Anatomical All-Inside Anterior Cruciate Ligament Reconstruction Using Quadrupled Semitendinosus Tendon Graft with Posteromedial Harvest - Clinical Results of Prospective Study at a Minimum 12-Months Follow-up

PURPOSE OF THE STUDY This original paper aims to present the conclusions of the prospective study evaluating the clinical results of anatomical all-inside ACL reconstruction using quadrupled semitendinosustendon graft with posteromedial harvest using suspensory fixation by Tightrope implants at the follow-up of at least 12 months. MATERIAL AND METHODS The prospective study included a total of 119 patients (74 men/39 women) with the mean age of 28.3 (18-52) years, in whom demographic data was collected and a clinical examination was performed. The patients satisfying the "inclusion" and "exclusion" criteria were enrolled in the study and subsequently underwent the same, aforementioned surgical procedure performed by a single surgeon. Preoperatively and at a minimum 12-month follow-up the following subjective criteria were evaluated using the Lysholm and IKDC subjective scores and the Visual Analogue Scale (VAS) (0-10). The objective parameters comprised the side-to-side difference in anterior knee laxity assessed by Genourob arthrometer with an applied pressure of 134 and 250 N, anterior drawer test, and the pivot shift test. The occurrence of graft failure, complications and return to pre-injury sport levels were monitored. The obtained data was statistically evaluated at the statistical significance level of 0.05. RESULTS A total of 89 patients were assessed at the follow-up of at least 12 months after the surgery. The median Lysholm score increased over time from 58.7 preoperatively to 94.2 postoperatively (p < 0.05) and the IKDC subjective score went up from 46.3 to 91.4 (p < 0.05). The median postoperative VAS kept decreasing from 7.3 (Day 2), 5.1 (Day 14), 3.1 (Week 6), 1.2 (Month 6) to 0.3 at 12 months after the surgical procedure. Preoperatively, the results were significantly positive (i.e. C, D) in 52.8% (C) and 21.4% (D), whereas postoperatively the results of the PST were significantly positive only in 4%. Therefore, the surgical procedure was conducive to a statistically significant decrease in rotational knee laxity over time (p < 0.05). The median side-to-side difference in anterior laxity of the operated knee objectively assessed by GNRB arthrometer with the applied pressure of 134 N was 4.2 mm (3.1-6.8) as against the postoperative 1.2 mm (0.4-2.1) and with the applied pressure of 250 N it was 6.2 mm (4.6-8.7) prior to the surgical procedure versus 2.4 mm (1.6-3.5) postoperatively. That concerned a statistically significant decrease of postoperative side-to-side difference in anterior laxity of the operated knee at both the measured pressures (p < 0.05). The graft failed in 3 patients only (3.4%), no major complications associated with the surgical procedure were observed and 62 of the evaluated patients (69.6%) were able to return to the pre-injury level of sport within one year after the surgery. DISCUSSION When comparing the results obtained by our study with the conclusions of clinical studies carried out by other authors and evaluating similar clinical parameters with the identical surgical technique applied, it is obvious that in our group of patients we achieved similar clinical results as the other authors from abroad. CONCLUSIONS The results of our study showed that the all-inside ACL anatomical reconstruction using quadrupled semitendinosus tendon graft with posteromedial harvest with suspensory fixation by Tightrope implants at one year after the surgery bring very good subjective as well as objective clinical results and minimum complications. Key words:anterior cruciate ligament tear, anatomical ACL reconstruction, all-inside technique, posteromedial harvest, quadrupled semitendinosustendon graft, retrograde drilling, suspensory graft fixation.