Abstract
Purpose
The aim of the study was to compare the results 2 years after anterior cruciate ligament (ACL) reconstruction using a hamstring tendon (HT) autograft in patients operated within 5 months after the injury (Group A) and patients operated more than 24 months after the injury (Group B).
Methods
Sixty-one patients (27 women, 34 men), with a unilateral ACL rupture, underwent reconstructive surgery using semitendinosus (ST) or semitendinosus and gracilis (ST/G) autografts. Thirty patients (Group A) were operated on within 5 months median 3 (2–5) after the injury, and 31 patients (Group B) were operated on more than 24 months median 30 (24–48) after the injury. The follow-up examination was performed after a median of 25 months (18–43) after the reconstruction.
Results
A significantly higher Lysholm score was registered in Group A 90 (58–100) than in Group B 81 (38–100), P = 0.01, as well as a higher Tegner activity level 6 (2–9) versus 5 (0–9), P = 0.01. The clinical assessments revealed no significant differences between the groups in terms of the one-leg-hop test, KT-1000 arthrometer laxity measurements, manual Lachman test and range of motion (ROM). Furthermore, there was no significant difference between the groups in terms of meniscal and cartilage damage at the index operation.
Conclusion
At 2 years post-operatively, patients who underwent subacute reconstruction had a significantly better outcome in terms of the Lysholm score and Tegner activity level than patients who underwent delayed reconstruction. The clinical relevance of the present study is that if the patient wishes to continue doing sports on a higher level, subacute reconstruction appears beneficial.
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References
Ahlden M, Kartus J, Ejerhed L, Karlsson J, Sernert N (2009) Knee laxity measurements after anterior cruciate ligament reconstruction, using either bone-patellar-tendon-bone or hamstring tendon autografts, with special emphasis on comparison over time. Knee Surg Sports Traumatol Arthrosc 17:1117–1124
Beynnon BD, Johnson RJ, Abate JA, Fleming BC, Nichols CE (2005) Treatment of anterior cruciate ligament injuries, part 2. Am J Sports Med 33:1751–1767
Beynnon BD, Johnson RJ, Abate JA, Fleming BC, Nichols CE (2005) Treatment of anterior cruciate ligament injuries, part i. Am J Sports Med 33:1579–1602
Bottoni CR, Liddell TR, Trainor TJ, Freccero DM, Lindell KK (2008) Postoperative range of motion following anterior cruciate ligament reconstruction using autograft hamstrings: a prospective, randomized clinical trial of early versus delayed reconstructions. Am J Sports Med 36:656–662
Brandsson S, Faxen E, Kartus J, Eriksson BI, Karlsson J (2001) Is a knee brace advantageous after anterior cruciate ligament surgery? A prospective, randomised study with a two-year follow-up. Scand J Med Sci Sports 11:110–114
Corry IS, Webb JM, Clingeleffer AJ, Pinczewski LA (1999) Arthroscopic reconstruction of the anterior cruciate ligament. A comparison of patellar tendon autograft and four-strand hamstring tendon autograft. Am J Sports Med 27:444–454
Daniel DM, Malcom LL, Losse G, Stone ML, Sachs R, Burks R (1985) Instrumented measurement of anterior laxity of the knee. J Bone Joint Surg Am 67:720–726
Daniel DM, Stone ML, Dobson BE, Fithian DC, Rossman DJ, Kaufman KR (1994) Fate of the acl-injured patient. A prospective outcome study. Am J Sports Med 22:632–644
Gillquist J, Messner K (1999) Anterior cruciate ligament reconstruction and the long-term incidence of gonarthrosis. Sports Med 27:143–156
Howell SM, Taylor MA (1996) Brace-free rehabilitation, with early return to activity, for knees reconstructed with a double-looped semitendinosus and gracilis graft. J Bone Joint Surg [Am] 78:814–825
Höher J, Bach T, Münster A, Bouillon B, Tiling T (1997) Does the mode of data collection change results in a subjective knee score? Self-administration versus interview. Am J Sports Med 25:642–647
Indelicato PA, Bittar ES (1985) A perspective of lesions associated with acl insufficiency of the knee. A review of 100 cases. Clin Orthop Relat Res 198:77–80
