[Short-term effectiveness of arthroscopic single-bundle reconstruction of anterior cruciate ligament being centered within native ligament's tibial and femoral insertions].

OBJECTIVE

To evaluate the short-term effectiveness of arthroscopic single-bundle reconstruction of anterior cruciate ligament (ACL) being centered within the native ligament's tibial and femoral insertions with independent drilling of tibial and femoral tunnels.

METHODS

Between September 2008 and September 2010, 33 patients with chronic ACL ruptures underwent arthroscopic reconstruction with four-stranded hamstring tendons in single-bundle. There were 19 males and 14 females, aged 22-33 years (mean, 26.4 years). Injuries were caused by traffic accident in 15 cases, by falling in 13 cases, and by sports in 5 cases. The location was the left knee in 20 cases and the right knee in 13 cases. The average time from injury to surgery was 6 months (range, 2-20 months). ACL reconstruction could be optimized when single-bundle grafts were centered within the native ligament's tibial and femoral insertions with independent drilling of tibial and femoral tunnels. KT-1000 test, Lachman test, and pivot-shift test were used to evaluate the knee stability, and the International Knee Documentation Committee (IKDC) and Lysholm scores to assess the knee function.

RESULTS

Primary healing of incision was obtained in all patients, who had no complications of intra-articular infection, deep venous thrombosis of the lower extremity, and injury of blood vessels and nerves. All the patients were followed up 18.6 months on average (range, 13-24 months). At 1 year after operation, the results of Lachman test were negative in 31 cases and I degree positive in 2 cases, showing significant difference when compared with preoperative results (I degree positive in 4, II degree positive in 26, and III degree positive in 3) (Z = -5.42, P = 0.00). The results of pivot-shift test were negative in 31 cases, I degree positive in 2 cases, showing significant difference when compared with preoperative results (I degree positive in 15 and II degree positive in 18) (Z = -5.17, P = 0.00). The KT-1000 results of examination (134 N) showed that the side difference of anterior laxity was (1.2 +/- 0.7) mm at 25 degrees flexion and (0.8 +/- 0.6) mm at 70 degrees flexion, showing significant differences when compared with preoperative ones [(7.8 +/- 2.1) mm and (5.0 +/- 1.8) mm] (t = 16.19, P = 0.00; t = 13.28, P = 0.00). The IKDC score was significantly increased from 39.6 +/- 4.5 at preoperation to 95.1 +/- 1.6 at postoperation (t = - 78.88, P = 0.00), and Lysholm score was significantly increased from 48.3 +/- 3.6 at preoperation to 92.0 +/- 2.5 at postoperation (t = -42.00, P = 0.00).

CONCLUSION

It is a reliable procedure to restore the stability of the knee that arthroscopic single-bundle reconstruction of ACL is centered within the native ligament's tibial and femoral insertions with independent drilling of tibial and femoral tunnels.