K n e e pa in , s w e l l i n g a n d g i v i n g w a y : a r e t h e s e s y m p t o m s i n f l u e n c e d by A C L r e c o n s t r u c t i o n ?

A. Bryant ~*, R. Newton ~ & J. Steele ~ ~Central Queensland University

2Edith Cowan University 3University of Wollongong

The purpose of this study was to examine the subjective symptoms reported by chronic ACL deficient patients compared to symptoms reported by patients following ACL reconstruction, using either a patella tendon (PT) or semitendinosus-gracilis tendon (STGT) graft. Patients' symptoms of pain, swelling, partial giving way and full giving way episodes were collected for the involved limb of 10 chronic, functional ACL deficient patients, 27 ACL reconstructed patients (14 PT grafts and 13 STGT grafts; average time since surgery = 14.6 + 4.7 months); and 22 matched controls, using the Cincinnati Knee Rating System. One-way ANOVA results revealed that the ACL deficient patients sustained a significantly (p < 0.05) lower activity level before the onset of swelling compared to controls (20% difference) and a significantly lower activity level before the onset of pain compared to both the STGT (27% difference) and control (31% difference) groups. The ACL deficient patients also experienced full giving way episodes at significantly lower activity levels compared to STGT patients (17% difference) and controls (20% difference) and were more prone to partial giving way episodes compared to the PT (48% difference), STGT (56% difference) and control (58% difference) groups. It was concluded that ACL deficient patients were more symptomatic at lower activity levels compared to their reconstructed counterparts. Furthermore, both reconstruction techniques were equally effective at improving the patients' knee functionality scores. These results further support the notion that patients wishing to return to sports should be advised to seek reconstructive surgery so that they may actively participate with fewer symptoms at a higher activity level.

O s t e o a r t h r i t i s a f t e r A C L r e c o n s t r u c t i o n . A c o m p a r i s o n of p a t e l l a r t e n d o n a n d h a m s t r i n g t e n d o n g r a f t fo r A C L r e c o n s t r u c t i o n o v e r 7

y e a r s L. Pinczewski*, V. Russell & L. Salmon AIMS Research, Crows Nest, Australia

Aim: The aim of this study is to compare the clinical outcomes of endoscopic ACL reconstruction utilizing ipsilateral 4-strand hamstring tendon or pateilar tendon autograft over a 7-year period. Method: 90 consecutive patients with isolated ACL rupture received PT autograft and 90 who received HT autograft were studied annually for 7 years. Assessment included the IKDC Knee Ligament Evaluation, KT1000, Lysholm Knee Score, thigh atrophy, kneeling pain, hamstring pain, radiographs and clinical outcomes. Results: At 2 years, 8% of the PT group had a fixed flexion deformity, significantly increasing to 25% at 7 years. The HT group showed no significant change with time. Forty-four percent of the PT group and 27% of the HT experienced kneeling pain at 5- year review, this figure increased significantly to 55% for the PT group at 7 years. Lachman, pivot shift and instrumented testing demonstrated a significant decrease in laxity in the HT group over time. KT1000 testing showed a significant increase in the PT between 5 & 7 years. Radiological assessment at 5 years displayed early osteoarthritic changes in 4% of the HT group and 18% of the PT group. At 7 years a significant increase to 44% of PT was seen. Conclusion: Radiological early osteoarthritic changes are seen after ACL reconstruction in few patients up to 5 years, but the number of PT patients demonstrating such changes increases markedly by 7 years. PT grafts demonstrate a significant increase in laxity with time and kneeling pain remains a persistent problem that is worsening with time.

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