Tag Archive for: functional outcome.

Pawan Kamal, Shekhar Singhal, Akshdeep Bawa, Rajnish Garg

Volume 3 | Issue 1 | Jan – Apr 2018 | Page 47-51


Author: Pawan Kamal [1], Shekhar Singhal [2], Akshdeep Bawa [3], Rajnish Garg [2]

[1] Navnoor Hospital and trauma centre, Balachaur, Punjab
[2] Dept of Orthoapedics, Dayanand Medical College, Ludhiana, Punjab
[3] King’s College Hospital, London.

Address of Correspondence
Dr Akshdeep Bawa, Fellow Trauma and Orthopaedics,King’s College Hospital,London.
Email: bawa.akshdeep@gmail.com


Abstract

Rupture of the ACL is one of the most common sports injuries in active young people. The exact incidence of anterior cruciate ligament injuries is unknown. Other than sports injuries, road side accidents are the second most common cause of ACL injury. There are no studies where the results after ACL reconstruction done for an acutely injured knee as a result of road side accident have been documented. Our study aimed to determine if the functional outcome was satisfactory if it was done in a patient of road side accident irrespective of any associated meniscal injuries and to evaluate the complications.
Methods: This prospective study was conducted in the Department of Orthopaedics of Dayanand Medical College and Hospital, Ludhiana, Punjab. The patients presenting with knee injury at indoor/ outdoor patient Department of Orthopaedics for period starting from Jan 2007 to Dec 2011 were taken up for study. The diagnosis was confirmed clinically as well as radiographically. Patients with multiligamentous injuries were excluded from the study.Reconstruction was done arthroscopically using ipsilateral Quadrupled hamstring or patellar tendon autograft. Standard operative technique of transtibial ACL reconstruction was followed. The patients were followed at 6 months and one year postoperatively from 2007 to 2011 for assessment of functional results. A total of 107 patient met the inclusion criteria out of which 102 patient could be examined clinically while 5 patients were lost to follow up and one patient died due to some natural cause. After completion of study observations were tabulated & were analyzed qualitatively as well as quantitatively using proper statistical methods.
Results: Post operatively, instability disappeared in 100(98.04%) patients post ACL reconstruction. Only 2(1.96%) patients had occasional episode of instability the operated knee. One patient had instability due to missed postero-medial instability. The mean preoperative subjective IKDC score was 37.9513.88 and post-operative subjective IKDC score changed to 87.9010.07 after ACL reconstruction. After comparing the two scores the P value came out to be <0.001 which was highly significant.
Conclusion: Road traffic accidents and Sports injuries are the commonest cause for anterior cruciate ligament injuries in our country. Arthroscopic ACL reconstruction provides a stable knee with minimal complications. Arthroscopic anterior cruciate ligament reconstruction with BPTB and ST/G grafts is an excellent treatment option for anterior cruciate ligament deficient knees after road side accidents.
Keywords: ACL injury, road side accident, non athletes, functional outcome.


