ACL presentation for Scientific research committee.pptx

ACL presentation for Scientific research committee

1. EVALUATION OF PRE OPERATIVE AND INTRA OPERATIVE FINDINGS WHICH AFFECT FUNCTIONAL OUTCOME OF FIVE STRAND BUNDLE ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION IN PATIENTS WITH ANTERIOR CRUCIATE LIGAMENT TEAR PRINCIPAL INVESTIGATOR - DR SIVA SARAVANAN A 1ST YEAR PG GUIDE- DR RAJARAJAN HOD AND PROFESSOR CO GUIDE- DR MUARAK BASHA ASSOCIATE PROFESSOR DEPARTMENT OF ORTHOPEDICS ESIC MEDICAL COLLEGE AND PGIMSR

2. RATIONALE FOR STUDY Graft selection for anterior cruciate ligament reconstruction (ACLR) is important for optimizing post-operative rehabilitation, facilitating return to full sporting function and reducing the risk of complications. Four-strand hamstring autograft is a common choice for anterior cruciate ligament reconstruction. A potential disadvantage of hamstring autograft for anterior cruciate ligament reconstruction is the inherent variability in graft diameter. Multiple studies have shown increased revision rates when using an undersized hamstring graft. Using an EndoButton (Smith & Nephew, Andover, MA) for femoral tunnel fixation, we convert a standard quadrupled hamstring graft into a 5-strand graft by creating 3 equal strands of the typically larger semitendinosus combined with a double-stranded gracilis. This technique may help alleviate some surgeon reluctance to use a hamstring graft by providing an intraoperative “bailout” option for an unexpectedly small tendon. On the basis of current data, increasing the diameter of the graft in these situations may decrease revision rates

3. OBJECTIVE PRIMARY OBJECTIVE- TO ASSESS PREOP AND INTRA OP FACTORS THAT INFLUENCE OUTCOME ACL TEAR PATIENTS UNDERGOING FIVE STRAND BUNDLE ACL RECONSTRUCTION SECONDARY OBJECTIVE- TO ASSESS OVERALL FUNCTIONAL OUTCOME OF FIVE STRAND BUNDLE ACL RECONSTRUCTION

4. M ETHOD SAMPLE SIZE - 30 SAMPLE CALCULATION n= ( ) S1 = Standard deviation of functional outcome of ACL reconstruction using peroneus longus tendon graft in reference study 1 S2 = Standard deviation of functional outcome of ACL reconstruction using semitendinosis tendon graft in reference study 2 μ1 = Mean of functional outcome of ACL reconstruction using peroneus longus tendon graft in reference study 1 μ2 = Mean of functional outcome of ACL reconstruction using semitendinosis graft in reference study 2 Reference study for sample size calculation 1. Single bundle ACL Reconstruction with Peroneus longus Tendon graft by DrRavikumar,Dr Bharat Singh,Dr Ajinkya Gautam 2. A prospective study of functional outcome of ACL reconstruction with Semitendinosis graft with Endobutton and Bioabsorbable screw by Dr Anil Kumar Mishra and Dr Girish S S1=3.52 μ1=96.12 S25.54 μ2=88.70 Hence n=30,ie, 30 patients each receiving ACL reconstruction using peroneus longus graftand semitendinosis graft. SAMPLING TECHNIQUE Subjects satisfying the study inclusion criteria will be added consecutively until the required sample size is met.  

5. SAMPLING METHOD Written informed consent from patient/guardian will be obtained after giving information about the study in a language well understood by the parents or legal guardians and the subjects before submitting the patient to examination. All patients with suspected ACL injury will be evaluated.Ontheir first visit to OPD/Casualty,a detailed history will be taken about the nature of injury,mechanism of injury,duration of injury,other associated injury,symptoms,details of initial treatment and medical history.Then a detailed general examination and physical examination will be carried out.Finally to end with all required radiological investigations are done. Diagnosis: History. Physical examination. Radiology: Xray and MRI. Diagnostic arthroscopy before the graft harvesting to confirm the nature of injury at the same setting as ACL reconstruction.

