engleski

Is it ACL reconstruction sufficient for competetive sport activities?

Most surgeons prefer reconstruction anterior crutiate ligament (ACL) with bone-patellar-bone greft (BPB), or hamstrings (HS). Advantage of BPB is early bone to bone healing and is easy to harvest, but disadvantage is harvest side morbidity, patellar chondromalacia, loss of range of motion, and injuy of the infrapatellar branch of the saphenus nerve. Advantage of the HS tendon is that is stronger and stiffer, less anterior knee pain, injury of the infrapatellar branch is rare, the big disadvantage is difficulties with graft fixation in the tunnel and longer graft healing, harvests difficulties. In the period 2004-2006 we had done 390 reconstructions of the ACL, 81% (316) with HS and 19% (74) with BPB graft. Last year we use HS tendon at 92.3 cases for primary ACL reconstruction. For proximal fixation HS and BPB we use cross pins and fir distal interference screw (metallic for BPB and bioapsorbable or Bio intrafix for HS). According our experience and literature there were no differences between the two grafts in terms of anterior knee laxity or functional knee scores. In the BPB group is higher prevalence of postoperative kneeling discomfort and an increased area of decreased skin sensitivity. In the HS group it is recorded a higher prevalence of tunnel widening. In the conclusion we belive that with use of accurate and proven surgical and rehabilitation techniques, booth grafts are an equivalent option for anterior crutiate ligament reconstruction. But, surgical techique or HS group is in our opinion much easier with less pitfalls. This is reason thet number of the ACL reconstruction with HS graft increasing not just for every day labour of our patients, but for competetive sport activity too. Reconstruction of the ACL by HS tendons with modern type of the bone fixation proves aggressive postoperative rehabilitation like before “ golden standard” using BPB. In the future we need evaluation for double tunnel tecnique which become be routine method for ACL reconstruction with HS for competetive sports also.

ACL reconstruction; sport; hamstrings

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