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Partial ACL tear: Is the selective single bundle reconstruction enough? A minimum 5 years follow-up study.
ESSKA Academy. Ibañez F. May 12, 2018; 218165; FP49-1136
Federico Ibañez
Federico Ibañez
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Abstract
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Objectives: In the last years, the two anterior cruciate ligament (ACL) bundles have increased relevance regarding to their individual function on knee stability. The purpose of this study is to determine the outcome of a selective reconstruction of an injured bundle of isolated anteromedial bundle (AMB) or posterolateral bundle (PLB), in a long term follow up.

Methods: Consecutive series of ACL reconstructions was prospectively analyzed, wich were performed between October 2008 and December 2012. All partial ACL tears who underwent selective bundle reconstructions were studied. Pre op stability was assessed with the Lachman, anterior-drawer test, and pivot-shift tests and KT-1000. Lysholm, Tegner, the International Knee Documentation Committee (IKDC) and Level of Satisfaction scores were used for clinical and functional assessment. Arthroscopy findings were the accurate method to diagnose the specific partials tears.

Results: Eighty-nine partial ACL reconstructions were performed. The minimum follow-up period was 60 months (range 60-100 months). At this time, seventy-six (85%) were able to contact and telephone interview with the functional scores. Thirty-four had AMB and forty-two had PLB tears. Twenty seven reconstructions were performed with semitendinosus tendon, twelve with gracilis, thirty-three using both of them, and four with allograft. Two patients (2.6%) suffered a re-rupture (1 motorcycle accident and 1 playing soccer).
The median Tegner score was 4 (range 1-10) before surgery and 6 (range 3-10) at the follow up (p<0.001). The mean Lysholm score before surgery was 64.09 and 95.93 at the follow up (p<0.001). The mean IKDC improved from 56.45 to 91.62 at the follow up (p<0.001). The level of satisfaction was very high.

Conclusions: The reconstruction of the single injured bundle provides excellent functional scores at a minimum 5 years follow up, also a normalized stability is achieved and gives the patient the opportunity and confidence to return to previous level of activity.

Keywords:
ACL, partial tears, single bundle reconstruction
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