ASSESSMENT OF OUTCOME OF ARTHROSCOPIC RECONSTRUCTION OF ANTERIOR CRUCIATE LIGAMENT USING QUADRICEPS TENDON GRAFT IN A KASHMIRI POPULATION ”.

Abstract

Background: Various grafts are used for the reconstruction of ACL. Bone patellar bone graft, Hamstrings graft, Quadriceps graft, allografts, synthetic grafts. Allografts result in the lower level of stability & higher failure rates and increased risk of infection. Synthetic grafts are not in vogue due to their high rate of rupture and recurrent sterile knee effusions. Hamstring grafts have longer healing and integration time and the use of hamstrings eliminates the protective and stabilizing action that these muscles exert on the knee, this lands the knee into quadriceps dominant and valgus position which may predispose to rupture of ACL graft. Quadriceps tendon graft reduces the risk of infra patellar scarring as its harvesting does not affect the patellar tendon.

AIMS & OBJECTIVES: To assess the outcome of Arthroscopic reconstruction of Anterior cruciate ligament using Quadriceps tendon graft in a kashmiri population.

STUDY DESIGN: Prospective observational study.

PARTICIPANTS: 30 patients with ACL injury meeting the inclusion criteria.

METHODS: After seeking approval from Institutional Ethical Committee, this study was conducted on patients attending Out patient department with Anterior cruciate ligament injury at SKIMS Medical College Hospital Bemina, Srinagar from February 2018 to June 2019. Informed and written consent was obtained from all the patients in urdu language. The functional outcome was assessed at 9 months follow up using using Lysholm score, IKDC score and Tegner activity level.

RESULTS: Based on Lysholm score, 15 patients (50%) had excellent functional outcome while 10 patients (33%) had good outcome. The remaining 5 patients (17%) had a fair outcome. There was significant improvement in postoperative IKDC score and tegner activity level when compared with preoperative IKDC score.

CONCLUSION: This study found that the ACL injuries are common in younger age group individuals. Males are more prone to this injury. Sports injuries are the commonest cause for ACL injuries. ACL reconstruction with Quadriceps tendon graft is an excellent treatment option for ACL deficient knees. ACL reconstruction using Quadriceps provides a stable knee with minimal complications and reduces postoperative morbidity and enables early rehabilitation. Graft has a larger uniform diameter.

IMPLICATIONS: ACL reconstruction using quadriceps tendon graft is an excellent treatment option for ACL deficient knees. The suprapatellar pouch should not be disrupted while harvesting the Quadriceps tendon graft. Preoperative MRI can be done for determining Quadriceps tendon graft thickness.