Comparative analysis of arthroscopic techniques of anterior cruciate ligament reconstruction in adolescents

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Abstract

Background. According to the considerably contradictory information across the international literature, both the anatomical and transtibial reconstruction of the anterior cruciate ligament (ACL), under similar conditions, yield good functional results from treatment. Therefore, it is important to evaluate the comparative effectiveness and the prospects of certain methods of ACL reconstruction. The purpose of this study was to analyze the possibilities and advantages of anatomical technologies for the reconstruction intervention.

Aim. To compare the outcomes of ACL reconstructions among adolescent children using different methods.

Materials and methods. The outcomes of 94 arthroscopic reconstructions of the ACL in adolescents were analyzed. The patients were categorized into 3 groups: Group 1 included 32 patients (34%) who underwent isometric plastic surgery of the ACL, wherein the femoral canal was formed using the transtibial technique. Group 2 included 30 patients (32%) who underwent anatomical plastic surgery of the ACL, with the formation of the femoral canal through additional anteromedial arthroscopic access. Group 3 included 32 patients (34%) who underwent the “all-inside” anatomical reconstruction of the ACL.

Results. A comparative analysis of the outcomes of reconstruction of the ACL among adolescents revealed that the anterior-posterior and rotational stability of the knee joint was better in group 3 patients than in groups 1 and 2 patients. In fact, the group 3 patients showed a significantly less positive pivot-shift (0 degree to 87.5%; I+ the extent of 12.5%) — than the group 1 patients (0 degree — 46.8%; I+ degree — 25%; II+ degree and 21.9%; III+ degree and 6.3%), followed by the group 2 patients (0 degree to 86.6%; I+ degree 6.7%; II+ degree of 6.7%).

Conclusion. Considering the safety aspects of intra-articular structures and for the better anatomical orientation of the femoral canal, the all-inside method of ACL reconstruction yielded better outcomes of postoperative anterior-posterior and rotational stability of the knee joint.

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About the authors

Marsel R. Salikhov

Vreden National Medical Research Center of Traumatology and Orthopedics

Author for correspondence.
Email: virus-007-85@mail.ru
ORCID iD: 0000-0002-5706-481X

MD, PhD, Assistant Researcher

Russian Federation, Saint Petersburg

Vladislav V. Avramenko

Saint Petersburg State Pediatric Medical University

Email: avramenko.spb@mail.ru
ORCID iD: 0000-0003-0339-6066

MD, Head of the Department of Traumatology and Orthopedics

Russian Federation, Saint Petersburg

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Supplementary files

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2. Fig. 1. Scheme of the surgery, axial view: a, group 1; b, group 2; c, group 3

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3. Fig. 2. Scheme of the surgery, frontal view: a, group 1; b, groups 2 and 3.

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Copyright (c) 2020 Salikhov M.R., Avramenko V.V.

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