Primary transosseous ACL repair in proximal lesions

Transcription

1 Primary transosseous ACL repair in proximal lesions G.L. Canata, V. Casale Centre of Sports Traumatology, Koelliker Hospital, Torino Institute of Sports Medicine, Torino, Italy

2 Gian Luigi Canata, MD I have no financial conflicts to disclose

3 ACL primary transosseous repair Successful in specific cases (both acute or chronic) with a proximal injury location and a good tissue quality A renewed interest is rising in the primary healing capacity of the anterior cruciate ligament (ACL), usually when approaching acute lesions. In this prospective study we present an arthroscopic technique for ACL primary repair as a suitable choice for managing both acute and chronic ligament lesions, reporting outcomes.

4 MATERIAL: Patients undergoing a primary arthroscopic ACL transosseous repair with a cortical button fixation for a proximal avulsion tear between patients (26 m., 21 f.), mean age 34 ys (r. 13-7) of which 11 patients (acute) underwent the repair within 3 weeks from injury 36 patients (chronic) were treated after at least 4 weeks from trauma. All the patients practiced sports activity before the trauma. Mean follow-up was 6,7 years (r. 1-11,5 years).

5 METHODS: Clinical evaluation subjective outcomes: Tegner Activity Scale Knee Injury and Osteoarthritis Outcome Score (KOOS) preand postoperatively International Knee Documentation Committee (IKDC) IKDC objective score Functional outcomes: Anterior stability measured with a KT-1 arthrometer Pre- and postoperative conditions were statistically compared using the Student t-test.

6 RESULTS: Statistically significant differences were found in pre- and postoperative KOOS scores, and both the subjective and objective IKDC scores (p<,5) Four patients underwent an ACL reconstruction for traumatic failure of the repair, of whom 1 patient after a primary acute lesion and 2 patients after a chronic tear repair. Fig. 1: ACL arthroscopic repair: PDS sutures Fig. 2: ACL reinsertion One patient quit sports activity at all. Fig. 3: Cortical fixation with a button

7 PATIENTS RESUMING PRE-INJURY ACTIVITY LEVEL: 79%

8 RESULTS FUNCTIONAL OUTCOMES PRE- AND POSTOPERATIVE IKDC AND KT 1 OBJECTIVE SCORES TEST PREOPERATIVE LAST FOLLOW-UP IKDC objective -A (normal) -B (nearly normal) -C (abnormal) -D (severly abnormal) 41 (86%) 6 (13%) 47 P-VALUE (METHOD) P <,5 (Student t-test) KT-1 < 3 mm 3-5 mm > 5 mm TEST PREOPERATIVE LAST FOLLOW-UP 2 (4%) 39 (83%) 6 (13) 47 P-VALUE (METHOD) P <,5 (Student t-test)

9 CONCLUSIONS The ACL primary repair is a valid surgical option in specific cases, provided a good quality of ligamentous tissue and a proximal location of the lesion, in both acute and chronic ACLdeficient knees. This technique consisting in re-tensioning the ACL through cortical fixation is effective and minimally invasive with excellent results and a failure rate of less than 1%. Further research is needed to identify the best surgical indications for this procedure and to reduce the revision incidence.

10 REFERENCES: Van der List JP and DiFelice GS. Primary repair of the anterior cruciate ligament: a paradigm shift. Surgeon. 217;15(3): Van der List JP and DiFelice GS. Range of motion and complications following primary repair versus reconstruction of the anterior cruciate ligament. Knee. 217;24(4): Van der List JP and DiFelice GS. Successful arthroscopic primary repair of a chronic anterior cruciate ligament tear 11 years following injury. HSSJ. 217;13:9-95. DiFelice GS, Villegas C, Taylor S. Anterior cruciate ligament preservation: early results of a novel arthroscopic technique for suture anchor primary anterior cruciate ligament repair. Arthroscopy. 215;31(11): Malahias MA, Chytas D, Nakamura K et al. A narrative review of four different new techniques in primary anterior cruciate ligament repair: back to the future or another trend?. Sports Med Open. 218;4(1):37.