Immediate Post Operative Complications in Arthroscopic ACL Reconstruction and Open Reconstruction with Bone-Tendon-Bone Graft
DOI:
https://doi.org/10.70749/ijbr.v3i7.1958Keywords:
Immediate Post-Operative Complications, Arthroscopic, Open ACL Reconstruction, Bone-Tendon-Bone Autograft.Abstract
Background: Arthroscopic autograft ACL restoration increasingly superseded primary open repair of the ACL, which was the conventional surgical procedure. After ACLR, postoperative infection is also rare. Objective: To compare the immediate post-operative complication in patient undergoing arthroscopic ACL reconstruction versus open ACL reconstruction with bone-tendon-bone autograft. Material and Methods: A total of 304 participants participated in a randomized controlled experiment. After being randomly assigned to one of two groups, Group-A had arthroscopic ACL reconstruction, whereas Group-B had open ACL reconstruction. Every twelve hours, the VAS was used to assess postoperative discomfort. SPSS was used to evaluate all of the data that was gathered. The chi-square test or Fisher's exact test were used to compare the frequencies of complications across groups. To account for possible effect modifiers, stratification was used. A P-value of less than 0.05 is regarded as statistically significant. Results: Comparable demographics were displayed by both groups, with identical mean ages (46.82 ± 8.11 vs. 47.34 ± 8.58 years) and somewhat more men (64.5% arthroscopic vs. 61.2% open). Patients who had arthroscopy experienced consistently reduced pain levels at 12, 24, and 36 hours (p < 0.001) and a shorter hospital stay (1.56 ± 0.27 vs. 2.00 ± 0.79 days, p < 0.001). The open group experienced higher complications, including discomfort (4.6% vs. 12.5%) and infection (2.6% vs. 4.6%). In order to reduce postoperative morbidity, they are all in favor of the arthroscopic method. Conclusion: Comparing arthroscopic ACL surgery to open ACL reconstruction, our study revealed a noticeably lower risk of complications.
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1. Gharpinde MR, Pundkar A, Dhanwani Y. Navigating post-operative challenges: a comprehensive review of complications following anterior cruciate ligament (ACL) tear surgery. Cureus. 2024 August;16(8):e67768.
https://doi.org/10.7759/cureus.67768
2. Yoo H, Marappa-Ganeshan R. Anatomy, bony pelvis and lower limb, knee anterior cruciate ligament. Stat Pearls. Stat Pearls Publishing, Treasure Island; 2024.
3. Evans J, Mabrouk A, Nielson J. Anterior cruciate ligament knee injury. Stat Pearls. Stat Pearls Publishing, Treasure Island; 2024.
4. Friel NA, Chu CR. The role of ACL injury in the development of posttraumatic knee osteoarthritis . Clin Sports Med. 2013;32:1-12
https://doi.org/10.1016/j.csm.2012.08.017
5. Boyd E, Endres NK, Geeslin AG. Postoperative healing and complications based on anterior cruciate ligament reconstruction graft type. Ann Joint 2024;9:30.
https://doi.org/10.21037/aoj-24-3
6. Lind DR, Patil RS, Amunategui MA, DePhillipo NN. Evolution of anterior cruciate ligament reconstruction and graft choice: a review. Ann Jt. 2023;8:19.
https://doi.org/10.21037/aoj-22-39
7. Sherman MF, Lieber L, Bonamo JR, Podesta L, Reiter I. The long-term followup of primary anterior cruciate ligament repair. Defining a rationale for augmentation. The American journal of sports medicine. 1991;19(3):243-55.
https://doi.org/10.1177/036354659101900307
8. Engebretsen L, Benum P, Fasting O, Mølster A, Strand T. A prospective, randomized study of three surgical techniques for treatment of acute ruptures of the anterior cruciate ligament. The American journal of sports medicine. 1990;18(6):585-90.
https://doi.org/10.1177/036354659001800605
9. Garrett WE, Jr., Swiontkowski MF, Weinstein JN, Callaghan J, Rosier RN, Berry DJ, et al. American Board of Orthopaedic Surgery Practice of the Orthopaedic Surgeon: Part-II, certification examination case mix. The Journal of bone and joint surgery American volume. 2006;88(3):660-7.
https://doi.org/10.2106/00004623-200603000-00027
10. Bohensky MA, deSteiger R, Kondogiannis C, Sundararajan V, Andrianopoulos N, Bucknill A, et al. Adverse outcomes associated with elective knee arthroscopy: a population-based cohort study. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association. 2013;29(4):716-25.
11. Heusdens CHW. ACL Repair: A Game Changer or Will History Repeat Itself? A Critical Appraisal. Journal of clinical medicine. 2021;10(5).
https://doi.org/10.3390/jcm10050912
12. van Eck CF, Limpisvasti O, ElAttrache NS. Is There a Role for Internal Bracing and Repair of the Anterior Cruciate Ligament? A Systematic Literature Review. The American journal of sports medicine. 2018;46(9):2291-8.
