ACL repair in proximal lesions Vs. ACL reconstruction

Transcription

1 ACL repair in proximal lesions Vs. ACL reconstruction 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 INTRODUCTION Proximal chronic lesions of the anterior cruciate ligament (ACL) are usually treated by ligament reconstruction. Recently, a renewed interest in primary ACL repair has raised, especially when a good ligamentous quality is still present despite the chronicity of the lesion. This prospective study aims to compare ACL primary repair with ACL reconstruction outcomes in chronic ACL-deficient knees.

4 MATERIAL: Study conducted on 72 patients operated between for a chronic ACL proximal lesion but still a good ligamentous quality. GROUP A: ACL transosseous repair with cortical fixation GROUP B: ACL reconstruction with a bone-to-bone patellar tendon autograft 22 males, 14 females 27 males, 9 females 19 right, 17 left 17 right, 19 left Mean age 34 years (r ) Mean age 29 years (r ) Mean injury to surgery time 27 weeks (r ) Mean injury to surgery time 55 weeks (r ). Criteria selection for Group B: close proximity to each repair surgery All patients practiced sport before injury. Mean follow-up: 6 years (range 1 to 10).

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-1000 arthrometer Pre- and postoperative conditions were statistically compared using the Student t-test.

6 RESULTS: No statistically significant differences were found between the two groups (p >0.05). In Group A, 3 patients underwent an ACL reconstruction, two of which for a subsequent trauma. In Group B, 3 patients required an ACL revision surgery for a subsequent trauma. Fig. 1 Arthroscopic repair of the ACL In both groups, one patient quit sports activity. Fig. 2 ACL Reconstruction with patellar tendon

7 RESULTS SUBJECTIVE OUTCOMES

8 GROUP A RESULTS OBJECTIVE SCORES GROUP B

9 CONCLUSIONS The ACL primary repair shows good results and a failure rate of less than 10% in specific cases of chronic ACL-deficient knees with a good quality of ligamentous tissue and a proximal location of the lesion. Re-tensioning the ACL through cortical fixation may restore knee stability with comparable functional outcomes to a control group treated with a single-bundle ACL reconstruction using a bone-to-bone patellar tendon autograft. Further research is needed to improve the selection of ideal candidates for repair.

10 REFERENCES: Van der List JP and DiFelice GS. Primary repair of the anterior cruciate ligament: a paradigm shift. Surgeon. 2017;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. 2017;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. 2017;13: 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. 2015;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. 2018;4(1):37.