Isolated anterior cruciate ligament reconstruction in patients aged fifty years: comparison of hamstring graft versus bo
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ORIGINAL PAPER
Isolated anterior cruciate ligament reconstruction in patients aged fifty years: comparison of hamstring graft versus bone-patellar tendon-bone graft Johannes Struewer & Ewgeni Ziring & Ludwig Oberkircher & Karl F. Schüttler & Turgay Efe
Received: 11 December 2012 / Accepted: 19 January 2013 / Published online: 3 February 2013 # Springer-Verlag Berlin Heidelberg 2013
Abstract Purpose Anterior cruciate ligament (ACL) deficiency contributes to symptomatic functional instability of the knee, regardless of age. We evaluated patient-reported clinical outcome, instrumental stability and prevalence of radiological osteoarthritis based on two homogenous patient samples aged 50 years, an average of three years after isolated ACL reconstruction. Methods ACL reconstruction using a bone-patellar tendonbone (BPTB) autograft was done in 19 patients and a fourstranded semitendinosus tendon (ST) autograft in 22 patients. Clinical and functional follow-up assessment was performed an average of 32 months after surgical treatment. Clinical and functional follow-up assessment included the International Knee Documentation Committee (IKDC) score, Tegner score and Lysholm score. Instrumental stability testing was carried out using the KT–1000™ arthrometer. The degree of degenerative changes and prevalence of osteoarthritis was based on the Kellgren–Lawrence classification. Results Mean follow-up was 32 months (range, 28–36). Mean age was 49.4 years in both groups. The median preinjury Tegner score was 5.5 (range, 2–8) and the median preoperative Lysholm score was 35 (range, 15–69). At two years, all variables improved significantly for both groups compared to the preoperative values (P Kellgren-Lawrence grade II) or concomitant medial collateral ligament repair at the time of reconstruction [29, 30]. Surgical methods and rehabilitation BPTB group Reconstruction was performed with an autogenous BPTB autograft from the middle third of the patellar tendon. The Location
Sex
Age
Follow-up
(range)
(range)
10 male
12 right
49.1 years
36 months
9 female Hamstring group (N=22)
7 left Location
(45–62 years) Age
(29–39 months) Follow-up
Sex 13 male
14 right
(range) 49.4 years
(range) 32 months
9 female
8 left
(46–64 years)
(28–34 months)
International Orthopaedics (SICOT) (2013) 37:809–817
central third of the patella (ten millimetres in width) was harvested through a single longitudinal incision. The graft was removed with a rectangular bone plug (20–25 mm in length). An arthroscopic-assisted reconstruction was used. The ruptured ACL was debrided and the anatomical tibial and femoral footprints were identified and left intact. The tibial tunnel was drilled using a drill guide under arthroscopic view through the posterior part of the middle of the tibial ACL footprint. To create the femoral tunnel, a five millimetre offset guide system was placed in a trans-tibial direction at the posterior margin of the intercondylar notch. Bone blocks were positioned in the tunnel, and the autograft placed with its cortical
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