individual parameters were allotted specific scores depending on the patient’s functional ability. The maximum possible knee score was 100. Based on the outcome scores they were divided into Excellent, Good, Fair and Poor. The Subjective IKDC scale was evaluated by summing the scores for the individual items and then transforming the score to a scale that ranges from 0 to 100. The patients were followed up in OPD and their functional outcomes were measured by Lysholm scoring and IKDC scoring at 2 weeks, 8 weeks, 12 weeks, 24 weeks. There were 20 (83.3%) male patients and 4 (16.7%) female patients. The right side was more commonly injured (54.2%) than the left side (45.8%). The most common mode of injury in our study was Road Traffic Accidents (58.3%) followed by sports (20.8%). Most of the patients (41.7%) presented 4 to 6 months after injury. The most common symptom at presentation was knee pain (37.5%) followed by instability (29.2%). Both knee pain and instability were present in 16.7% of patients. There was associated meniscal injury in 75.0% of patients. The most commonly injured was medial meniscus (50%) followed by injury to both medial and lateral menisci (16.7%). Isolated ACL tear was present in 25% of the patients. In our study, 83.3% had excellent functional outcome while 16.7% patients had good outcome on the basis of Lysholm Scoring. In our study the mean pre-operative IKDC score was 55.60 whereas the post-operative score after 24 weeks was 86.13. There was significant improvement in post-operative IKDC score when compared with preoperative score. In young active adults, anatomic single bundle reconstruction with quadrupled hamstring graft gives good functional results. Endobutton on the femoral side and Bioabsorbable interference screw and suture disc on the tibial end is a good mechanical and strong suspensory type of fixation device for ACL reconstruction. This technique offers an excellent knee function, knee stability and restoration of preoperative functional status with minimal complication. The patients undergoing hybrid method of fixation return to preinjury level of activity early.