Short term functional outcome of patients with anterior cruciate ligament tear treated by arthroscopic ACL reconstruction using hamstring tendon autograft at Muhimbili Orthopaedic Institute.

Abstract

ABSTRACT The anterior cruciate ligament (ACL) is the most frequently injured knee ligament, accounting for about 50% of all knee ligament injuries. The majority of injuries occur during sports activities, soccer being one of the sports with the highest prevalence of ACL injury. Other causes are motor traffic crush and falling from height. Currently arthroscopic ACL reconstruction is the recommended standard treatment for anterior cruciate ligament deficient knees in most tertiary hospitals worldwide. Arthroscopic ACL reconstruction was first done at Muhimbili Orthopaedic Institute (MOI) in 2011, since then the number of patients treated by this procedure has been growing (total of 624 patients to date) but the surgical outcome has not yet established. Objectives: To determine the short term functional outcome of patients with anterior cruciate ligament tear treated by arthroscopic ACL reconstruction using hamstring tendon autograft at MOI. Materials and Methods: A prospective hospital based descriptive study involving adult patients with anterior cruciate ligament tear treated by arthroscopic ACL reconstruction using hamstring tendon autograft, was conducted at MOI for a period of twelve months from May 2017 to June 2018. A total of 47 patients met inclusion criteria and were all enrolled for the study. The patients were assessed and scored using Lysholm Functional Knee Scoring Scale (LFKSS) before treatment, and at 2 nd , 6 th , 12th and 16 th weeks post treatment. Flexion/extension angles was obtained on each visit by using a goniometer. At 2nd week the wound was assessed for infection and stitches removed. Data was collected, guided by structured questionnaire. At 16 th week the scores were compared with those before treatment. The data obtained were analyzed using SPSS version 20. vi Results A total of 47 patients with anterior cruciate ligament tear were enrolled at MOI for the study from May 2017 to December 2017 and all were followed up for functional outcome. 4 patients were lost to follow up, and only 43 patients were analyzed at 16 th week. Among 43 patients, 32 (74.4%) were male and 11(25.6%) were female with male to female ratio of 2.9:1. Out of the 43 patients 38 (88.4%) were below 40years whereas 5 (11.6%) were above 40years; with a mean age of 30.09±6.99SD Majority 35(81.4%) were treated 3months after their injury whereas 8(18.6%) were treated less than 3months after injury. The leading cause of ACL tear was sports-related activities which accounted for 36(83.7%), followed by Road traffic accidents which accounted for 7(16.3%). The mean flexion angle was 78.44±16.22˚SD before treatment and 134.58±4.18˚SD degrees at 16 weeks post treatment. (p value =0.001). The median Lysholm score was 55.98±12.24SD before treatment and 97.19± 3.14 SD at sixteenth week post treatment (p value=0.001). Functional outcome at sixteenth week postoperatively assessed and graded by (LFKS) was excellent in 34(79.1%) patients and good in 9(20.9%) patients. Outcome was not affected by age (p=0.686), sex (p=0.843) or duration of symptoms (p=0.294)