Summary

Outcome of three different grafts of ACL reconstruction with Arthroscopy has no significant difference in end results final followup of 18months

Abstract

Introduction

The anterior cruciate ligament (ACL) is highly susceptible to injury. Since the introduction of arthroscopic ACL reconstruction, various tendons and grafts have been used. Achieving a good functional outcome with minimal donor site morbidity requires meticulous reconstruction.

Aim

The study aim to compare, the functional outcome and morbidity of the donor site, taking consideration. ACL reconstruction with arthroscopy of three different graft BTB, HT & PLT.

Method

This comparative cross-sectional study of ACL reconstruction was conducted between 2020 and 2022, using Bone Tendon Bone (BTB), Hamstring Tendon (HT), and Peroneus Longus Tendon (PLT) grafts. The study included 60 cases with BTB, 57 with HT, and 47 with PLT, all performed with the same surgical technique. BTB grafts were fixed using two bioabsorbable screws, while HT and PLT grafts were secured with tightrope fixation for the femur and a bioabsorbable screw for the tibia. Knee function outcomes were measured using the Lysholm scale and the International Knee Documentation Committee (IKDC) scale, along with assessments of ankle range of motion (ROM), knee strength, and overall ROM.

Results

Out of 164 cases—60 BTB, 57 HT, and 47 PLT—a minimum follow-up period of 1.8 years was achieved, with a range of 18 to 30 months. Assessed by Lysholm Knee score BTB-64, HT-57 & PLT-58, on 18 months BTB-98, HT-99.5 & PLT-98.5 (p-0.32) & IDKC Score with mean preoperative BTB-61, HT-60.5 & PLT-60 on follow-up of 18 months BTB-95, HT-96.5 & PLT-96.36 (p-0.38)

Discussion

Each graft option presents its own advantages and disadvantages. The surgeon's skill and the appropriate selection of grafts are crucial for achieving good functional outcomes, reducing donor site morbidity, and ensuring early rehabilitation. In this study, donor site morbidity was less common with HT and PLT grafts compared to BTB. While BTB grafts were associated with anterior knee pain and difficulty in kneeling, HT and PLT grafts showed fewer complications. PLT grafts, however, were occasionally linked to ankle pain, reduced ankle ROM, and reflex sympathetic dystrophy (RSD) of foot bones. Importantly, no significant pain or complications were observed near the lateral malleolus after harvesting the PLT. HT grafts were associated with weak knee flexion, reduced thigh girth, and occasional knee flexion instability.

Conclusion

This study highlights the clinical relevance of using Bone Tendon Bone (BTB), Hamstring Tendon (HT), and Peroneus Longus Tendon (PLT) grafts in arthroscopic ACL reconstruction. The PLT graft is emerging as a viable alternative to HT, offering similar functional outcomes with less donor site morbidity. Although BTB grafts are considered the gold standard in arthroscopy, they require high technical skill to minimize donor site complications. In conclusion, the study suggests that the PLT graft is a safe alternative to the HT autograft in terms of strength, graft diameter, and the prevention of potential complications. While BTB grafts yield excellent functional outcomes, they may involve slightly higher non signification donor site morbidity.