Purpose

Despite various challenges, orthopaedic sports surgeons are still providing the arthroscopic service in developing countries like Nepal; however, it is hardly being reported. The main purpose of this study was to compare the clinical outcomes and complications of patients undergoing arthroscopic ACLR in the urban group and that of the rural group.

Methods

We evaluated a total of 245 patients, including 128 patients in the urban group and 117 patients in the rural group, undergoing arthroscopic ACLR between August 2015 and January 2019, and had completed a minimum of 2-year follow-up. Subjective evaluations were performed using the Tegner-Lysolm score [1] and IKDC subjective knee evaluation form [2]. Laxity assessments were performed using the Lachman test and the Pivot-shift test. Radiological assessment was performed according to the IKDC guidelines. SPSS was used for data analysis.

Results

The rural group people presented very late 20-month post-injury vs. 10-month in the urban group. Road traffic accident was the primary etiology for ACL tear which consisted of 80(62.5%) in the urban group and 50(42.7%) in the rural group, followed by sports-related injuries in the urban group and farming in the rural group. The average follow-up period in the urban group was 39-month and 37-months in the rural group. The average postoperative Tegner-Lysolm score is 88-points in urban group and 84-points in the rural group(p=0.03). Similarly, the average IKDC score is 85-points in urban group and 82-points in the rural group(p=0.17). No statistically significant differences existed between 2-groups in laxity assessment, however, the proportion of laxity, in terms of Lachman test and Pivot-shift test, was higher in the young and active individuals, and the proportion of abnormal and severely-abnormal in all parameters of functional outcomes and stiffness was higher in the older females in the rural group. Overall graft failure occurred in 21(16.4%) knees in the urban group and 19(16.2%) knees in the rural group.

Conclusion

Functional outcomes were significantly lower in patients living in rural areas as they are found to have poor compliance with the rehabilitation protocol. Graft failure was common in young and active males in the urban area, whereas postoperative pain and stiffness were more common in females living in the rural area.
Keywords: Arthroscopy, Anterior cruciate ligament, Developing country, Urban group, Rural group,
References
1. Tegner Y, Lysholm J. Rating systems in the evaluation of knee ligament injuries. Clin Orthop. 1985 Sep;(198):43–9.
2. Irrgang J, Anderson A, Boland,A, et al. Development and Validation of the International Knee Documentation Committee Subjective Knee Form. Am J Sports Med 2001; 29(5): 600-13.