DOI: https://doi.org/10.22141/1608-1706.4.20.2019.178749

Results of primary isolated anterior cruciate ligament reconstruction and combined anterior cruciate and anterolateral ligaments

M.L. Golovakha, S.N. Krasnoperov

Abstract


Background. Modern surgical techniques to treat anterior knee instability provide excellent and good results in 75–91 %. However, there is a large group of patients — up to 25 %, with residual rotational instability after anterior cruciate ligament (ACL) reconstruction. The purpose of our work was to improve results of ACL reconstruction by developing specific indications for anterolateral ligament reconstruction. Materials and methods. The study included 119 patients, who were divided into two groups: a study group (63 patients, 52.9 %), where reconstruction of ACL and anterolateral ligaments were performed; the comparison group (56 patients, 47.1 %), where only ACL reconstruction was performed. In the early postoperative period, we evaluated VAS and time of knee flexion more than 90°. After 12-month follow-up, the stability of the knee joint was evaluated (Lachman test and pivot shift test), the subjective and objective IKDC and Lysholm scale were evaluated. Results. The level of pain according to VAS was statistically significantly higher, starting from the first post-op day in the study group. By the 3rd week, 57 patients (90.4 %) in the study group and 49 patients in the comparison group (87.5 %) had more than 90° flexion. Twelve months after surgery, in the study group, the results of the stability tests were statistically significantly better: Lachman test was negative in 83.6 %, while in the comparison group in 67.4 % (p < 0.05); negative pivot shift test was noted in 83.6 % of patients in the study group and 69.6 % of patients in the comparison group (p < 0.05). Providing detailed analysis of patients, who had positive Lachman tests and a pivot shift test, we noted a correlation with the presence of hypermobility in those patients. The results of the subjective IKDC, Lysholm scale in the study group were statistically significantly better than in the comparison group. Conclusions. When comparing two groups of patients, it should be noted that we obtained statistically significant best results in the group, where both ACL and anterolateral ligaments were reconstructed. It should also be noted that the additional reconstruction of anterolateral ligament did not increase functional morbidity and postoperative management of patients. The analysis of the results of treatment help us to identify some indications for anterolateral ligament reconstruction in patients with ACL injury.

Keywords


anterior cruciate ligament; anterolateral ligament; ­injury; reconstruction

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