6. Methods Inclusion criteria:  ACL tear diagnosed clinically and by MRI  Willingness to participate and follow up Normal contralateral knee minimum of 6 months follow up Exclusion criteria: Revision ACL reconstruction  ACL injuries with associated intra articular fractures previous knee surgery  Anterior cruciate ligament tear with posterior cruciate ligament, collateral ligament requiring surgery, posterolateral complex injuries Osteoarthritis of knee

7. Methods History: Nature of injury. Mechanism of injury. Duration since injury. Pain: onset, duration, location and the site of maximum pain. Effusion: onset, duration. Stiffness. History of giving way (instability). Locking. Associated injuries. Primary treatment if any. Past medical illness if any.

8. Physical Examination: Gait. Tenderness. Effusion of the knee joint. Wasting. Range of movements. Patellar tracking.Signs of instability of ACL Anterior drawer test Lachman test Pivot shift test.  Tests for associated ligamentous injuries and meniscal injuries For Posterior Cruciate Ligament Sag sign Godfrey’s test Posterior drawer test Active Quariceps test For Lateral Collateral Ligament Injury • Varus stress test. For Medial Collateral Injury • Valgus stress test. For Meniscal Injury • Mcmurrays test. • Apleys grinding test. For Posterolateral Corner Injury • Varus recurvatum test. • Dial test.

9. Methods INTRA OPERATIVE we look for the following intra op findings in diagnostic arthoscopy 1. type of acl tear 2.menical injury and status of menisci 3. graft length 4.osteochondral damages in femur,tibia and patella POST OPERATIVE OUTCOME MEASUREMENTS All patients are subjected to post operative anteroposterior and lateral radiographs to determine the tunnel placement and position of endobutton and interference screw. Patients are followed at 6 weeks, 6 months and 1 year and functional outcomes assessed. The International Knee Documentation 2000 score(IKDC) and Lysholm and Gillquist Knee Scoring Scale ar e used for evaluation of patients. The Subjective IKDC scale was evaluated by summing the scores for the individual items and then transforming the score to a scale that ranges from 0 to 100. To calculate the final subjective IKDC score simply add the score of each item and divide by the maximum possible score which was 87. Subjective IKDC score = [Sum of items/Maximum possible score] × 100 The score is interpreted as a measure of function such that higher scores represent higher levels of function and lower levels of symptoms. A score of 100 is interpreted to mean no limitation with activities of daily living or sports activities and the absence of symptoms Patients subjected to Lysholm knee scoring scale questionnaire. The Lysholm Knee Scoring Scale comprised of eight parameters for evaluation. The parameters evaluated are– limp, use of support on walking, locking episodes, instability, pain, swelling, stair climbing and squatting. The individual parameters were allotted specific scores depending on the functional ability of the patient. The maximum possible knee score was 100 points. Based on the outcome scores they were divided into Excellent, Good, Fair and Poor

10. STATISTICAL ANALYSIS Preoperative and post operative ACL reconstruction with five bundle repair will be statisticaly assesed for their clinical outcome. IKDC SCORE and lysholm score will be used to analyse the outcome at 6 weeks , 6 months and at one year

11. Expected Outcomes post operative prediction of outcome five bundle ACL reconstruction based on the intra op ad preop status of acl tear patients can be found

12. References Prospective Randomized Clinical Evaluation of Conventional Single-Bundle, Anatomic Single-Bundle, and Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction Incidence of anterior cruciate ligament injury and other knee ligament injuries: a national population-based study Five-Strand Hamstring Autograft for Anterior Cruciate Ligament Reconstruction Hamstring Autograft Size Can Be Predicted and Is a Potential Risk Factor for Anterior Cruciate Ligament Reconstruction Failure Single bundle ACL Reconstruction with Peroneus longus Tendon graft by Dr Ravikumar,Dr Bharat Singh,Dr Ajinkya Gautam A prospective study of functional outcome of ACL reconstruction with Semitendinosis graft with Endobutton and Bioabsorbable screw by Dr Anil Kumar Mishra and Dr Girish S