Relation between Second-look Arthroscopic Findings and Clinical Results after Double Bundle Anterior Cruciate Ligament Reconstruction

ABSTRACT

PURPOSE: This study examined the relationship between the findings of a second-look arthroscopy and clinical results in double bundle anterior cruciate ligament (ACL) reconstruction using hamstring tendons fixed with a Ligament Plate(R). MATERIALS AND METHODS: Twenty eight cases of a double bundle ACL reconstruction using hamstring tendons were retrospectively reviewed. The follow-up period was more than 1 year and all cases were reviewed by second-look arthroscopy. The average follow-up period was 20.6 months (range 12-34 months). In second-look arthroscopy, the anteromedial (AM) bundle and posterolateral (PL) bundle of the grafts were evaluated based on the tension, rupture and synovial coverage. Clinical evaluation was assessed using the Lysholm score, international knee documentation committee score, Hop test, Lachman test, pivot shift test, KT-2000 arthrometer and anterior drawer stress radiograph using Telos(R) in 30degrees knee flexion. The correlation between the arthroscopic findings of the grafts and the instability tests was evaluated. RESULTS: The AM graft was evaluated as being taut in 89.3% and lax in 10.7%, and the PL graft was assessed as being taut in 71.4% and lax in 28.6% according to the tension. The AM and PL grafts were evaluated as 'no rupture' in 78.6% and 'partial rupture' in 21.4%. There was no 'complete rupture' in any graft. The AM grafts were found to be good in 53.6%, fair in 35.7% and poor in 10.7%; the PL grafts were assessed as good in 50.0%, fair in 28.6% and poor in 21.4% according to the synovial coverage. The AM graft tension showed statistically significant results regarding both the Lachman test (rho=0.743, p<0.001) and degree of rupture (rho=0.438, p=0.020). The PL graft tension showed statistically significant results regarding both the pivot shift test (rho=0.548, p=0.003) and the degree of rupture (rho=0.663, p<0.001). CONCLUSION: Double bundle ACL reconstructions using hamstring tendons show good biological and clinical results. The graft tension and the degree of rupture show a statistically significant relationship to the stability of the reconstructed joint. On the other hand, the synovial coverage did not show a significant result.