Subscribe to RSS
DOI: 10.1055/s-0038-1653948
Return to Sport after ACL Surgery: A Comparison between Two Different Reconstructive Techniques
Publication History
04 May 2017
08 April 2018
Publication Date:
23 May 2018 (online)
![](https://www.thieme-connect.de/media/jks/201906/lookinside/thumbnails/10-1055-s-0038-1653948_170102oa-1.jpg)
Abstract
The anterior cruciate ligament reconstruction (ACLR) has become a very common surgical procedure. One of the main success indicators of the surgical procedure is the return to preinjury sporting level. In recent years, reconstructive techniques have been geared toward less morbidity and optimized ligaments process to speed up the recovery of sports activity. This study compares clinical and imaging data, to evaluate the timing of return to sport, of two populations undergoing ACLR using two different techniques: ACLR with hamstring maintaining tibial insertion (MHG) and an all-inside technique with complete hamstring detachment (DHG). Patients were clinically evaluated with Marx rating scale, International Knee Documentation Committee (IKDC) score, and Tegner activity scale at a minimum follow-up (FU) of 4 years. The two groups have homogeneous characteristics: age, sex, type, and level of sports activity. Since November 2012, 59 patients with unilateral ACL insufficiency underwent ACLR: 31 patients using the MHG technique and 28 patients using the DHG technique. In both groups, a significant improvement in the clinical scores of the administered tests was observed. The MHG group reported a higher percentage of normal knees (83.8%) compared with the DHG group (78.6%). IKDC subjective score improved at each FU. Comparing the two techniques, at 12 months' FU the MHG group achieved better IKDC results (89.6) compared with the DHG technique (84.2). Marx and Tegner score values improved over time reaching comparable results at final FU. At final FU, 98% of patients returned to the same preinjury professional sporting level. Both techniques have been able to provide good clinical results. The MHG group, however, had a resumption of sports activity of the same level and intensity slightly longer (6.3 months) than that in the DHG group (5.9 months). Furthermore, the resumption of training and athletic gestures for the type of sport practiced was earlier than the DHG group. However, in the long run the level of sporting activity leveled in both groups, demonstrating the effectiveness of both techniques.
-
References
- 1 Arendt EA. American Orthopaedic Society for Sports Medicine, American Academy of Orthopaedic Surgeons. OKU Orthopaedic Knowledge Update. Sports Medicine 3. 3rd ed. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2004
- 2 Marrale J, Morrissey MC, Haddad FS. A literature review of autograft and allograft anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2007; 15 (06) 690-704
- 3 Frank CB, Jackson DW. The science of reconstruction of the anterior cruciate ligament. J Bone Joint Surg Am 1997; 79 (10) 1556-1576
- 4 Roos H, Adalberth T, Dahlberg L, Lohmander LS. Osteoarthritis of the knee after injury to the anterior cruciate ligament or meniscus: the influence of time and age. Osteoarthritis Cartilage 1995; 3 (04) 261-267
- 5 Barber-Westin SD, Noyes FR. Factors used to determine return to unrestricted sports activities after anterior cruciate ligament reconstruction. Arthroscopy 2011; 27 (12) 1697-1705
- 6 Claes S, Verdonk P, Forsyth R, Bellemans J. The “ligamentization” process in anterior cruciate ligament reconstruction: what happens to the human graft? A systematic review of the literature. Am J Sports Med 2011; 39 (11) 2476-2483
- 7 Webb JM, Corry IS, Clingeleffer AJ, Pinczewski LA. Endoscopic reconstruction for isolated anterior cruciate ligament rupture. J Bone Joint Surg Br 1998; 80 (02) 288-294
- 8 Ardern CL, Taylor NF, Feller JA, Webster KE. A systematic review of the psychological factors associated with returning to sport following injury. Br J Sports Med 2013; 47 (17) 1120-1126
- 9 Cole BJ, Ernlund LS, Fu FH. Soft tissue problems of the knee. In: Baratz ME, Watson AD, Imbriglia JE. , eds. Orthopaedic Surgery: The Essentials. New York, NY: Thieme Medical Publishers, Inc; 1999: 551-560
- 10 Yagi M, Wong EK, Kanamori A, Debski RE, Fu FH, Woo SL. Biomechanical analysis of an anatomic anterior cruciate ligament reconstruction. Am J Sports Med 2002; 30 (05) 660-666
- 11 Buda R, Ruffilli A, Vannini F, Parma A, Giannini S. Anatomic anterior cruciate ligament reconstruction using distally inserted doubled hamstrings tendons. Orthopedics 2013; 36 (06) 449-453