References

1. Eriksson E. Reconstruction of the anterior cruciate ligament. Orthop Clin North Am 1976;7:167-79.
2. Bartlett RJ Clatworthy MG, Nguyen TN. Graft selection in reconstruction of the anterior cruciate ligament. J Bone Joint Surg Br 2001;83:625-34.
3. Canale ST, Beaty JH. Campbell’ Operative Orthopaedics. 11th ed. Philadelphia: Elsevier; 2008. p. 2811-922.
4. Uhorchak JM, Scoville CR, Williams GN, Arciero RA, St Pierre P, Taylor DC. Risk factors associated with noncontact injury of the anterior cruciate ligament: A prospective four-year evaluation of 859 West Point cadets. Am J Sports Med 2003;31:831-42.
5. Jomha NM, Pinczewski LA, Clingelffer AJ, Otto DD. Arthroscopic reconstruction of the anterior cruciate ligament with patellar-tendon autograft and interference screw fixation. J Bone Joint Surg 1999;81:775-9.
6. Levy AS, Meier SW. Approach to cartilage injury in the anterior cruciate ligament-deficient knee. Orthop Clin North Am 2003;34:149-67.
7. Veltri DM. Arthroscopic anterior cruciate ligament reconstruction. Clin Sports Med 1997;16:123-44.
8. Tegner Y, Lysolm JL. Rating systems in the evaluation of knee ligament injuries. ClinOrthopRel Res 1985;198:43-9.
9. Ellenbecker TS. Clinical examination. In: Ellenbecker T, editor. Knee Ligament Rehabilitation. Philadelphia: Churchill Livingstone; 2000. p. 38.
10. Scoring Instructions for the 2000 IKDC Subjective Knee Evaluation. Available from: http://www.sportsmed.org/research/index.asp. [cited 2011 August 22]
11. Keays SL, Anthony JE, Peter K, NewcombeA, Bullock MI. A 6-year follow-up of the effect of graft site on strength, stability, range of motion, function, and joint degeneration after anterior cruciate ligament reconstruction patellar tendon versus Semitendinosus and Gracilis tendon graft. Am J Sports Med2007;35:729-39.
12. Barenius B, Nordlander M, Ponzer S, Tidermark J, Eriksson K. Anterior cruciate ligament reconstruction with Semitendinosus graft provided similar stability and knee function and fewer problems with kneeling compared with the bone-patellar tendon-bone graft. J Bone Joint Surg Am 2011;May 18;93(10):969
13. Svensson M, Sernert N, Ejerhed L, Karlsson J, Kartus T. A prospective comparison of bone-patellar tendon-bone and hamstring grafts for anterior cruciate ligament reconstruction in female patients. Knee Surg Sports Traumatol Arthrosc 2006;14:278-86.
14. Lee S, Seong SC, Hyunchul JC, Han HS, An JH, Lee MC. Anterior cruciate ligament reconstruction with use of autologous quadriceps tendon graft. J Bone Joint Surg Am 2007;89:116-26.
15. Webb JM, Corry IS, Clingeleffer AJ, Pinczewski LA. Endoscopic reconstruction for isolated anterior cruciate ligament rupture. J Bone Joint Surg 1998;80-B:288-94.
16. Drogset JO, Strand T, Uppheim G, Boe A, Grontvedt T. Autologous patellar tendon and quadrupled hamstring grafts in anterior cruciate ligament reconstruction: A prospective randomized multicentre review of different fixation methods. Knee Surg Sports Traumatol Arthrosc 2010;18:1085-93.
17. Sadoghi P, Müller PE, Jansson V, Griensven M, Kröpfl A, Fischmeister M. Reconstruction of the anterior cruciate ligament: A clinical comparison of bone-patellar tendon-bone single bundle versus Semitendinosus and Gracilis double bundle technique. IntOrthop (SICOT) 2011;35:127-33.
18. Gifstad T, Foss OA, Engebretsen L, Lind M, Forssblad M, Albrektsen G, et al. Lower risk of revision with patellar tendon autografts compared with hamstring autografts: a registry study based on 45,998 primary ACL reconstructions in Scandinavia. Am J Sports Med. 2014 Oct;42(10):2319-28
19. Bourke HE, Gordon DJ, Salmon LJ, Waller A, Linklater J, Pinczewski LA. The outcome at 15 years of endoscopic anterior cruciate ligament reconstruction using hamstring tendon autograft for ‘isolated’ anterior cruciate ligament rupture. J Bone Joint Surg Br 2012;94:630-7.
20. Corry IS, Webb JM, Clingeleffer AJ. Arthroscopic reconstruction of the anterior cruciate ligament: A comparison of patellar tendon autograft and four-strand hamstring tendon autograft. Am J Sports Med 1999;27:444-54.
21. O’Brien SJ, Warren RF, Pavlov H. Reconstruction of the chronically insufficient anterior cruciate ligament with the central third of the patellar ligament. J Bone Joint Surg 1991;73A:278-86.
22. Aune AK, Holm I, Risberg MA, Jensen HK, Steen H. Four-strand hamstring tendon autograft compared with patellar tendon-bone autograft for anterior cruciate ligament reconstruction. Am J Sports Med 2001;29:722-8.


How to Cite this article:. Kamal P, Singhal S, Bawa A, Garg R. Functional Outcome after Reconstruction in Patients with Anterior Cruciate Ligament Injuries after Roadside Accident in Non-athlete Population. Asian Journal of Arthroscopy Jan – April 2018;3(1):47-51.


(Abstract)      (Full Text HTML)      (Download PDF)