Baur C.*, Mathieu N.***, Delamorclaz S.*, Hilfiker R.***, Siegrist O.**, Blatter S**., Fournier S.*

Transcription

1 Anterior cruciate ligament reconstruction : Comparison of Hamstring Tendon autograf vs Bone Patellar Tendon Bone autograf : a retrospective cohort study of 111 patients. Baur C.*, Mathieu N.***, Delamorclaz S.*, Hilfiker R.***, Siegrist O.**, Blatter S**., Fournier S.* * Physical and rehabilitation department, Hôpital du Valais, Martigny, Switzerland ** Orthopedic department, Hôpital du Valais, Martigny, Switzerland *** University of applied Sciences HES SO Valais Sion, Switzerland

2 Introduction

3 Introduction ACL: the most common complete ligamentous injuries that occur in the knee joint. In Switzerland: most patients with ACL injuries sportsmen & athletes aged about 30 years Amateur Recreational And often professional sports. Richard DF et al.,

4 Introduction The most commonly used autografts : BPTB graft and HT graft Bizzini M. et al., 2006 Fu et al.,

5 Introduction BUT... The graft choice for ACL reconstruction continues to be controversial Dheerendra SK et al.,

6 Goals of the reconstruction to stabilize the knee to allow a safe and powerful return to the previous level of sports or recreational activity. 6

7 Introduction Postoperative rehabilitation plays a crucial role in returning patients to athletic or demanding occupational activities. 7

8 Introduction It is very important to restore: normal muscle strength balance proprioception other neuromuscular indices required for high-risk activities (cutting, twisting, turning, jumping and pivoting) Wilk KE et al., 1994 Barber-Westin SD,

9 Introduction The orthopaedic surgeons of our institution tend to prefer (without any strong argument) the HT autografts. 9

10 Key issue Is there a relevant difference in muscular properties after ACLreconstruction regarding graft choice? 10

11 Literature review Extensor muscles : No difference in strength for both grafts (BPTB HT) Flexor muscles : HT group weaker than BPTB group Condouret et al., revue chir orth., 2008 Mean peak flexion torque and extension work : No difference between both groups (BPTB HT) Overall flexion work lower in HT group Gifstad et al., KSSTA,

12 LITTERATURE REVIEW : META-ANALYSIS HT autografts vs BPTB autografts - similar postoperative effects in terms of restoring knee joint function Li et al., Arch. of Ortho. and Trauma Surg., 2012

13 Aim of the study to assess muscular properties after ACLreconstruction in both techniques with functional outcomes (BPTB vs HT grafts) 13

14 Hypothesis Power, Strength Velocity of HT muscles = less altered after BPTB-graft than HT-graft Ageberg E et al.,

15 Method

16 Study Design Design Retrospective cohort study ( ) Non-randomized Data acquisition by 3 physiotherapists and a surgeon Follow-up 45 months ( months) 16

17 Inclusion s criteria ACL tear operated at Hôpital du Valais no previous ligamentous injury and/or surgery of either knee no previous meniscal pathology treated with resection or repair 17

18 Flowchart 18

19 4ceps & HT muscle capacities assessed with maximal isotonic contraction assessed with an accelerometer (Myotest ) Power (W/Kg) Strength (Nm/Kg) Velocity (m/sec.) open - and closed kinetic chain 19

20 Dynamic knee stability evaluated with two functional tests the single-leg hop (Bosco 1983) the Olympic-test (n.v. 2012) 20

21 Self-assessed knee function reported using : Tegner scale Lysholm score KOS-SAS (Knee Outcome Survey Sports Activities Scale) Tampa-scale Q 21

22 Statistical analyses Data expressed as means and standard deviations. Samples t-test level of significance set at P<0.05. Effect size index (Cohen 1992) (t-test): 0.2 = small effect 0.5 = moderate effect 0.8 = large effect 22

23 Results

24 Descriptive Data 24

25 Objective Outcomes Isotonic test 25

26 Objective Outcomes Single-Hop-test (Bosco) 26

27 Objective Outcomes Dynamic Knee Stability 27

28 RESULTS (n = 111; f/up 45 mts) 13 observations and analyzis 4 statistically sign. differences 28

29 Subjective Outcomes Self reported Questionnaire 29

30 RESULTS (n = 111; f/up 45 mts) 5 observations and analyzis 1 statistically sign. difference

31 Discussion BPTB group performed better in 14 of the 18 observed outcomes 6 were statistically and clinically significant velocity in 4ceps & HT hamstring power-max and mean-power functional score (Tegner & KOS-SAS) 4 outcomes were in favor of HT group but none was statistically significant. 31

32 Discussion Following ACL surgery, a safe return to full activity and prevention of re-injury require advanced physical therapy rehabilitation based on the specific sport or activity with an individualised program. Kvist J, 2004 Dheerendra SK. Et al.,

33 Strenght of the study Functional outcomes observed Length of the follow-up (mean: 45.4 months). Same surgeon in the same hospital Same procedure for both types of grafts 33

34 Limits Retrospective cohort not randomized with regard to the surgical interventions. Confounding factors with non-measured variables? Power testing of hamstring muscle 90 flex. 34

35 Conclusion Side to side differences statistically significant difference in favour of BPTB for Hamstring & 4-ceps acceleration Hamstring mean-power & power max Grafts differences statistically significant difference in favour of BPTB for Tegner score KOS- SAS 35

36 for your attention Baur C. Mathieu N. Delamorclaz S. Hilfiker R. Blatter S. Siegrist O. Fournier S. 36

37 Thank you!