Graduate Thesis Or Dissertation

Isolated anterior cruciate ligament deficiency : comparison of results following acute and chronic arthroscopic reconstruction with patellar tendon autograft

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  • Isolated injury of the anterior cruciate ligament (ACL) is less frequent and typically perceived as less severe than ACL injuries with concurrent damage to other knee stabilizing structures. The timing of the ACL reconstructive surgery is thought to be a critical factor that affects the patient's postoperative outcome. No previous study has compared the results of acute reconstruction (interval between injury and surgery less than or equal to 3 months) and chronic reconstruction (interval between injury and surgery greater than 3 months) of isolated ruptures of the ACL. The primary aim of this study was to assess the differences in functional outcomes between two distinct patient populations treated using the same surgical intervention. The secondary aim of this study was to determine which functional outcome variables differed between the acute isolated and chronic isolated patient populations in order to identify the etiology of any long-term functional impairment. Two separate investigations were conducted to address these questions. The first study evaluated the efficacy of an arthroscopic-assisted surgical technique using an autogenous substitute for the ACL in a group of patients who had surgery more than 3 months after isolated injury to their ACL. Fifty-five patients from Cairo, Egypt (mean age, 27.1 ± 4.5 years) underwent ACL reconstruction an average of 7.0 ± 2.6 months (range, 3.3 to 16.6 months) after injury. Patients were evaluated at an average of 2.2 ± .3 years postoperatively (range, 2.0 to 3.4 years) using a battery of objective and subjective tests. No significant differences were observed between the patients' surgical and contralateral normal knees (p>.05). International Knee Documentation Committee (IKDC) scores questionnaire rated 48 of 55 patients (87.3%) as "normal", 5 patients (9.1%) as "nearly normal" and 2 patients (3.6%) as "abnormal"; no patients were categorized as "severely abnormal". The second investigation evaluated the effect of timing of surgery on functional outcomes. From a group of 773 arthroscopic-assisted ACL reconstruction patients in Cairo, Egypt, 200 of 234 patients (mean age, 32.2 ± 6.9 yrs.) with isolated ACL injuries participated in this study. Subjects were assigned to groups based on the interval between ACL injury and surgery. Patients in the acute reconstruction group (n=100) had surgery an average of 62 days postinjury, while the chronic reconstruction group (n=100) had surgery an average of 211 days postinjury. The mean follow-up period was 2.2 ± 0.3 years (range, 2.0 to 3.8 years) for all subjects. There were statistically significant differences between the acute and chronic group in the final score (x² 2=6.43 with p=0.04). IKDC scores rated 62% of the acute and 58% of chronic group patients as "normal", 37% of acute and 38% of chronic group patients as "near normal", and 1% of acute and 4% of chronic group knees as "abnormal". Delaying the ACL reconstruction to allow for reduction of the acute inflammatory process and participation in pre-operative rehabilitation resulted in fewer cases of postoperative arthrofibrosis in the chronic group compared to the acute group. However, delays of surgery more than 3 months between isolated injury of the ACL and surgical reconstruction resulted in greater frequency of arthritic changes.
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