[The ACL tear from the pre-operative analysis to a 2-year follow-up, influence of the graft choice on the subjective and objective evaluation].
This study is a synthesis of three series. The first study was prospective on 418 patients with an anterior cruciate ligament (ACL) tear (group I). Two population of ACL ruptures were identified. One population with a postero-lateral bundle preserved in 16%, the mean medial anterior tibial translation side to side was 4.97 mm, the Lachman test was delayed in 40% with no or glide pivot shift in 73%. The second population with a complete ACL tear had a mean medial anterior tibial translation side to side of 7.93 mm, the Lachman test was soft in 98% with gross pivot shift in 80%. The second study was a retrospective study on 258 patients (group II) at 26 months follow-up, it correlated the impact of the type of graft on the clinical objective and subjective results. Twenty-eight percent had anterior knee pain, 33% for the patellar tendon and 25% for the hamstrings, the subjective IKDC was significantly lower for the painful knees, and 68% of the patellar tendon had a hypoesthesia and only 32% for the hamstrings. The ability to walk on the knee was 68% for the hamstrings and 35% for the patellar tendon. The third study was retrospective on 127 patients, 24 months after ACL reconstruction (group III), all were tested on a isokinetic machine for the extensor, the flexor and the internal rotator. In the total population, a 10% extensor and flexor deficit and a 5% rotator deficit was noted. A significant difference between patellar tendon and hamstrings in terms of muscular recovery was found. It pointed out that a more specific rehabilitation should be done on the hamstring group. The muscular recovery was correlated to the highest subjective score. This study allowed the surgeon to be more specific in the ACL tear definition, to adapt the graft choice to the type of sport activity but also to the type of work the patient does and finally to modify the rehabilitation protocol for the hamstring technique.
Dejour
D
D
Service de chirurgie orthopédique, Corolyon, 8, avenue Ben-Gourion, 69009 Lyon, France. corolyon@wanadoo.fr
Potel
J-F
JF
Gaudot
F
F
Panisset
J-C
JC
Condouret
J
J
D000328:Adult; D016118:Anterior Cruciate Ligament / Q000473:pathology / Q000601:surgery; D000070598:Anterior Cruciate Ligament Injuries; D001182:Arthroscopy / Q000379:methods*; D005206:Fascia Lata / Q000637:transplantation*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007537:Isometric Contraction / Q000502:physiology; D007593:Joint Instability / Q000175:diagnosis / Q000601:surgery; D007718:Knee Injuries / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D053580:Muscle Strength / Q000502:physiology; D010147:Pain Measurement; D026741:Physical Therapy Modalities; D011183:Postoperative Complications / Q000209:etiology* / Q000503:physiopathology / Q000534:rehabilitation; D011446:Prospective Studies; D016059:Range of Motion, Articular / Q000502:physiology; D012189:Retrospective Studies; D012421:Rupture; D013709:Tendon Transfer / Q000379:methods*