Anterior Cruciate Reconstruction Using Bone-patellar Ligament–Bone Autograft
Background: Injuries to ligaments of knee are common in our society especially in the young athletes and sports men participating in football, volleyball, rugby etc. Tears of the anterior cruciate ligament (ACL) leads to knee instability which leads to inability to participate in sports. In the none athletes ACL injury tends to decline in their level of daily activity. This is a study of ACL tears seen and managed by the author over a long period along with scientific data of clinical presentations, diagnosis, associated injuries, the ACL repair, rehabilitation protocol and the overall outcome. Objective: To review the authors experience of patients with anterior cruciate ligament tears who have been treated by bone-patellar tendon-bone autografts. That was to be achieved through clinical, radiological, athroscopy and extensive rehabilitation programme and arthroscopic review after one year follow-up. Setting: Menelik Hospital and the Nairobi Hospital. Methods: Thirty five patients with anterior cruciate ligament tear in one knee and a normal contralateral knee were evaluated and followed up for six years. Clinical history, physical evaluation, X-ray and athroscopies were done to rule out concomitant meniscal lesions and facilitate their treatment accurately. Follow up arthroscopy; physical examinations by Lachman test, pivot test and anterior drawer test were done. Subjective and objective data were obtained and reviewed to assess final outcome. Results: A total of 35 patients were seen and treated. Only 25 patients were available having been followed up fully. There were 18 males and seven females giving a male to female ratio of 2:1. The injuries were unilateral 18 (72%) on the right and seven (28%) on the left. Initial Lachman”s test was graded at 2 and 3 while anterior drawers test and pivot test at 2 and 3 respectively in all patients. Post operatively these improved to grade zero with negative pivot test in all patients. The subjective results were excellent and good in 80% of the patients, while the objective were 68% . Follow up arthroscopy showed a stable ligament at one year while follow up X-ray showed mild arthrosis. A few complications occurred with one infection and calcification of ligament in two patients, arthrofibrosis in two patients. Conclusion: This study is of clinical relevance as it shows alleviation of pain after surgical treatment of the torn ACL which has been described as the stabiliser of the knee and guardian of the Meniscus.