Non-use of intra-articular drain after anterior cruciate ligament reconstruction does not affect postoperative knee pain and muscle strength on early period

Introduction: This study aimed to determine the effect of using an intra-articular drain after anterior cruciate ligament (ACL) reconstruction on early postoperative pain, range of motion (ROM), muscle strength, and complications. Materials and methods: Between 2017 and 2020, of the 200 consecutive patients who underwent anatomical single-bundle ACL reconstruction, 128 patients underwent primary ACL reconstruction with hamstring tendons and were evaluated for postoperative pain and muscle strength at 3 months postoperatively. Sixty-eight patients who received intra-articular drain before April 2019 were classified as group D and 60 patients without an intra-articular drain after ACL reconstruction after May 2019 were classified as group N. Patient background, operative time, postoperative pain, number of additional analgesics used, presence of intra-articular hematoma, ROM at 2, 4, and 12 weeks postoperatively, extensor and flexor muscle strength at 12 weeks postoperatively, and perioperative complications were compared between the two groups. Results: The postoperative pain at 4 h after surgery was significantly greater in group D than in group N although no significant difference was found in the pain felt in the immediate postoperative period and at 1 day and 2 days postoperatively and in the number of additional analgesics used. No significant difference in the postoperative ROM and muscle strength was noted between the two groups. Six patients with intra-articular hematomas in group D and four patients in group N needed puncture by 2 weeks postoperatively, and no significant difference was found between the two groups. Conclusion: Postoperative pain was greater at 4 h postoperatively in group D. Furthermore, the intra-articular drain did not affect muscle strength, ROM, and complications on the early postoperative period. The usefulness of intra-articular drain after ACL reconstruction was considered low. Level of Evidence: Level IV

Preoperative psychological competitive ability has little relationship with subjective knee function and return to sports at 6 months postoperatively in patients with anterior cruciate ligament reconstruction

Objective: This prospective study aimed to investigate the relationship between preoperative psychological competitive ability and preoperative and 6 months postoperative subjective knee function in patients undergoing anterior cruciate ligament (ACL) reconstruction. Methods: Eighty-four patients who underwent ACL reconstruction and had a Tegner Activity Scale score of 6 or more were included in this study. Preoperatively, all patients were administered the Diagnostic Inventory of Psychological Competitive Ability for Athletes (DIPCA.3) for psychological competitive ability assessment and the International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form for subjective knee function assessment. The IKDC subjective score was re-evaluated 6 months postoperatively. We evaluated the associations of volition for competition, mental stability and concentration, confidence, strategic ability, and cooperation (DIPCA.3 factors) with the IKDC subjective score preoperatively and 6 months postoperatively. Furthermore, patients were classified into two groups according to whether they could return to participate in the entire practice and compared the DIPCA.3 total score and IKDC subjective score. Results: The DIPCA.3 confidence score negatively correlated with the preoperative IKDC subjective score (β = −0.34, p = 0.04). However, there was no association between the DIPCA.3 score for all variables and IKDC subjective score at 6 months after ACL reconstruction. Moreover, the DIPCA.3 total score was not related to return to participate in the entire practice 6 months after ACL reconstruction. Conclusion: Psychological competitive ability is not associated with a return to participate in the entire practice, and a low preoperative IKDC subjective score should not be viewed too negatively