Current trends in Anterior Cruciate Ligament reconstructions

The rupture of the Anterior Cruciate Ligament (ACL) is a common complication of knee trauma. Arthroscopic ACL reconstructive surgery is the method of choice in most of these cases. This is an increasingly common procedure due to low invasiveness, good treatment results and a constantly growing number of operators able to perform them. The aim of the study is to review currently used methods for the reconstruction of the Anterior Cruciate Ligament. There are many types of transplants, and the choice depends on individual factors (including gender, age, occupation, physical activity) and the patient's expectations. The operator's skills and preferences also determine the choice of therapy. Considering the above-mentioned aspects, authors of the study will analyze ACL reconstruction methods based on the latest literature. Currently, the basic treatment of ACL injuries are arthroscopic procedures. Due to the various types of transplants, the procedure, result and complications may vary depending on the choice. An autograft is the preferred treatment for this injury. Autografts that are prefered are the ligaments of the semitendinosus muscle and the patellar tendon. Less frequently used autografts include ligaments of the quadriceps muscle of the thigh and gastrocnemius muscle (Achilles tendon). Another type of transplant is an allograft. The graft is taken from a donor (a deceased donor in cases of ligament transplants). It is less frequently used due to its high cost, lower strength compared to an autograft and a greater number of complications. The third type of transplants are synthetic grafts. These are fibers made of materials such as Gore-Tex. Synthetic grafts are also rarely used for the same reasons as allografts. Internal Bracing (IB) is becoming a more popular procedure. This method allows you to re-attach broken ligaments in their original position. This is possible if only one end of the ligament is broken. An important issue is the number of bundles (single-bundle, double-bundle), the position and the type of attachment (titanium screws, absorbable, endobutton). The final choice of the treatment method depends on the operator's skills and preferences

Rehabilitation after one-stage anterior cruciate reconstruction and osteochondral grafting

At least 10–20% of all ACL reconstructions require additional cartilage repair. The aim of this study was to compare the activity recovered by patients after one-stage open ACL reconstruction and osteochondral autologous grafting of articular cartilage lesions and after isolated open ACL reconstruction. The study group included 21 patients with chronic ACL deficiency and grade III or IV cartilage lesion according to the ICRS scale who were treated with combined ACL reconstruction and osteochondral grafting in one step. The control group included 32 patients with chronic ACL insufficiency and no chondral deficit higher than grade I on the ICRS scale who underwent isolated reconstruction of the ligament. For the assessment, the Lysholm and Gillquist (L&G) score and the functional Marshall score were used. Both groups displayed a statistically significant improvement in the L&G score and the Marshall score between the preoperative and 12-month assessments. The mean gain in L&G score over this period was 30.66±7.79 in the study group and 31.65±6.96 in the control group. The difference between the control group and the study group was not significant. The difference between 12 months and initial assessment was counted. The mean gain in Marshall score was 9.05±3.81 in the study group and 10.71±3.43 in the control group. The difference between the initial and the 12-month evaluation was statistically significant (p=0.49). Return to normal activity was slower and patient satisfaction was lower during the first year after operation in the study group than in the control group, however the overall advantage of the one-step operation outweighs the slightly inferior functional results at 12 months

Comparison of bioabsorbable interference screws and posts for distal fixation in anterior cruciate ligament reconstruction

Comparison of the results of bioabsorbable interference screws and posts for hamstring graft distal fixation in ACL reconstructions are presented. The results of 20 patients with bioabsorbable screws were compared to 22 patients with posts. The assessement was based on Lysholm-Gillquist and Marshall scores and the KT-1000 device. In the study group the points gained were 38.9 in the Lysholm-Gillquist and 12.89 in the Marshall scale. The average KT-1000 difference was 2.46 mm. In the control group the points gained were 32.93 in the Lysholm-Gillquist and 11.47 in the Marshall scale. The average KT-1000 difference was 2.5 mm. There were 14 patients in the study group with interference screw problems; in 2 the implants were removed. (1) There are no differences in outcome using bioabsorbable interference screws and posts for distal fixation of hamstring ACL grafts. (2) The lack of bioabsorbtion with poly L-lactide interference screws is frequent and causes problems