ABSTRACT
The purpose of this study was to determine the incidence of patient-reported numbness following anterior cruciate ligament reconstruction (ACLR), if postoperative numbness dissipates with time, and how the graft type affects numbness severity. A total of 218 patients undergoing ACLR were prospectively enrolled. At 6 weeks, 6 months, and 1 year postoperatively, patients completed a questionnaire assessing numbness severity and location. Each time, patients rated their sensory deficit from 0 to 10 (0 = no deficit; 10 = complete lack of sensation) and indicated the location of their sensory deficit by marking a picture of a knee divided into nine rectangular segments. A mixed effect linear regression model was used to identify predictors for the patient-reported numbness severity. Overall, 69.8% (150/218) of patients reported numbness at 6 weeks, 50.0% (97/194) at 6 months, and 42.2% (78/185) at 1 year. Allograft patients reported a mean numbness severity of 2.9 ± 0.3 (mean ± standard error), 1.7 ± 0.2, and 1.4 ± 0.3 at 6 weeks, 6 months, and 1 year, respectively. The 6-week, 6-month, and 1-year averages were 4.7 ± 0.4, 2.7 ± 0.4, and 1.7 ± 0.4 for bone-patellar tendon-bone (BTB) autograft patients and 4.3 ± 0.4, 2.9 ± 0.4, and 2.5 ± 0.4 for hamstring autograft patients. The model indicated that the use of hamstring autografts increased patient-reported numbness by an average of 1.4 ± 0.5 across all time points, and the use of a BTB autograft increased patient-reported numbness by 1.2 ± 0.4 across all time points. Time from surgery decreased the severity of patient-reported numbness for all graft types (-1.3 ± 0.2 at 6 months and -1.7 ± 0.2 at 1 year). Hypoesthesia in the distribution of the infrapatellar branch of the saphenous nerve is common after ACLR but is likely to dissipate with time. Patients undergoing ACLR with allograft may be less likely to develop sensory deficits, and these deficits may be less severe.
Subject(s)
Anterior Cruciate Ligament Reconstruction/adverse effects , Hypesthesia/etiology , Knee Injuries/surgery , Knee Joint/surgery , Peripheral Nerve Injuries/etiology , Adult , Anterior Cruciate Ligament Reconstruction/methods , Female , Humans , Incidence , Knee/innervation , Knee/surgery , Knee Joint/innervation , Male , Middle Aged , Prospective Studies , Recovery of Function , Self Report , Transplantation, Autologous/adverse effects , Transplantation, Autologous/methods , Transplantation, Homologous/adverse effects , Transplantation, Homologous/methods , Young AdultABSTRACT
The prognosis of osteoarthritis (OA) is worsened by persistent subchondral defects known as bone marrow lesions (BMLs), which herald severe joint degeneration and the need for joint replacement. Joint-preserving treatments that reverse the progression of pain and immobility are limited. Subchondroplasty is a procedure developed to treat BMLs by injecting a calcium phosphate bone substitute into compromised subchondral bone, under fluoroscopic guidance. Here we evaluate the effectiveness of this approach for relieving pain and improving function in patients with documented BMLs and advanced knee OA, in a retrospective study. Data were collected from a consecutive patient series (n = 66) who underwent subchondroplasty combined with arthroscopy, performed at a single center by one surgeon. We observed significant improvements in both pain and function following subchondroplasty with arthroscopic debridement, as measured by the visual analog scale (VAS) and the International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, through 2 years postoperative follow-up. Given that arthroscopic debridement alone has been previously shown to yield insignificant pain relief beyond 6 months postoperatively, our results suggest that subchondroplasty may be a promising approach for the treatment of OA with BMLs.