Jomha NM, Borton DC, Clingeleffer AJ, Pinczewski LA (1999) Long-term osteoarthritic changes in anterior cruciate ligament reconstructed knees. Clin Orthop Relat Res 358:188–193
Karlsson J, Kartus J, Magnusson L, Larsson J, Brandsson S, Eriksson BI (1999) Subacute versus delayed reconstruction of the anterior cruciate ligament in the competitive athlete. Knee Surg Sports Traumatol Arthrosc 7:146–151
Kartus J, Stener S, Köhler K, Sernert N, Eriksson BI, Karlsson J (1997) Is bracing after anterior cruciate ligament reconstruction necessary? A 2-year follow-up of 78 consecutive patients rehabilitated with or without a brace. Knee Surg Sports Traumatol Arthrosc 5:157–161
Kartus J, Stener S, Lindahl S, Engstrom B, Eriksson BI, Karlsson J (1997) Factors affecting donor-site morbidity after anterior cruciate ligament reconstruction using bone-patellar tendon-bone autografts. Knee Surg Sports Traumatol Arthrosc 5:222–228
Keays SL, Newcombe PA, Bullock-Saxton JE, Bullock MI, Keays AC (2010) Factors involved in the development of osteoarthritis following anterior cruciate ligament surgery. Am J Sports 38:455–463
Keene GC, Bickerstaff D, Rae PJ, Paterson RS (1993) The natural history of meniscal tears in anterior cruciate ligament insufficiency. Am J Sports Med 21:672–679
Levy AS, Meier SW (2003) Approach to cartilage injury in the anterior cruciate ligament-deficient knee. Orthop Clin North Am 34:149–167
Liden M, Sernert N, Rostgard-Christensen L, Kartus C, Ejerhed L (2008) Osteoarthritic changes after anterior cruciate ligament reconstruction using bone-patellar tendon-bone or hamstring tendon autografts: a retrospective, 7-year radiographic and clinical follow-up study. Arthroscopy 24:899–908
Oiestad BE, Engebretsen L, Storheim K, Risberg MA (2009) Knee osteoarthritis after anterior cruciate ligament injury: a systematic review. Am J Sports Med 37:1434–1443
Outerbridge RE (1961) The etiology of chondromalacia patellae. J Bone Joint Surg Br 43-B:752–757
Roe J, Pinczewski LA, Russell VJ, Salmon LJ, Kawamata T, Chew M (2005) A 7-year follow-up of patellar tendon and hamstring tendon grafts for arthroscopic anterior cruciate ligament reconstruction: differences and similarities. Am J Sports Med 33:1337–1345
Roos EM (2005) Joint injury causes knee osteoarthritis in young adults. Curr Opin Rheumatol 17:195–200
Samuelsson K, Andersson D, Karlsson J (2009) Treatment of anterior cruciate ligament injuries with special reference to graft type and surgical technique: an assessment of randomized controlled trials. Arthroscopy 25:1139–1174
Seon JK, Song EK, Park SJ (2006) Osteoarthritis after anterior cruciate ligament reconstruction using a patellar tendon autograft. Int Orthop 30:94–98
Shelbourne KD, Nitz P (1990) Accelerated rehabilitation after anterior cruciate ligament reconstruction. Am J Sports Med 18:292–299
Smith TO, Davies L, Hing CB (2009) Early versus delayed surgery for anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 18:304–311
Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 198:43–49
Tegner Y, Lysholm J, Lysholm M, Gillquist J (1986) A performance test to monitor rehabilitation and evaluate anterior cruciate ligament injuries. Am J Sports Med 14:156–159
von Porat A, Roos EM, Roos H (2004) High prevalence of osteoarthritis 14 years after an anterior cruciate ligament tear in male soccer players: a study of radiographic and patient relevant outcomes. Ann Rheum Dis 63:269–273
Wright RW, Preston E, Fleming BC et al (2008) A systematic review of anterior cruciate ligament reconstruction rehabilitation: part ii: open versus closed kinetic chain exercises, neuromuscular electrical stimulation, accelerated rehabilitation, and miscellaneous topics. J Knee Surg 21:225–234
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Åhlén, M., Lidén, M. A comparison of the clinical outcome after anterior cruciate ligament reconstruction using a hamstring tendon autograft with special emphasis on the timing of the reconstruction. Knee Surg Sports Traumatol Arthrosc 19, 488–494 (2011). https://doi.org/10.1007/s00167-010-1312-0
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DOI: https://doi.org/10.1007/s00167-010-1312-0