Priyank Uniyal1, Srinivasa Reddy D2, Bharath B. N3, Rakesh Reddy4
BACKGROUND: Anterior cruciate ligament is an intra-articular, extra synovial structure present in the central complex of knee joint. It functions in concert with all other anatomical structures in the knee joint to control and limit motion and to maintain both static and dynamic equilibrium. It is commonly injured in athletic activities specially contact sports and motor vehicle accidents. Ligament disruption occurs without a fall or direct contact where deceleration along with valgus external rotation or hyper extension force comes into play. The aim of surgical treatment is to restore knee stability, thereby allowing the patient to return to his original physical activity levels. The choice of graft and its fixation plays a key role in ACL reconstruction. An ideal graft would be one that provides as much strength as native anterior cruciate ligament, allows for secure fixation, has minimal harvest site morbidity, enables unrestricted rehabilitation and restores normal knee biomechanics and kinematics. AIM: To assess the effectiveness of the bone-patellar tendon-bone graft compared to hamstring tendon graft as used in the treatment of anterior cruciate ligament injuries of the knee. DESIGN: This is a prospective study. MATERIALS AND METHODS: This prospective study was conducted at a tertiary hospital for a period of twelve months from June 2013 to July 2014. Patients presenting with unilateral knee injury in Outpatient department and Casualty of the hospital were evaluated by a thorough general and local clinical examination of the knee. Uninjured knees of same subjects in supine position were taken as reference. Subjects fulfilling the predetermined inclusion and exclusion criteria were included in the study. STATISTICAL METHODS: Intergroup comparison was analysed by K- Independent sample t test. Intragroup comparison was analysed by Paired t - test. RESULTS: Patients were divided into two groups and treated with using Bone-patellar tendon-bone graft and Hamstring graft respectively. Mean age group of patients was 29.16 yrs. (range 16-51yrs) and 30.88yrs. (range 19-48yrs) in group A and B respectively we found the incidence of ACL injury in 15-44 years age group to be greater than twice the general population. A mean delay in surgery of 4.66 months (range 2-12 months) since the time of injury in group A and 4.46 months (range 2-7 months) in group B was observed. Subjective IKDC evaluation was done at the end of 12 months. There was no difference in both the groups in the terms of effusion, passive motion, knee compartment findings, ligament examination, X-ray findings. Functional test and IKDC grade of both the groups showed statistically very highly significant improvement. However, there was statistically very high Harvest site pathology in group A. CONCLUSION: We found that there is statistically no significant difference in the overall clinical outcome between hamstring autograft with transfix and bone-patellar tendon-bone autograft with interference screw except that the patellar tendon group had a greater tendency of having donor site morbidity compared to the hamstring tendon group.
