Arthroscopic and Open Anterior Cruciate Ligament Reconstruction with Patellar Bone-Tendon- Bone Graft in Young Adult Knee

Abstract

Objective: To compare the outcome of arthroscopic assisted Anterior Cruciate Ligament (ACL) reconstruction of knee with limited open anterior cruciate ligament reconstruction in young patient with complete anterior cruciate ligament rupture.

Methods: This randomized controlled trial single blinded study using probability simple rando sampling was conducted from October 2014 to October 2016. Total 30 patients fulfilling the inclusion and exclusion criteria were divided into two groups on the basis of availability of expertise of arthroscopy surgeon. Patients in group A was managed with arthroscopic ACL reconstruction while patient in group B were managed with limited open reconstruction. Each group consisted of 15 patients. The bone-tendon-bone was utilized as the graft material to reconstruct the ACL in both the groups. Rehabilitation protocol was same for both the groups. Duration of surgery, loss of range of motion (ROM) and Tegner Lysholm Knee score were compared in patients of both groups after 6 months of surgery.

Result: Mean age of the patient in group A was 24.33± 3.73 years (range 18-32 year) while that in group B was 24.89± 5.37 years (range 18-34 years). The duration of surgery was statically significantly high in arthroscopic ACL reconstruction than that in open ACL reconstruction (92.00±2.64 vs 68.07±3.63 minutes in group A and B respectively) with p-value less than 0.0001. Loss of ROM at the end of 6^th month was comparable (6.00⁰±1.19 versus 5.73⁰±1.33 in group A and B respectively) between the two groups with p-value of 0.526 at 95% confidence interval. We had 86.67% (13) patient in group A and 80% (12) in group B with good- excellent result according to Tegner Lysholm knee score.  There was no statistically significant difference in Tegner Lysholm test between two groups with p-value of 0.497. Two patients in group A and 3 in group B had superficial wound infection. Two patients in group B had failure of graft following RTA. All the patients from both group had lost sensation on the anterior aspect of knee in both groups.

Conclusion: The result did not substantiate superiority of either technique in terms of functional outcome. However, arthroscopic ACL reconstruction required more surgical time than the limited open technique.