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Contralateral versus ipsilateral quadriceps graft, for anterior cruciate ligament reconstruction.

2021 Congress Paper Abstracts

Contralateral versus ipsilateral quadriceps graft, for anterior cruciate ligament reconstruction.

Franco Della Vedova, MD, ARGENTINA Hernan Galan, MD, ARGENTINA Daniel A. Slullitel, MD, Prof., ARGENTINA

Instituto Dr. Jaime slullitel, Rosario, Santa Fe, ARGENTINA


2021 Congress   Abstract Presentation   6 minutes   Not yet rated

 

Anatomic Location

Anatomic Structure

Diagnosis / Condition

Treatment / Technique

Ligaments

ACL

Patient Populations

Sports Medicine

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Summary: One of the most common complications in anterior cruciate ligament reconstructions is high donor site morbidity. We propose that contralateral quadriceps graft could be a reasonable option especially in patients that have poor tolerance to pain and need to return to work sooner.


Introduction

One of the most common complications in anterior cruciate ligament reconstructions is high donor site morbidity and postoperative pain, which is often associated with difficulties in the restoration of motion and delayed return to daily activities.
The objective of this paper is to compare postoperative pain, time to return to daily activities, and other clinical outcomes, in two groups of patients undergoing primary ACL reconstructions with autologous bone-quadriceps tendon (BQT) graft from the ipsilateral or contralateral knee.
We propose that contralateral BQT could be a reasonable option especially in patients that have poor tolerance to pain and need to return to work sooner.

Methods

Patients with primary ACL reconstruction using autogenous BQT graft were non-randomized and prospectively evaluated. Patients were given the choice of where to obtain the graft from, either from the ipsilateral knee (injured) or from the contralateral knee (healthy). It was explained to the patients that, according to our experience, patients operated on with contralateral knee graft suffered less pain in the immediate postoperative period, because the surgical trauma was divided between the two knees and that they could have a sooner return to daily activities or light work. It was also explained to the patients that, as a disadvantage, a totally healthy knee was being operated on, with possible surgical complications.

The inclusion criteria were isolated ACL tears, less than one year from injury to surgery, use of an autologous quadriceps tendon graft, and correct follow-up. Patients with associated ligament injuries, meniscal repairs, Outerbridge II or higher osteochondral injuries, patellofemoral pathology, and revision surgeries were excluded.
We evaluated postoperative pain, the amount of analgesics consumed, time to full range of motion, and time to return to activities of daily living and sport activities.

Results

Seventy-eight patients with primary ACL reconstruction using autogenous BQT graft were prospectively evaluated. In 34 patients (Group A) the graft was obtained from the ipsilateral knee, in the others 44 patients (Group B) the graft was obtained from the contralateral knee.
Patients in Group B had less postoperative pain than Group A (1,8 ± 0,6 - 3,1 ± 0,6 - p < 0,0001) consumed less amount of pain medication (p<0,0001) , and re-established flexion and extension faster than those with ipsilateral graft harvest (P < 0,0001). Group B patients also returned earlier to their daily activities (26.5 ± 15.3 days) than those in Group A (37 ± 11.42 days) (p < 0.0001). Patients in group B return to work sooner than group A (Graph 3). There was no difference in time to return to sport.

Conclusions

Patients operated with contralateral quadriceps tendon graft have less postoperative pain, achieve earlier full mobility, consume less pain medication post-operatively, and return faster to activities of daily living and work than those undergoing ipsilateral graft harvest. We think contralateral harvest of BQT graft is an excellent choice especially for patients who have poor pain tolerance and in those in which a quicker return to their activities of daily living or work is a priority.


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