Clinical results of Anterior Cruciate Ligament(ACL) Reconstruction: Bone-patellar Tendon-bone Autograft Versus Allograft

PURPOSE: To compare the clinical results of anterior cruciate ligament(ACL) reconstruction between the bone-patellar tendon-bone(BPTB) autograft and the allograft. MATERIALS AND METHODS: The clinical results of thirty-three patients of BPTB autograft and thirty-six patients of BPTB allograft performed between the periods of May 1994 and March 2004 were compared retrospectively in terms of Lysholm score, IKDC knee rating system, Tegner scale, physical examination, and KT-1000 arthrometry. Minimum follow-up period was 2 years(range: 24 to 144 months, average: 51.9 months). RESULTS: The postoperative Lysholm score at final follow-up was 89.4 in autograft group and 90.1 in allograft group on average. The difference between the two groups was not significant statistically in postoperative Lysholm score, IKDC knee rating system, and Tegner scale. Twenty-seven cases(81.8%) of autograft group had a negative Lachman test versus thirty-one cases(86.1%) of allograft goup, postoperatively. There was no significant difference in Lachman test, flexion-rotation-drawer(FRD) test, pivot shift test, and KT-1000 arthrometry between the two groups. CONCLUSION: The clinical results of ACL reconstruction using the BPTB autograft or allograft was equally good without statistically significant difference.

Comparison of Arthroscopic Anterior Cruciate Ligament Reconstruction between Autologous Hamstring Tendonand Bone-patellar Tendon-bone Graft: Short Term FollowUp / 대한정형외과학회잡지

PURPOSE: To evaluate the stability, activity level and clinical results of an autologous hamstring and Bone-patellar tendon-bone (BPTB) graft in an Anterior cruciate ligament (ACL) reconstruction. MATERIALS AND METHODS: Between September 1997 and January 2003, 22 patients with an ACL reconstruction with an autologous four strand hamstring tendon, and 30 patients with a BPTB autograft were enrolled in this study. At the time of the final follow-up, the patients were evaluated by stress radiographs using a Telos instrument, the Lysholm score, Tegner activity score, IKDC activity grades, and anterior kneeling pain. RESULTS: An evaluation of the anterior laxity using the Telos instrument revealed no significant difference in the hamstring and BPTB groups: side to side difference 2.6 mm in the hamstring group vs 2.3 mm in the BPTB groups (p>0.05). The Lysholm score improved from a preoperative score of 58 to a postoperative score of 88 in the hamstring groups and from 56 to 91 in the BPTB groups. The Tegner score for the hamstring groups was 2.4 preoperatively and 5.8 at the final follow up, and the Tegner score for the BPTB groups were 2.3 and 6.2 preoperatively and after the last follow-up, respectively. The Tegner score was similar in the two treatment groups (p>0.05). According to the IKDC rating system, 9% were normal and 64% were almost normal in the hamstring group. In the BPTB group, 10% were normal and 67% were almost normal. Anterior kneeling pain after a reconstruction with the hamstring tendon autograft (13%) was significantly less common than with the patellar tendon autograft (37%)(p<0.05). CONCLUSION: The hamstring autograft for an ACL reconstruction decreased the incidence of anterior kneeling pain and produced equivalent clinical results to the BPTB autograft.

A Comparison Study between Conservative Treatment and Reconstruction with Autogenous BPTB Augmented with Kennedy LAD in the Injuries of PCL

The posterior cruciate ligament is the primary static restraint to posterior translation of the tibia and provides proprioception within the knee. The goals of treatment in the injuries of PCL are restoration of normal tibiofemoral stability and reduction of long term osteoarthrosis of the knee. The purpose of this study is to cornpare functional outcome, muscle power, and posterior stability between conservative treatment and reconstruction with autogenous RPTB augmented with Kennedy LAD in PCL injuries. Twenty-seven patients with PCL rupture who have been treated from November 1990 to May 1996 were reviewed. The patiens were divided into conservative group and reconstruction group. Conservative treatment was done in 15 patients and reconstruction by autogenous bone patellar tendon bone with Kennedy LAD was performed in 12 patients. All patients were evaluated with posterior stress x-ray films, KT-2000 knee ligament arthrometer, Cybex 340 isokinetic dynamometer, subjective Cincinnati symptom rating scale and Lysholm knee score, complication. The results were as follows; 1. Mild and moderate posterior instability was remained in spite of BPTB graft and need more stable fixation technique and vigorous rehabilitation program. 2. At the angular velocity of 90 degree/sec and 180 degree/sec, the muscle strenth of quadriceps was decreased after PCL injury in both group in the test of Cybex 340 isokinetic exercises. The power of hamstrings were not changed after PCL injuries. 3. Average Lysholm knee score was 89 points in reconstruction group and 78 points in conservative group and average Cincinnati symptom-rating scale was 8.4 points in reconstruction group and 7.1 points in conservative group. More satisfied functional results and subjective symptoms were revealed in the reconstruction group and statiscal significancy (p<0.05) was showed when comparing conservative group with reconstruction poup. 4. Good clinical results did not always coincidence with lesser posterior instability and clinical results were influenced by associated injury of the knee. The more combined ligament injury of the knee, the worse clinical results.

Endoscopic Anterior Cruciate Ligament Reconstruction with Autogenous Bone-Patellar Tendon-Bone: In Arthroscopic Second Look Cases / 대한정형외과학회잡지

Nineteen cases out of over 100 cases which had been reconstructed the deficient anterior cruciate ligament(ACL) by the bone-patellar tendon-bone(BPTB) autograft 12 months before or more(mean 15.8 months) were evaluated during the second-look arthroscopy. Before the second-look, the patients were evaluated the clinical results of ACL reconstruction by the Müller's knee rating score and the radiographical results by the lateral roentgenography of the fully extended knees. The location of the center of tibial tunnel from the anterior end of the line of the tibial plateau was 35.2%(range, 22 to 47%) on average. The average intercondylar roof angle was 36.6 degrees(range, 28 to 45 degrees). The mean percentage of roof impingement was