2023 ISAKOS Biennial Congress ePoster
Changing the ACL Reconstruction Algorithm from Transtibial Hamstring to Transportal Patellar Tendon Is Associated With a More Physiological Knee Laxity At 5-To-10 Year Follow-Up, But Maintaining Activity Levels Remains A Greater Challenge
Iftach Hetsroni, MD, Associate Prof., Herzliya ISRAEL
Eyal Arami, MD, Kfar Saba ISRAEL
Guy Maoz, MD, Ramat Hasharon, Mercaz ISRAEL
Niv Marom, MD, Kfar Saba, ISRAEL
Nissim Ohana, MD, Kfar Saba ISRAEL
Gideon Mann, MD, Prof., Kfar Saba ISRAEL
Sports Medicine Injuries Service, Orthopedic Department, Meir General Hospital, Kfar Saba, ISRAEL
FDA Status Not Applicable
Summary
Changing the ACLR algorithm from transtibial hamstring to transportal bone-patellar tendon-bone results in maintaining a more physiological knee laxity at 5-to-10 year follow-up.
ePosters will be available shortly before Congress
Abstract
Objective
To test whether changing the surgical algorithm from transtibial technique using hamstring to transportal technique using patellar tendon result not only in a more physiological knee laxity but also in higher activity levels and improved perceptions of life quality at 5-to-10 years follow-up.
Methods
Transtibial ACL reconstructions using autologous hamstring tendons performed between 2004 and 2010 were compared to transportal ACL reconstructions using autologous bone-patellar-tendon-bone performed between 2011 and 2016. Inclusion criteria were: age 18-35 years, male sex, sports trauma, 5-10 years follow-up. Exclusion criteria were: contra-lateral ACL tear, revision ACL reconstruction during follow-up, and concomitant lower limb surgery. Outcome measures were compared between the groups.
Results
There were 55 patients eligible and available in the transtibial hamstring and 45 patients in the transportal patellar tendon group. At follow-up, KT-1000 was 2.8±2.3 vs. 1.4±1.9 (p<0.05), and high grade pivot shift (2+ or higher) was recorded in 34% vs. 4% of the cases (p<0.01). Decrease points in Marx score from preoperative to follow-up was 7.2±5.1 vs. 4.6±4.8, and in Tegner score was 2.1±2.1 vs. 1.2±1.5 (p<0.01 for both activity level scores). IKDC-subjective was 82±13 vs. 88±10 (p<0.01). Nevertheless, KOOS-ADL was 94±9 vs. 95±9, KOOS-sports 74±20 vs. 77±16, and KOOS- QOL 58±24 vs. 62±22 (p>0.05 for all comparisons).
Conclusions
Changing the ACLR algorithm from transtibial technique with hamstring tendons to transportal technique with bone-patellar tendon-bone results in maintaining a more physiological knee laxity at 5-to-10 year follow-up. However, substantial decrease in Marx scores and apparently similar KOOS sub-scores in both groups at follow-up imply that other factors than "just" knee laxity by itself deserve further exploration in order to dramatically improve sports activities maintenance and quality of life at this time frame after surgery.