Anterior-Posterior Instability of the Knee Following ACL Reconstruction with Bone-Patellar Tendon-Bone Ligament in Comparison with Four-Strand Hamstrings Autograft
Purpose. To evaluate anterior-posterior knee laxity using two different autografts. Material-Methods. 40 patients, (34 males and 6 women), 17–54 years old (mean: 31), were included in the present study. Group A (4SHS = 20) underwent reconstruction using four-strand hamstrings, and group B (BPBT = 20) underwent reconstruction using bone-patellar tendon-bone autograft. Using the KT-1000 arthrometer, knee instability was calculated in both knees of all patients preoperatively and 3, 6, and 12 months after surgery at the ACL-operated knee. The contralateral healthy knee was used as an internal control group. Results. Anterior-posterior instability using the KT1000 Arthrometer was found to be increased after ACL insufficiency. The recorded laxity improved after arthroscopic ACL reconstruction in both groups. However, statistically significant greater values were detected in the bone-patellar tendon-bone group, which revealed reduction of anteroposterior stability values to an extent, where no statistical significance with the normal values even after 3 months after surgery was observed. Conclusions. Anterior-Posterior instability of the knee improved significantly after arthroscopic ACL reconstruction. The bone-patellar tendon-bone graft provided an obvious greater stability. 1. Introduction The anterior cruciate ligament (ACL) is a major stabilizing element of the knee since it is the main anatomical structure which prevents the anterior displacement of the tibia relative to the femur [1, 2]. Simultaneously, it is an important factor for the normal knee movements, since it contributes not only to the static, but also to the dynamic stability of the joint [3]. Dynamic stability is guaranteed by the presence of specific ligament mechanoreceptors which are considered an essential element for knee proprioception as it has been revealed by a few anatomical and histological studies [3–6]. The ACL is the most frequently injured knee ligament especially as regards sports that include movements with sudden direction changes, as knee supports body weight during them [7–9]. These lesions often lead to ligament rupture with subsequent impairment and instability of the knee. Diagnosis is based presumably on several clinical examinations such as Lachman test, the anterior drawer test, and pivot shift test [2]. This kind of examinations, depending on the extent of the time that is inserted between the examination and the accident, the adeptness, and the experience of the health professional, as well as the body type of the patient, can lead to different results [10].
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