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Comparison Study on Recovery of Proprioception between Autograft and Allograft for Anterior Cruciate Ligament Reconstruction

Author: XieLei
Tutor: ChenBaiCheng
School: Hebei Medical University
Course: Surgery
Keywords: Autograft Allograft Anterior cruciate ligament Reconstruction Proprioception
CLC: R687.2
Type: Master's thesis
Year: 2012
Downloads: 66
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Abstract


Objective:Anterior cruciate ligament(ACL) injury is one of the mostcommon knee injury. Following ACL rupture, the stability of the knee can bedamaged seriously. Do not reconstructing the ACL will lead to to kneeinstability, meniscal tear, articular cartilage injury, traumatic arthritis andtraumatic synovitis. At present, the most effective treatment for ACL ruptureis arthroscopic anterior cruciate ligament reconstruction. One of the mostmature and commonly approach used in surgical reconstruction is arthroscopicsingle-bundle ACL reconstruction. This surgical approach focused on theanteromedial bundle reconstruction and can restore the stability of the knee.This approach comes to be the reconstruction standard and are widely used. Inclinically, we often found that patients complain that they still have the feelingof joint instability after ACL reconstruction of knee, but after the examinationof the knee we found that the knees of these patients with good ligamenttension and would not occur of the phenomenon of joint instability inactivities. Recent studies have found that the ACL play an important role ofproprioception. Similarly, studies have shown that the proprioceptivesensitivity of the normal knee, the knee with the ACL injury, the knee after theACL reconstruction were vary. How to achieve the best proprioceptiverecovery after ACL has become the focus of study. The purpose of this studyis to search if there is any proprioceptive difference between autograft andallograft single-bundle ACL reconstruction.Methods:From February2010to March2011, according to the inclusioncriteria, all the patients with arthroscopic ACL reconstruction come to bescreened and62patients met the inclusion criteria. According to the different sources of the grafts, all the patients were divided into two groups: autograftand allograft group. There were26cases in autograft group,and36cases inallograft group.20cases that were randomly and respectively selected fromthe two groups as the clinical data to be statistically analyzed. All patientswere informed consent. General information of the two groups such as gender,age, disease duration, functional scores, has no statistical significant difference(P>0.05). The surgical approach is using single-bundle graft and retaining theinjured ACL stump in the tibial or femoral intercondylar fossa. The autograftgroup harvested the semitendinosus and gracilis tendons as the grafts afteroverlapping sutured; the allograft group used two deep-frozen lower limballograft tendons as the grafts after overlapping sutured. At90°of flexion, thetibial guide was positioned in the center of the remaining ACL footprint todrill the tibial tunnel; at100°-110°of flexion, the femoral guide was placed atthe11:00-o’clock position(for a right knee) or the1:00-o’clock position (for aleft knee) to drill the femoral tunnel. Then the femoral side of the graft wasfixed by using the RetroButton; at30°of flexion, pressing the tibia, the tibialside of the graft was fixed by using the bio-absorbable interference screw withtension being maintained. Immediately after surgery, patients’ knees wereasked to rehabilitation exercises, from2weeks after the operation the range ofmotion had achieved45°,90°after1month and130°after3months. Allpatients were followed up at the3rd month and12th month after surgery, inorder to document the proprioceptive capabilities of the knees, patients wereasked to perform passive angle reproduction test at30°,60°and90°by thecontinuous passive motion (CPM) machine to evaluate the joint positionsense(JPS). Each test repeated3times to obtain a mean value for statisticalanalysis. In addition, the range of motion of the knee, IKDC (InternationalKnee Score Board) score and the Lysholm score were used to assess he kneeat the12th month after surgery.Results: The incisions of all the patients in both groups achieved healingof incision by first intention, without infection and intra-articular bleeding andother complications. Patients in allograft group had no rejection. All patients were followed up12-18months (mean,13.5months). At the12th month aftersurgery, the anterior drawer test, Lachman test, pivot shift test werenegative. There were significant differences in the range of motion of the knee,the IKDC score and the Lysholm score between preoperation and12monthspostoperatively in the two groups (P<0.05). There was no significantdifference in those evaluations between the two groups (P>0.05). There wasno significant difference in JPS30°, JPS60°and JPS90°between affectedknees and normal knees in autograft group at3months postoperatively(P>0.05). No significant difference was found in JPS30°between affectedknees and normal knees in allograft group at3months postoperatively(P>0.05); but significant differences were found in JPS60°and JPS90°between affected knees and normal knees in allograft group at3monthspostoperatively (P<0.05). There was no significant difference in JPS30°, JPS60°, and JPS90°between affected knees and normal knees in the two groupsat12months postoperatively (P>0.05). Significant differences were also foundin JPS60°and JPS90°between affected knees of the two groups (P<0.05) at3months postoperatively. No significant difference was found in JPS30°, JPS60°, and JPS90°between affected knees of the two groups at12monthspostoperatively (P>0.05).Conclusions: The results of this study showed the appearance ofsignificant deficit of the overall function of the knees after ACL injury;arthroscopic ACL reconstruction can restore the mechanical stability and theproprioception of the knee; autograft ACL reconstruction is better thanallograft ACL reconstruction regarding the recovery of proprioception in theearly time after surgery.

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CLC: > Medicine, health > Surgery > Orthopaedic Surgery ( movement system diseases,orthopedic surgery ) > Orthopedic surgery and surgery > Muscle and tendon surgery
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