[Arthroscopic reconstruction of the anterior cruciate ligament using the transtibial technique and a graft from the patellar ligament--results after 5-6 years].
OBJECTIVE
Arthroscopic reconstruction of the anterior cruciate ligament (ACL) by transtibial technique with free graft from the patellar tendon fixed by interference screws is a commonly used procedure. The aim of this study is to evaluate the results 5 to 6 years after the surgery.


METHODS
Fifty-two of 79 patients operated on in 1995 were checked in the period of 2000-2001. The average age of patients at the time of surgery was 26 years (range, 15-20 years), there were more men (62%), prevailing were injuries resulting from sports activities (92%).


METHODS
We have used evaluation according to IKDC. We focused on the problems at the site from which the graft was harvested, on the difficulties in the kneeling position and walking on knees. Evaluation of the activity was based on the Tegner score. On radiographs we assessed the length of the patellar tendon, dilatation of the tibial canal and the incidence and degree of osteoarthritis.


RESULTS
General evaluation according to IKDC was normal or nearly normal in 79% of patients. The difference of the anterior displacement of tibia between the operated on and non-operated on knee measured by arthrometer (KT 1000, 89N) was < 3 mm in 58% of patients and < or = mm in 95% of patients. Significant difficulties on the operated on side in the kneeling position and walking on knees were reported by 3 patients, slight difficulties were reported by 28 patients. Twenty patients reported slight difficulties also on the non-operated on side. Prior to the injury the average level of activity after Tegner was 7.9 (range, 6-10), prior to the operation 2.7 (range, 0-6) and at the time of check examination 7.0 (range, 4-10). The same level of activity as before the injury was reported by 61.5% of patients. Shortening of the patellar tendon on the operated on side > 5% (6 mm) was found out in 1 patient, shortening of < or = 5% (2-3 mm) in 30 patients. Tibial canal on the lateral projection 1 cm beneath the joint line was wider than 10 mm (dilated) in 6 patients. On the operated on knee osteoarthritis was found of the medial compartment of degree B and C in 42% of patients and on the non-operated knee in 19% patients. Aggravation of osteoarhritis of the medial compartment by one degree occurred after 5 to 6 years after the surgery in 4 out of 20 patients. All of them underwent meniscectomy. Eighty-six per cent (19 of 22) of patients with osteoarthritis of the medial compartment underwent medial meniscectomy.


CONCLUSIONS
General results according to IKDC are compared with results published by Aglietti, Jomha and Patel. Dilatation of the tibial canal was found out in 6 patients and it was associated with the graft-tunnel mismatch. The relationship between meniscectomy and arthritis is well-know. In 31% of patients after medial meniscectomy there was found out narrowing of the joint line to 2-4 mm (degree C). In case of partial medial meniscectomy the posterior horn, i.e. the most important part of the meniscus, was in most cases removed. Worsening of the arthritis after resection of the minor radial lesions of the lateral meniscus or after leaving incomplete lesions of the posterior horn of the lateral meniscus untreated has not been observed.


CONCLUSIONS
The surgery allows to improve the stability and extent of activity in most of the patients. The most frequent problem consists in the difficulties at the site of graft harvesting which may contribute to the decrease of subjective satisfaction. The relation between shortening of the patellar tendon and patellar difficulties was not proved. In the patients after medial meniscectomy osteoarthritis progresses even after ACL reconstruction.
Podskubka
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Ortopedická klinika IPVZ a I. LF UK, FN Na Bulovce, Praha. ortbul@ipvz.cz
Kasal
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Vaculík
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Krystlík
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D000293:Adolescent; D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D001182:Arthroscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D017847:Patellar Ligament / Q000637:transplantation*