Functional result relating to the positioning of the graft in anterior cruciate ligament reconstruction

Silva Júnior, Otávio de Melo; Ohashi, Bruno do Nascimento; Almeida, Murilo Oliveira de; Gonçalves, Murilo Reis

doi:10.1016/j.rboe.2015.01.008

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Original Articles • Rev. bras. ortop. 50 (1) • Jan-Feb 2015 • https://doi.org/10.1016/j.rboe.2015.01.008 copy

Functional result relating to the positioning of the graft in anterior cruciate ligament reconstruction ^☆ ☆ Work done at the Orthopedics and Traumatology Service, Sobradinho Regional Hospital, Brasilia, Federal District, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

OBJECTIVE:

To ascertain the coronal angles for the femoral and tibial tunnels that provide the best postoperative result from anterior cruciate ligament (ACL) reconstruction surgery, through assessing the variables of the IKDC and Lysholm-Tegner questionnaires and the hop test.

METHODS:

Sixteen patients with a single unilateral ACL injury who underwent this surgery between 24 and 36 months earlier were evaluated. They were divided into four groups in which the tibial and femoral tunnel angles were greater than or less than 65° in the coronal plane.

RESULTS:

The results demonstrated that a more vertical angle for the tibial tunnel (72°) and a more horizontal angle for the femoral tunnel (60°), with valgus alignment of 12° correlated with the best values for the variables studied. This may indicate that the long-term results from this surgery are excellent.

CONCLUSION:

A more horizontal femoral angle and a more vertical tibial angle produced better assessments in the tests that were applied and in the functional results evaluated.

Knee/surgery; Anterior cruciate ligament; Treatment result; Trauma among athletes

	n (%)
Gender
Male	13 (83.25)
Female	3 (17.75)

Age (years)
Up to 20	1 (6.25)
21–30	9 (56.25)
31–40	4 (25)
Over 40	2 (12.5)
Mean = 29.7

BMI (kg/m ² )
18.5–24.9 (Normal)	10 (62.5)
25–29.9 (Overweight)	6 (37.5)
Mean = 24.96

Dominant leg
Right	11 (68.75)
Left	3 (18.75)
Ambidextrous	2 (12.5)

	n (%)
Age (years) at the time of the injury
Up to 20	4 (25)
21–30	9 (56.25)
31–40	2 (12.5)
Over 40	1 (6.25)
Mean = 26.2

Environment at the time of the injury
Sports practice (leisure)	13 (81.25)
Others	3 (18.75)

Sport practiced at the time of the injury
Soccer	10 (62.5)
Others	6 (37.5)

Ground surfacing at the time of the injury
Synthetic grass	6 (37.5)
Natural grass	4 (25)
Parquet floor	2 (12.5)
Mat	2 (12.5)
Others	2 (12.5)

Interval between injury and surgery (months)
<6	8 (50)
6–12	2 (12.5)
13–24	4 (25)
>24	2 (12.5)
Mean = 13.85

Side operated
Right	7 (43.75)
Left	9 (56.25)

Relationship between dominant and operated sides
Ipsilateral	6 (37.5)
Contralateral	8 (50)
Ambidextrous	2 (12.5)

	TTC ≤ 65°	TTC > 65°
FTC ≤ 65°	GROUP I	GROUP II
FTC > 65°	GROUP III	GROUP IV

	n (%)
Coronal angle of the tibial tunnel (TTC)
≤60°	4 (25)
61–70°	9 (56.25)
>70°	3 (18.75)
Mean = 64.81°

Coronal angle of the femoral tunnel(FTC)
≤60°	2 (12.5)
61–70°	11 (68.75)
>70°	3 (18.75)
Mean = 67.68°

TTC-FTC (°)
<-10° (varus)	1 (6.25)
-10 to -1° (varus)	11 (68.75)
1 a 10° (valgus)	3 (18.75)
>10° (valgus)	1 (6.25)
Mean = -2.87° (varus)

	n (%)
Length of time since operation (months)
24–36	10 (62.5)
36–48	6 (37.5)
Mean = 34.5

IKDC
95–100 (Excellent)	5 (31.25)
84–94 (Good)	9 (56.25)
65–83 (Fair)	2 (12.5)
Mean = 89.94

Lysholm–Tegner
<91	4 (25)
91–99	5 (31.25)
100	7 (43.75)
Mean = 95.5

Hop test (limb symmetry index)
<0.9	2 (12.5)
0.91–0.99	6 (37.5)
1.00	7 (43.75)
>1.00	1 (6.25)
Mean = 0.968

Satisfaction with the result from the surgery
Yes	14 (87.5)
No	2 (12.5)

Group	FTC (°)	TTC (°)	ΔCoronal (°)	IKDC	Lysholm	LSI
I	61.2	61	-0.2	86.4	94.4	0.956
II	60	72	12	97	100	1.00
III	69.2	61.8	-7.4	89.8	93.4	0.946
IV	74.2	70.2	-4	92.2	97.8	0.996

Sociedade Brasileira de Ortopedia e Traumatologia Al. Lorena, 427 14º andar, 01424-000 São Paulo - SP - Brasil, Tel.: 55 11 2137-5400 - São Paulo - SP - Brazil
E-mail: rbo@sbot.org.br

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[1] * Corresponding author. E-mail: ortopediamurilo@gmail.com (M.O. de Almeida).

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Functional result relating to the positioning of the graft in anterior cruciate ligament reconstruction ☆ ☆ Work done at the Orthopedics and Traumatology Service, Sobradinho Regional Hospital, Brasilia, Federal District, Brazil.

OBJECTIVE:

METHODS:

RESULTS:

CONCLUSION:

Functional result relating to the positioning of the graft in anterior cruciate ligament reconstruction ^☆ ☆ Work done at the Orthopedics and Traumatology Service, Sobradinho Regional Hospital, Brasilia, Federal District, Brazil.