Functional Outcome of Anterior Cruciate Ligament Reconstruction by Tibial Attachment Preserving versus Sacrificing Hamstring Graft Technique- A Prospective Interventional Study

Abstract

Introduction: Anterior Cruciate Ligament (ACL) is a stout, short intra-articular, extra synovial structure. For a knee with the deficiency of ACL, the ligament reconstruction using an autograft, either a free bone patellar tendon bone graft or a Semi Tendinosus and Gracilis (STG) tendon free hamstring graft, is the most common surgical treatment. Tibial fixation region of the graft is presumed to be a delicate point in arthroscopic ACL reconstruction. There, can be a chance of graft pull out from the tibial tunnel before actual healing of the graft– tunnel can occur. To avoid this problem, the technique of tibial attachment preserved hamstring graft can be used instead of free hamstring graft. Aim: To evaluate and compare the functional outcome of patients who underwent ACL reconstruction with either a free hamstring graft or by tibial attachment preserving hamstring graft. Materials and Methods: A prospective interventional study was conducted in the Department of Orthopaedics, Swami Rama Himalayan University Hospital, Dehradun, Uttarakhand, India, over a period of one year (July 2019-July 2020). A total 52 patients were included and they were divided into two groups. Group A (tibial attachment preserving hamstring graft) and Group B (tibial attachment sacrificing hamstring graft) with each group comprised 26 patients. Patients were assessed with Lysholm score at 6, 12 and 24 weeks of follow-up. For determining the statistical difference between the two groups Independent Student’s t-test was used, whereas for more than two groups Analysis of Variance (ANOVA) test was used and a p-value <0.05 was considered to be significant. Results: The mean age of patients in group A was 30.73±10.02 years whereas in group B it was 29.54±9.84 years. For group A, mean Lysholm score at 6 weeks was 73.23±8.37, at 12 week score was 86.85±5.93 and at 24 week score was 95.58±4.91. For group B, mean Lysholm score at 6 weeks was 74.15±5.82, at 12 weeks score was 87.46±5.95 and at 24 weeks score was 96.92±3.61. Post-hoc analysis showed that there was a significant difference in mean Lysholm score {between preoperative and other time points (p<0.001, respectively)} for both the groups but there was no significant difference in Lysholm score at 6 weeks (p=0.646), 12 weeks (p=0.710) and 24 weeks (p=0.265) when compared between the two groups. Conclusion: The ACL reconstruction using hamstring autograft with preserved tibial insertion resulted in no statistically significant difference in functional outcome as compared with free autograft.

Keywords

• arthroscopy
• lysholm score
• tibial attachment sacrificing