Clinical outcome of anterior cruciate ligament partial injury repair with suture anchor under arthroscopy

doi:10.3877/cma.j.issn.1674-134X.2023.03.005

Abstract

Abstract:

Objective

To explore the early clinical outcome of partial injury of anterior cruciate ligament (ACL) repair with suture anchor repair under arthroscopy.

Methods

From January 2018 to December 2019, a total of 40 patients with ACL injuries attending the Department of Sports Medicine of the First Affiliated Hospital of Kunming Medical University were included. All the patients were acute injuries and partial tears of the femoral attachment of the ACL with good synovial coverage confirmed by MRI and arthroscopy, with positive results of anterior drawer test or Lachman test before operation. The patients with a history of gouty arthritis or rheumatoid arthritis were exluded. There were 25 males and 15 females, aged from 13 to 42 years. The injured knees were on the left side in 17 patients and on the right side in 23 patients. Under arthroscope, suture anchors were used to repair the partially injured ACL. The recovery of anterior cruciate ligament (ACL) was evaluated by MRI examination. The Tegner score, Lysholm score and IKDC score were compared before surgery and at three, six, 12 months after surgery by repeated measurement data analysis of variance. Forty healthy adults were also recruited for the knee function data by the Opti Knee three-dimensional movement analysis system. The independent sample t test was applied to compare the data of the patients and healthy adults and evaluate the knee function of the patients.

Results

The average age of the patients was (28.0±1.2) years, the time from injury to operation was (13±0.4 )days on average. All the patients were followed up after surgery. There was no secondary ACL injury and operative complications. There were statistically significant differences in Tegner score, Lysholm score and IKDC score at 12 months after operation compared with the data before operation( F=222.839, 295.774, 268.836, all P <0.05). The results of MRI showed that the continuity and fibrosis signal intensity grade of 40 patients were all gradeⅠ. There was no statistically significant difference in the range of internal-external rotation angle, the range of flexion and extension, the range of varus and valgus angles, the ranges of antero-posterior, internal-external and proximal-distal displacements, the maximum step length, the minimum step length or the step frequency compared with healthy adults at 12 months after operation (all P>0.05).

Conclusion

Partial injury of ACL repaired with suture anchor under arthroscope is beneficial to early rehabilitation of knee joint and function recovery of knee, that may achieve good early clinical outcome.

Key words: Anterior cruciate ligament, Wounds and injuries, Suture anchor, Suture techniques

Xu Wang, Yanlin Li, Guoliang Wang, Zhenglyu Zhao, Di Jia, Ziwen Ning, Zhengliang Shi, Lu He, Kun Wang. Clinical outcome of anterior cruciate ligament partial injury repair with suture anchor under arthroscopy[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2023, 17(03): 326-333.

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https://zhgjwkzz.cma-cmc.com.cn/EN/Y2023/V17/I03/326

Figures/Tables 7

Figure 1 Surgical procedure of partial ACL injury under arthroscope. A : intraoperative exploration of ACL femoral attachment tear.; B: ACL relaxation; C~D: the synovial membrane on the surface of ACL was well covered; E: an absorbable anchor with suture was implanted at the femoral attachment tear site of ACL; F~G: suture hooks were used to suture ACL in figure-of-eight suture; H: exploration of the torn end of the cruciate ligaments attached to the femur after fixation

Table 1 General information of the surgical group and healthy group

组别Groups	性别(例，男/女)Gender (male/ female)	年龄[岁，(±s)]Age	侧别(例，左/右)Operation side(left/ right)	BMI[kg/m^2, (±s)]
手术组Operation group	25/15	28.0±1.2	17/23	23.5±1.2
健康组Health group	22/18	28.5±4.9	15/15	23.3±1.0
统计值	χ²＝0.068	t＝1.076	χ²＝0.083	t ＝0.550
P值	>0.05	>0.05	>0.05	>0.05

Table 2 Tegner, Lyshlom and IKDC scores of the involved knees before and after knee surgery

时间Time	Tegner	Lyshlom	IKDC
术前Before operation	2.3±0.6	51.9±9.0	48.4±11.8
术后3个月Three months after operation	3.9±0.5^a	76.5±7.0^a	60.7±9.9^a
术后6个月Six months after operation	5.7±0.6^ab	92.6±3.4^ab	89.6±9.1^ab
术后12个月12 months after operation	6.1±0.6^abc	95.8±2.6^abc	96.4±3.7^abc
F值	222.839	295.774	268.836
P值	<0.001	<0.001	<0.001

Figure 2 Preoperative and postoperative MRI changes of the ACL of the left knee. A is preoperative MRI, showing a large number of high signals in the anterior cruciate ligament；B is MRI at six days after surgery, showing ACL running continuously with some high-signal shadows; C is MRI at six months after surgery, showing good alignment and continuity of ACL; D is MRI at 12 months after surgery, showing that ACL runs continuouslyNote: the ACL without injury presents as a strip of low signal, high signal indicates the ACL injury, the higher the signal indicates the more serious the injury

Table 3 Comparison of flexion and extension Angle, varus and valgus Angle, internal and external rotation Angle of the affected knee with healthy subjects 12 months after operation

组别Groups	例数Number of cases	屈伸角Flexion and extension	内外翻角Varus and valgus angles	内外旋角Internal and external rotation angles
手术组Operation group	40	56.0±4.2	11.9±2.1	13.4±2.4
健康组Health group	40	56.9±5.0	12.5±2.9	13.7±2.7
t值		0.756	0.899	0.474
P值		>0.05	>0.05	>0.05

Table 4 Anteroposterior, proximal-distal and internal-external displacements of the involved knee at 12 months after operation

组别Groups	例数Number of cases	前后位移Antero-posterior displacement	上下位移Proximal-distal displacement	内外位移Iinternal-external displacement
手术组Operation group	40	1.50±0.36	1.45±0.32	0.86±0.25
健康组Health group	40	1.49±0.39	1.38±0.34	0.85±0.25
t值		0.127	0.86	0.041
P值		>0.05	>0.05	>0.05

Table 5 Maximum and minimum stride lengths and stride frequency of the involved knee at 12 months after operation

组别Groups	例数Number of cases	最大步长(cm)Maximum step length	最小步长(cm)Minimum step length	步频(步/min)Step frequency
手术组Operation group	40	51.3±3.6	45.1±4.1	12.4±1.1
健康组Health group	40	51.2±3.9	45.1±4.1	12.8±1.2
t值		0.174	0.07	1.372
P值		>0.05	>0.05	>0.05

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