Long-term evaluation of knee stability and function following surgical reconstruction for anterior cruciate ligament insufficiency

Abstract

Currently used measures of knee stability and function for ACL reconstructed knees have not gained universal acceptance. Clinical test results often are given more value than the patient's subjective evaluation of the surgical outcome. This study was designed to identify specific knee stability and function variables that were most predictive of the patient's rating of knee function following one of two types of combined (intraarticular and extraarticular) ACL reconstruction procedures. Individual measures of knee stability and function were also evaluated for differences between contralateral operated and nonoperated limbs. Postoperative and healthy contralateral knees of 51 male and female patients aged 18 to 49 years (mean, 23.7 years) were evaluated on a battery of tests at an average of 48.0 months after surgery (range, 24 to 101 months). All subjects possessed a normal contralateral knee for comparative purposes. The results of this retrospective study indicated that the variables selected were not highly correlated with, nor could they effectively predict, the patients' perceptions of postoperative knee status as measured by the Knee Function Rating Form (KFR). Statistically significant differences (P less than 0.001) between operated and nonoperated knees were found for 9 of 11 variables analyzed. The data suggest that patients' perceptions of postoperative knee status were independent of the results of static and dynamic clinical tests commonly used to assess knee stability and function. Postoperative deficits of up to 30% between the surgically reconstructed and normal contralateral knees on specific measures of knee stability and function did not greatly influence the patients' perceptions of knee function. Development of new, more specific dynamic tests may be necessary before stronger relationships between clinical test results and patients' perceptions of knee status in the ACL reconstructed knee can be realized.

Objective measurements of static anterior and rotational knee laxity

“…This lack of methodological scientific evidence may explain why many studies have shown no difference in anterior laxity after different types of surgical reconstruction between a bone-patellar tendon-bone (BPTB) and a semitendinosus (ST) autograft [92][93][94]. However, two meta-analyses comparing the two main graft types (BPTB vs. ST) have demonstrated that a SSD superior to 3 mm was less frequent in BTPB compared to ST grafts [95,96].…”

Anterior Cruciate Ligament Injuries and Outcome of Arthroscopic Reconstruction Using Quadrupled Hamstrings: A Kenyan Experience

“…In four of the patients when physiotherapy was not followed or was inadequately performed the results were inferior. Physiotherapy does indeed contribute significantly to good results (8,9,18,19). …”

“…These include direct repair, extra-articular procedures (6,7) and intra-articular prostheses (8)(9)(10).…”

Clinical comparison of cross-pin and EndoButton for fixation of hamstring grafts

“…10,11 Even though the use of the bone-patellar tendon-bone autograft is considered the gold standard for ACL reconstruction by some surgeons, the quadriceps has many disadvantages such as weakness in muscle strength, loss of full extension and anterior knee pain in the postoperative period. 12,13 In a reconstruction with hamstring tendons, the preservation of the extensor mechanism prevents atrophy of the quadriceps muscle, and problems such as postoperative knee pain and extension deficit are rarely encountered. 14,15 The donor-site morbidity of hamstring tendons is much lower compared to that of the patellar tendon.…”

“…14,15 The donor-site morbidity of hamstring tendons is much lower compared to that of the patellar tendon. 12,13 Since the crosssection area is larger compared to that in the patellar tendon, vascularization is also easier. 16,17 Hamstring tendons are biomechanically superior to the patellar tendon.…”