- 12 Lubowitz JH, Akhavan S, Waterman BR, Aalami-Harandi A, Konicek J. Technique for creating the anterior cruciate ligament femoral socket: optimizing femoral footprint anatomic restoration using outside-in drilling. Arthroscopy 2013; 29 (03) 522-528
- 13 Lubowitz JH, Ahmad CS, Anderson K. All-inside anterior cruciate ligament graft-link technique: second-generation, no-incision anterior cruciate ligament reconstruction. Arthroscopy 2011; 27 (05) 717-727
- 14 Letchford R, Button K, Sparkes V, Van Deursen RWM. Assessing activity participation in the ACL injured population: a systematic review of activity rating scale measurement properties. Phys Ther Rev 2012; 17 (02) 99-109
- 15 Negahban H, Mostafaee N, Sohani SM. , et al. Reliability and validity of the Tegner and Marx activity rating scales in Iranian patients with anterior cruciate ligament injury. Disabil Rehabil 2011; 33 (23-24): 2305-2310
- 16 Ruffilli A, Pagliazzi G, Ferranti E, Busacca M, Capannelli D, Buda R. Hamstring graft tibial insertion preservation versus detachment in anterior cruciate ligament reconstruction: a prospective randomized comparative study. Eur J Orthop Surg Traumatol 2016; 26 (06) 657-664
- 17 Farber J, Harris JD, Kolstad K, McCulloch PC. Treatment of anterior cruciate ligament injuries by major league soccer team physicians. Orthop J Sports Med 2014; 2 (11) 2325967114559892
- 18 Dempsey IJ, Norte GE, Hall M. , et al. Relationship between physical therapy characteristics, surgical procedure, and clinical outcomes in patients after ACL reconstruction. J Sport Rehabil 2017; 15: 1-28
- 19 Mohtadi NG, Chan DS. Return to sport-specific performance after primary anterior cruciate ligament reconstruction: a systematic review. Am J Sports Med 2017; 363546517732541
- 20 Czuppon S, Racette BA, Klein SE, Harris-Hayes M. Variables associated with return to sport following anterior cruciate ligament reconstruction: a systematic review. Br J Sports Med 2014; 48 (05) 356-364
- 21 Zaffagnini S, Grassi A, Serra M, Marcacci M. Return to sport after ACL reconstruction: how, when and why? A narrative review of current evidence. Joints 2015; 3 (01) 25-30
- 22 Dugas JR, Pace JL, Bolt B, Wear SA, Beason DP, Cain Jr EL. Evaluation and comparison of femoral tunnel placement during anterior cruciate ligament reconstruction using 3-dimensional computed tomography: effect of notchplasty on transtibial and medial portal drilling. Orthop J Sports Med 2014; 2 (03) 2325967114525572
- 23 Volpi P, Bait C, Cervellin M. , et al. No difference at two years between all inside transtibial technique and traditional transtibial technique in anterior cruciate ligament reconstruction. Muscles Ligaments Tendons J 2014; 4 (01) 95-99
- 24 Benea H, d'Astorg H, Klouche S, Bauer T, Tomoaia G, Hardy P. Pain evaluation after all-inside anterior cruciate ligament reconstruction and short term functional results of a prospective randomized study. Knee 2014; 21 (01) 102-106
- 25 Lubowitz JH, Schwartzberg R, Smith P. Cortical suspensory button versus aperture interference screw fixation for knee anterior cruciate ligament soft- tissue allograft: a prospective, randomized controlled trial. Arthroscopy 2015; 31 (09) 1733-1739
- 26 Zaffagnini S, Golanò P, Farinas O. , et al. Vascularity and neuroreceptors of the pes anserinus: anatomic study. Clin Anat 2003; 16 (01) 19-24
- 27 Papachristou G, Sourlas J, Plessas S, Papachristou K. Arthroscopic ACL reconstruction with Delta plasty: an innovative approach with hamstrings' transfer and double tibial tunnel. Knee Surg Sports Traumatol Arthrosc 2008; 16 (04) 420-426
- 28 Schultz RA, Miller DC, Kerr CS, Micheli L. Mechanoreceptors in human cruciate ligaments. A histological study. J Bone Joint Surg Am 1984; 66 (07) 1072-1076
- 29 Marcacci M, Zaffagnini S, Giordano G, Iacono F, Presti ML. Anterior cruciate ligament reconstruction associated with extra-articular tenodesis: a prospective clinical and radiographic evaluation with 10- to 13-year follow-up. Am J Sports Med 2009; 37 (04) 707-714
- 30 Ruffilli A, Pagliazzi G, Ferranti E, Busacca M, Capannelli D, Buda R. Hamstring graft tibial insertion preservation versus detachment in anterior cruciate ligament reconstruction: a prospective randomized comparative study. Eur J Orthop Surg Traumatol 2016; 26 (06) 657-664
- 31 Zaffagnini S, Bruni D, Marcheggiani Muccioli GM. , et al. Single-bundle patellar tendon versus non-anatomical double-bundle hamstrings ACL reconstruction: a prospective randomized study at 8-year minimum follow-up. Knee Surg Sports Traumatol Arthrosc 2011; 19 (03) 390-397
- 32 Zaffagnini S, Bruni D, Russo A. , et al. ST/G ACL reconstruction: double strand plus extra-articular sling vs double bundle, randomized study at 3-year follow-up. Scand J Med Sci Sports 2008; 18 (05) 573-581