Estrada-Cruz K, Pérez-Meave JA

Language: Spanish
References: 7
Page: 157-162
PDF size: 178.16 Kb.

ABSTRACT

Background: Reconstruction of the anterior cruciate ligament (ACL) aims to restore the original anatomy. The clinical outcome could be imperfect when graft placement is not in an anatomical position; moreover, the conventional transtibial reconstruction of the ACL often locates the graft away from the anatomical site, leading to abnormal biomechanical behavior and kinematics of the knee. The objective of this work was to assess the importance of the angular reconstruction of the anterior cruciate ligament during arthroscopic replacement and to compare the postoperative functional results. Material and methods: We studied 21 patients to whom the IKDC 2000 form of objective and subjective evaluation was applied; radiographic evaluation in anteroposterior and lateral bending at 30^o. We made an statistical analysis with Pearson P, correlating the anteroposterior and lateral angulation of the graft direction and the subjective projection of the operated knee function, as well as age and time of evolution with the operated knee. Results: We included 21 patients of 18 to 56 years of age; follow-up: one to three years. Objective evaluation: 95.24% normal and 4.76% almost normal. Subjective assessment: average 84.31% (range 70.93 to 97.99%), CI 95%. AP angle: 68.8^o, range: 62^o to 77^o. Average sagittal angle: 64.9^o, range: 58^o to 75^o. Correlations: AP angle and subjective function -0.19, angle in sagittal and subjective function -0.54, age and subjective function -0.77, duration and subjective function -0.74. Function average: 84.31%. Discussion: The anatomical angular reconstruction of the ACL graft is key to the stability of the knee; the evaluated patients got a more similar direction to that of the native ACL, better stability and knee function.

REFERENCES

1. Zelle BA, Herzka AS, Harner CD, Irrgang JJ. Evaluation of clinical outcomes in anterior cruciate ligament surgery. Oper Tech Orthop. 2005; 15(1): 76-84.

2. Irrgang JJ, Ho H, Harner CD, Fu FH. Use of the International Knee Documentation Committee guidelines to assess outcome following anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 1998; 6(2): 107-14.

3. Zantop T, Petersen W, Sekiya JK, Musahl V, Fu FH. Anterior cruciate ligament anatomy and function relating to anatomical reconstruction. Knee Surg Sports Traumatol Arthrosc. 2006; 14(10): 982-92.

4. Hashemi J, Chandrashekar N, Mansouri H, Slauterbeck JR, Hardy DM. The human anterior cruciate ligament: sex differences in ultrastructure and correlation with biomechanical properties. J Orthop Res. 2008; 26(7): 945-50.

5. Bernard M, Hertel P, Hornung H, Cierpinski T. Femoral insertion of the ACL. Radiographic quadrant method. Am J Knee Surg. 1997; 10(1): 14-21.

6. Dienst M, Burks RT, Greis PE. Anatomy and biomechanics of the anterior cruciate ligament. Orthop Clin North Am. 2002; 33(4): 605-20, v.

7. Andersson C, Odensten M, Good L, Gillquist J. Surgical or non-surgical treatment of acute rupture of the anterior cruciate ligament. A randomized study with long-term follow-up. J Bone Joint Surg Am. 1989; 71(7): 965-74.