Anterior cruciate ligament reconstruction - Long-term results evaluated clinically and by means of a rollimeterter
Abstract
Purpose of the study: Anterior cruciate ligament (ACL) reconstruction has recently become a widely used method of treating chronic instability. We have performed this operation in our department since 1996.
The aim of this study was to evaluate the effect of this operation in a long-term perspective, using the rollimeter, a new device facilitating objective assessment of anterior stability of the knee. Material: Of 150 patients undergoing surgery for lesions of the anterior cruciate ligaments at the Department of Orthopedics for Children and Adults, 2nd Faculty of Medicine, Charles University and Motol Teaching Hospital, in the years 1996-2000, 42 were included in this study.
Ligament reconstruction was performed by the transtibial technique using B-T-B patellar ligament graft; 90 % of the patients were treated by arthroscopy, 10 % by open surgery. Methods: The patients operated on between 1996 and 2000 received a questionnaire and were invited to undergo examination at our outpatient department.
The evaluation was based on the IKDC from, the results of Lachman's test performed on the rollimeter which permits objective assessment of the test, Tegner scores for assessment of daily activities and Lysholm scores for comparison of pre- and post-operative values. The results were statistically analyzed.
Subjective evaluation was obtained from the questionnaires the patients submitted at this examination. Results: The results show that, if the appropriate procedure is observed, the operation provides a reliable outcome by restoring knee joint stability and enabling the patient to return to previous sports activities.
The new device rollimeter proved effective because of its simple construction and easy manipulation, and because the values obtained were more objective than those from clinical examination. The treated knee function evaluated on the basis of IKDC was normal or almost normal in 86 % of the patients.
The objective measurement by the rollimeter of the anterior tibial translation showed a difference of up to 5 mm between the treated and the contralateral extremity. The average activity assessed according to Tergner increased by 3 grades and the average Lysholm scores improved by 30 points.
A difference greater than 5 mm in anterior tibial translation between the treated and the contralateral extremity was considered as graft failure; this occurred in 7 % of the patients. The drawback of this operation, however, remains a restricted ability to kneel comfortably without pain and paresthesia in and around the tibial tuberosity.
Discussion: The first results of objective evaluation of ACL replacement show that a correctly performed operation results in a clear improvement in biomechanical properties of the knee joint. Our group of patients was evaluated by the established criteria and the results are in agreement with those reported in the relevant literature.
In addition, the purpose of our study was to inform about the use of a new, simple measuring device that would be more easily available to hospitals in the Czech Republic than the KT 1000 arthrometer of western provenance. Both these devices, in contrast to other scoring systems, can provide objective assessment of post-operative outcomes and their broader application would contribute to a higher quality of retrospective evaluation of patient groups also in other hospitals.
Conclusions: Our results are in agreement with those of published studies and give support to the fact that ACL reconstruction is a technically demanding operation whose results depend on strict observations of the surgical procedure and on the frequency of surgery carried out at individual institutions. Our study shows the possibility of a broader use of the rollimeter as an alternative to the KT 1000 arthrometer commonly used in other countries.