Influence of Anterior Pain on Results From Anterior Cruciate Ligament Reconstruction

Abstract

Objective: To examine the impact of residual pain on functional outcomes two years after arthroscopic anterior cruciate ligament (ACL) reconstruction and compare the types of graft used during the procedure (patellar vs. flexor). Method: A retrospective epidemiological study on 129 ACL reconstructions with a mean follow-up of 28 months was conducted. The presence, intensity and location of the anterior pain were investigated. Pain provocation tests were conducted, sensitivity was analyzed and functional scores were applied (IKDC, femoropatellar and SF-36), comparing the results with the type of graft used. Results: Anterior pain was present in 28% of patients with a mean intensity of 2.9 in 10. When pain was present, the functional scores decreased significantly. Abnormalities of knee sensitivity and gait occurred frequently with use of the patellar tendon, but there was no statistical difference regarding the presence of pain. Conclusion: The presence of anterior pain in ACL reconstructions, even if minimal, has a deleterious effect on the final outcome over the medium term. Because of the influence of graft harvesting on the presence of abnormalities of knee sensitivity and gait, choosing the graft should take into account the patient's professional and sports activities.

Comparação dos enxertos para reconstrução anatômica do LCA: patelar versus semitendíneo/grácil

“…9,22,24 Assim como observado por outros autores, não houve diferença entre o uso dos enxertos quando foram avaliados pelo IKDC. [24][25][26] Jansson et al, 27 26 apresentaram em seu artigo prospectivo que não se observou diferença estatisticamente significativa na amplitude de movimento entre os grupos estudados, assim como neste trabalho.…”

“…9,25,27 No trabalho de Vasconcelos et al, 25 em pacientes nos quais se usou enxerto dos tendões flexores, a queixa álgica era principalmente na região medial. 25 Entretanto, outros estudos reportaram-se à ausência de diferença estatística na dor do joelho entre os enxertos usados, 15,18 similares aos resultados obtidos neste trabalho.…”

Comparison of grafts for anatomical reconstruction of the ACL: patellar versus semitendinosus/gracilis

“…As also observed by other authors, no difference in graft use was observed when this was assessed using the IKDC scale. 24 , 25 , 26 …”

“…Some studies have shown that patients present greater complaints of pain in the anterior region of the knee, particularly when kneeling down, when the patellar tendon is used as a graft. 9 , 25 , 27 In a study by Vasconcelos et al, 25 among patients in whom grafts from the flexor tendons were used, the complaints of pain were mainly from the medial region. 25 However, other studies have reported that there was no statistical difference in knee pain between the grafts used, 15 , 18 in the same way as seen in the results from the present study.…”

Contralateral Patellar Tendon Autograft in Anterior Cruciate Ligament Reconstruction

“…An improved surgical technique for reconstructing this ligament has made it less invasive, and when combined with early rehabilitation leads to joint stability and decreases the time patients need to return to their normal activities (not only professional sports, but particularly to work in ordinary patients), which has greatly increased the number of surgical reconstructions in recent years. 3 …”