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, 51 (5), 600-605

Transportal Anterior Cruciate Ligament Reconstruction With Quadrupled Hamstring Tendon Graft: A Prospective Outcome Study

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Transportal Anterior Cruciate Ligament Reconstruction With Quadrupled Hamstring Tendon Graft: A Prospective Outcome Study

Chandan Kumar et al. Indian J Orthop.

Abstract

Background: Anterior cruciate ligament (ACL) reconstruction has been one of the most commonly performed procedures throughout the world. Unsatisfactory outcome with conventional ACL reconstruction has been attributed to nonanatomic graft placement. Researchers have advised placing the graft in the native footprint of ACL to avoid nonanatomic graft placement. The goal of this study was to analyze the outcome of anatomic single bundle ACL reconstruction using transportal technique.

Materials and methods: This was a prospective outcome study conducted on 85 consecutive patients of ACL reconstruction of which 62 patients met inclusion and exclusion criteria and were analyzed for final results. All the patients underwent ACL reconstruction by quadrupled hamstring tendon graft using transportal technique and the accessory anteromedial (AAM) portal for femoral tunnel creation. The graft was fixed with endobutton on femoral side and bioabsorbable screw on the tibial side. Patients were evaluated for range of motion, International Knee Documentation Committee (IKDC) score, and Lysholm scores at a minimum followup period of 2 years. The mean pre- and postoperative scores were compared using Wilcoxon signed-rank test.

Results: The mean Lysholm and IKDC scores improved significantly (P < 0.0001) from preoperative value. According to IKDC score, 90.3% (n = 56) were either normal or near normal at final followup. According to Lysholm score, 75.8% of patients had excellent and 13.3% had good results. Preoperatively, pivot shift was present in 85.5% (n = 53) of patients which reduced to 4.8% (n = 3) postoperatively. Infection and knee stiffness occurred in two patients, and femoral tunnel blowout and graft re-rupture occurred in one patient each.

Conclusion: Anatomic ACL reconstruction by AAM portal is a reproducible technique which gives good clinical outcome at short-term followup.

Keywords: Accessory anteromedial portal; Arthroscopy; anatomic anterior cruciate ligament reconstruction; anterior cruiciate ligament; artrhroscopy; knee; surgical procedures.

Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Arthroscopic view showing torm anterior cruciate ligament with empty intercondylar notch
Figure 2
Figure 2
Arthroscopic view showing guide wire placed through accessory anteromedial portal in the center of femoral footprint of native anterior cruciate ligament
Figure 3
Figure 3
Arthroscopic view showing tibial guide wire placed in the centre of tibial footprint with tibial aimer
Figure 4
Figure 4
Arthroscopic view showing sutures shuttled from femoral to tibial tunnel
Figure 5
Figure 5
Arthroscopic view showing reconstructured anterior cruciate ligament
Figure 6
Figure 6
(a) Postoperative anteroposterior radiograph and (b) lateral radiograph of knee joint showing proper implant and tunnel position

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