Ozdamar Ihsan
Orthopaedics and Trauma, Marmara University Pendik Training and Research Hospital, Istanbul, TUR.
Cureus. 2024 Apr 7;16(4):e57761. doi: 10.7759/cureus.57761. eCollection 2024 Apr.
Background An anterior cruciate ligament (ACL) tear is one of the most common sports injuries in the knee region. Currently, anatomical ACL reconstruction with quadrupled hamstring tendon autograft and controlled accelerated rehabilitation is a frequently used treatment approach. This study aims to add to the literature the early and mid-term clinical results of the controlled accelerated rehabilitation program we implemented in our clinic to enable patients to return to their daily activities faster after ACL reconstruction. Methodology In this retrospective study, 51 patients (50 males, 1 female) diagnosed with ACL tear and undergoing ACL reconstruction with quadrupled hamstring tendon graft were included in our study. In the femoral fixation of the graft, the transfix method was used in 22 patients and the Endobutton-CL method was used in 29 patients. A controlled accelerated rehabilitation program developed by Shelbourne was employed with some modifications to the patients. Clinical evaluation of patients was performed using Lysholm, Cincinnati, Tegner, and International Knee Documentation Committee (IKDC) scoring systems. Results The mean postoperative follow-up period was 18.7 months (range = 6-36 months). During the physical examination, Lachman, anterior drawer, and pivot shift, 49 (96%) patients achieved excellent or good results, while only two (5%) patients experienced fair clinical outcomes. On clinical assessment using the Lysholm and IKDC scoring systems, 50 (98%) patients demonstrated excellent or good results, whereas only one (2%) patient showed fair results. Excellent and good outcomes were observed in all patients using the Cincinnati scoring system. We found a significant decrease in Tegner activity score pre-surgery, which significantly increased post-surgery. Conclusions The combination of Endobutton and cross-pin for femoral fixation and staples and interference screw for tibial fixation is thought to be safe in patients undergoing controlled accelerated rehabilitation after ACL reconstruction. The implementation of controlled accelerated rehabilitation enables patients to return to their social lives earlier without resulting in clinically poor outcomes in grafts and implants applied in the early and middle stages.
背景 前交叉韧带（ACL）撕裂是膝部最常见的运动损伤之一。目前，采用四股腘绳肌腱自体移植进行解剖学ACL重建以及控制性加速康复是一种常用的治疗方法。本研究旨在将我们在诊所实施的控制性加速康复计划的早期和中期临床结果补充到文献中，以使患者在ACL重建后能更快恢复日常活动。方法 在这项回顾性研究中，51例（50例男性，1例女性）被诊断为ACL撕裂并接受四股腘绳肌腱移植ACL重建的患者纳入我们的研究。在移植物的股骨固定中，22例患者采用贯穿固定法，29例患者采用Endobutton - CL法。对患者采用经Shelbourne制定并经一些修改的控制性加速康复计划。使用Lysholm、辛辛那提、Tegner和国际膝关节文献委员会（IKDC）评分系统对患者进行临床评估。结果 术后平均随访期为18.7个月（范围 = 6 - 36个月）。在体格检查中的Lachman试验、前抽屉试验和轴移试验中，49例（96%）患者获得优或良的结果，而只有2例（5%）患者临床结果为尚可。使用Lysholm和IKDC评分系统进行临床评估时，50例（98%）患者表现为优或良的结果，而只有1例（2%）患者结果为尚可。使用辛辛那提评分系统时，所有患者均观察到优和良的结果。我们发现术前Tegner活动评分显著降低，术后显著升高。结论 对于ACL重建后接受控制性加速康复的患者，Endobutton与交叉克氏针用于股骨固定以及骑缝钉与挤压螺钉用于胫骨固定的联合方式被认为是安全的。控制性加速康复的实施使患者能够更早回归社会生活，且不会导致早期和中期应用的移植物和植入物出现临床不良结果。
