Arthroscopic ACL reconstruction with hamstring

Abstract

Introduction: Today, in clinical practice, methods of stabilizing operations arthroscopic ACL are widely used, and extensively described. According to most authors, positive outcomes (of such procedures) are being observed in 80-90% of patients, with a return to the previous level of physical condition in 50-70% of patients. Currently, the literature describes the advantages and disadvantages of using different grafts, single-beam or double-bundle of ACL plastics, and its various fixation design. The usage of the autograft from the tendon of semitendinosus and gracilis muscles, with the use of the lock "endobutton" is the best method to restore the stability of the knee joint. The main advantages of this method are: good biological compatibility; low-impact at the face of the graft; the absence of pain and complications of the donor site, the strength of twice the native ACL, a quicker and painless rehabilitation, the best cosmetic result. Purpose of the study: Rate the postoperative results of the reconstruction of the anterior cruciate ligament (ACL) under arthroscopic control with the use of autograft from the tendon of semitendinosus and gracilis muscles with the use of the lock,“endobutton.” Methods: The analysis of the treatment results of 167 patients with ACL injury of the knee, and the anterior-medial decompensated instability in the period from 2010 to 2015, was conducted. The representation of the group included 144 men and 23 women, with the average age of 26 years old (range 18 to 45 years). Eighty percent (80%) of the patients had sports injury: football - 69 patients, 28 - ski, fight - 9 and other sports - 35. In 33 cases, the damage to the anterior cruciate ligament was combined with damage to the medial meniscus, in 16 of the outer meniscus, 5 - both the meniscus, different types of damage to the articular cartilage - 28 cases. The diagnisis was confirmed by clinical, radiological, ultrasound and MRI methods. The maximum diameter of the graft reached 10,5 mm, the minimum - 7 mm, the depth of the femoral canal was formed to the 30 mm, the width according to the diameter of the graft. All operations are performed under endoscopic control, with maximum preservation of natural points of fixation on the tibia and femur, which ensures the normal anatomy and biomechanics of the knee joint during the postoperative period. Results: Postoperative, the patients were followed up for 6-48 months, using the LYSHOLM scale. Based on these studies, excellent and good results were obtained in 151 patients (90%), satisfactory in 11, unsatisfactory in 5 patients. All athlete patients resumed training after 6 months. Negative results were observed in 3 patients with recurrent instability after reinjury, and 2 septic complication about distal thibial screw fixations after one year. Conclusion: 1. In most cases, the rupture of the anterior cruciate ligament is the result of an injury sustained in sporting activities: during a football game, while downhill skiing or wrestling. 2. Autoplasty ACL tendon of the popliteal area provides a reproduction of the anatomical structure and biomechanics close to natural, with minimum damage around the joint and joint tissues. 3. A locking system ligament "Endobutton", ensures a secure fit of the graft, and does not require subsequent removal structures. 4. This method provides the minimum rehabilitation period, the optimal functional and cosmetic results.