Anterior cruciate ligament reconstruction with bone-patellar tendon bone graft by hour-glass technique | ||
| The Egyptian Orthopaedic Journal | ||
| Volume 53, Issue 3, July 2018, Pages 266-273 PDF (3.33 M) | ||
| DOI: 10.4103/eoj.eoj_59_18 | ||
| Author | ||
| Tarek Abdel Aziz Mahmoud | ||
| Abstract | ||
| Background Torn anterior cruciate ligament (ACL) is a major cause of knee instability, and reconstruction by hour-glass technique is an effective method of treatment. Aim of the study This study evaluated the clinical and functional outcomes after using bone-patellar tendon bone graft for ACL reconstruction through hour-glass technique. Patients and methods This prospective study was done on 20 patients, all males, attending the Saudi German Hospital in Saudi Arabia between May 2011 and January 2013, and the mean age was 28 (range, 21–42) years at the time of surgery. The patients included in the study had posttraumatic knee instability with torn ACL. Clinical and functional evaluation was done after 1 year of follow-up using the Gillquist Lysholm score. Grading of the results was based on clinical evaluation using Lysholm score, and radiological evaluation using Kellgren score was done also after 1 year of follow-up. Results Patients who presented late after trauma (3–12 months) represented 75% of patients included in the study, and the main complaint of almost all patients was knee instability and pain. Other associated complaints were limping in 80%, locking of the knee in 20%, and difficulty in climbing stairs in 15% of patients. During arthroscopy, 14 (70%) patients had ACL torn at femoral attachment, four (20%) patients had mid substance torn ACL, and only two (10%) patients had torn ACL at tibial attachment. Moreover, meniscal lesions were found in four (20%) patients, and partial meniscectomy was done through arthroscopy. In addition, 90% of patients had excellent and good results, and the average Lysholm score was increased from preoperative of 42 (22–65) to postoperative of 95 (75–98) after 1-year follow-up. Radiological evaluation of osteoarthritis was done with comparison of the operated knee and the contralateral side according to Kellgren classification. In the current study, 30% of patients decreased by one grade and 45% of patients decreased by two grades, and in 25% of patients, there is no change. Only one (5%) patient had marked retropatellar pain, and this patient had degenerative changes before surgery owing to late presentation. Moderate graft pain with tenderness was found in two (10%) patients. No other complications were found except one (5%) patient who developed superficial infection and improved with frequent dressing and antibiotics. Conclusion ACL reconstruction by bone-patellar tendon bone graft by hour-glass technique is an effective method to restore knee stability with early weight-bearing and high satisfactory results. | ||
| Keywords | ||
| Anterior Cruciate Ligament Reconstruction; bone graft; hour-glass | ||
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