Short-term Clinical Results Of Arthroscopic All-inside Reconstruction Of The Anterior Cruciate Ligament With A Single Hamstring Tendon

ObjectiveTo investigate the Short-term clinical results of arthroscopic all-inside reconstruction of the anterior cruciate ligament with a single hamstring Tendon.MethodsPatients with anterior cruciate ligament rupture who met the inclusion and exclusion criteria and were admitted to the Department of Bone,Joint and Sports Medicine,Qingdao Municipal Hospital between September 2020 and June 2022 were collected.All patients underwent all-inside technique ACL reconstruction by the same surgically experienced deputy chief surgeon under arthroscopy using an autologous semitendinosus tendon as a graft and fixing the femoral and tibial ends with a Tight-rope locking buckle with tabbed titanium plate(Arthrex,USA)suspension fixation.The patient’s Lachman test,axial shift test,MRI findings of ACL injury and the patient’s knee Vas score,IKDC score and Lysholm score were recorded preoperatively.Intraoperatively,the diameters and lengths of the patients’ surgical grafts,the lengths of the femoral and tibial tracts,and the management of combined meniscal injuries were recorded.Postoperatively,Lachman’s test,axial shift test,and MRI of the anterior cruciate ligament of the knee were collected at the patient’s last follow-up.Postoperative complications and knee Vas score,IKDC score,and Lysholm score at 1,3,and 6 months postoperatively were followed up and recorded.The preoperative and postoperative rates of positive Lachman test,positive axial shift test and positive MRI of anterior cruciate ligament injury were compared,as well as the preoperative,1-month,3-month and 6-month postoperative Vas score,IKDC score and Lysholm score of the knee to assess the short-term clinical outcome of the procedure.Results28 patients were included in the study,aged between 16 and 50 years,mean age:32.89 ± 10.83 years,including 18 male patients,10 female patients,12 patients with left knee injury,16 patients with right knee injury,16 patients with combined meniscal injury,7 patients with preoperative positive Lachman test grade II with hard termination point,21 patients with positive Lachman test grade III with soft termination point,4 patients with positive axial shift test grade I,16 patients with positive axial shift test grade II,8patients with positive axial shift test grade III.There were 21 patients with a positive Lachman test grade III with soft termination point,4 patients with a positive axial shift test grade I,16 patients with a positive axial shift test grade II,8 patients with a positive axial shift test grade III,8 patients with a grade III anterior cruciate ligament injury signal on MRI,and 20 patients with a grade IV injury signal.All patients were followed up for6 months.7 patients with a positive Lachman test grade II with a hard termination point were confirmed to have a majority of ACL rupture intraoperatively,and 21 patients with a positive Lachman test grade III with a soft termination point were confirmed to have a complete ACL rupture intraoperatively.Among them,16 patients had combined meniscal injuries,11 patients underwent meniscal suture,4 patients underwent meniscectomy,and1 patient underwent partial meniscectomy.The mean length of the femoral tract drilled during surgery was(19.64±2.33)mm,the mean length of the tibial tract was(21.96±3.14)mm,the mean length of the grafts used during surgery was(66.67±2.73)mm,and the mean diameter of the grafts was(7.77±0.64)mm.28 patients had Lachman test,axial shift test,and anterior MRI results of the ACL at the last follow-up: 1 patient with a positive Lachman test degree I,27 patients with a negative Lachman test,2 patients with a positive axial shift test grade I,26 patients with a negative axial shift test,26 patients with MRI results of the ACL suggestive of normal,and 2 patients with MRI of the ACL suggestive of grade I injury.After comparing the positive rate of Lachman test and positive rate of axial shift test between patients before surgery and at the last follow-up,there was a significant difference in the positive rate of MRI of anterior cruciate ligament injury(P < 0.05).The mean Vas scores of the 28 patients included in the inclusion criteria were(6.21±1.37),(3.64±1.16),(1.61±0.92),and(0.68±0.67)points before,1 month after,3 months after,and 6 months after surgery,respectively,and the mean IKDC scores were(44.75±5.64),(52.68±(4.91),(60.93±4.60),(72.98±4.51),and the mean Lysholm scores were(50.04±7.16),(58.07±7.59),(64.86±6.86),and(73.64±4.51),respectively.After comparison,the postoperative Vas score,IKDC score,and Lysholm score were significantly improved in 28 patients compared with the preoperative scores,with significant differences(P < 0.05).The Vas score,IKDC score and Lysholm score at different time points were significantly different when compared two by two(P < 0.05),and the Vas score gradually decreased with time,and the IKDC score and Lysholm score gradually increased with time.ConclusionArthroscopic single-bundle hamstring tendon all-inside technique to reconstruct the anterior cruciate ligament can restore the stability of the affected knee joint,reshape the continuity of the ruptured ligament,reduce the patient’s pain symptoms,and gradually improve the functional activity of the affected knee joint,with satisfactory results in the short term.