13. Ahmad SS, Schreiner AJ, Hirschmann MT, Schröter S, Döbele S, Ahrend MD, et al. Dynamic intraligamentary stabilization for ACL repair: a systematic review. Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA. 2019;27(1):13-20.
https://doi.org/10.1007/s00167-018-5301-z
14. Konstantinou, E, Pfeiffer T, Rocca MS, Grandberg C, Dias K, Musahl V. Prevention and Management of Postoperative Infection After Anterior Cruciate Ligament Reconstruction: A Narrative Review. J Clin Med. 2025;14:336.
15. Schmitz JK, Lindgren V, Edman G, Janarv PM, Forssblad M, Stalman A. Risk Factors for Septic Arthritis After Anterior Cruciate Ligament Reconstruction: A Nationwide Analysis of 26,014 ACL Reconstructions. Am J Sports Med. 2021;49:1769-76.
https://doi.org/10.1177/0363546521993812
16. Sircana G, Passiatore M, Capasso L, Saccomanno MF, Maccauro G. Infections in arthroscopy. Eur Rev Med Pharmacol Sci. 2019;23 (Suppl. S2):279-87.
17. Schneider JG, Ormseth B, DiBartola AC, Magnussen RA, Duerr RA, Stoodley P, et al. Incidence, Common Pathogens, and Risk Factors for Infection after Primary Anterior Cruciate Ligament Reconstruction: A Systematic Review. J. Knee Surg. 2024;37:470-81.
https://doi.org/10.1055/a-2179-3678
18. Eisenberg MT, Block AM, Vopat ML, Olsen MA, Nepple JJ. Rates of Infection After ACL Reconstruction in Pediatric and Adolescent Patients: A Market Scan Database Study of 44,501 Patients. J Pediatr Orthop. 2022;42:362-66.
19. van der List JP, Vermeijden HD, Sierevelt IN, DiFelice GS, van Noort A, Kerkhoffs G. Arthroscopic primary repair of proximal anterior cruciate ligament tears seems safe but higher level of evidence is needed: a systematic review and meta-analysis of recent literature. Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA. 2020;28(6):1946-57.
20. Nwachukwu BU, Patel BH, Lu Y, Allen AA, Williams RJ, 3rd. Anterior Cruciate Ligament Repair Outcomes: An Updated Systematic Review of Recent Literature. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association. 2019;35(7):2233-47.
https://doi.org/10.1016/j.arthro.2019.04.005
21. Hoogeslag RAG, Brouwer RW, de Vries AJ, Boer BC, Huis In 't Veld R. Efficacy of Nonaugmented, Static Augmented, and Dynamic Augmented Suture Repair of the Ruptured Anterior Cruciate Ligament: A Systematic Review of the Literature. The American journal of sports medicine. 2020;48(14):3626-37.
22. Andrés-Cano P, Godino M, Vides M, Guerado E. Postoperative complications of anterior cruciate ligament reconstruction after ambulatory surgery. Revista Española de Cirugía Ortopédica y Traumatología (English Edition). 2015;59(3):157-64
https://doi.org/10.1016/j.recote.2015.03.005
23. Nair RS, Nair RR, Munshi S, Walkay S, Radhamony NG. Analysis of postoperative complications following elective arthroscopic surgeries of the knee- a retrospective cohort study. Annals of Medicine and Surgery. 2022;77:103546.
24. Raab DJ, Fischer DA, Smith JP, Markman AW, Steubs JA. Comparison of arthroscopic and open reconstruction of the anterior cruciate ligament. Early results. The American journal of sports medicine. 1993;21(5):680-3; discussion 3-4.
25. 0-Kapoor R, Verma A, Saroj AK. Comparative evaluation of pre and post operative functional outcomes determined by Lysholm knee score of patients undergoing arthroscopic anterior cruciate ligament reconstruction. Int J Res Orthop 2022;8:655-9.
https://doi.org/10.18203/issn.2455-4510.intjresorthop20222703
26. Pang L, Li P, Li T, Li Y, Zhu J, Tang X. Arthroscopic Anterior Cruciate Ligament Repair Versus Autograft Anterior Cruciate Ligament Reconstruction: A Meta-Analysis of Comparative Studies. Front Surg. 2022;9:887522.
27. van der List JP, DiFelice GS. Primary repair of the anterior cruciate ligament: a paradigm shift. Surgeon. 2017;15(3):161-8.
https://doi.org/10.1016/j.surge.2016.09.006
28. Enneking WF, Horowitz M. The intra-articular effects of immobilization on the human knee. J Bone Joint Surg Am. 1972;54(5):973-85.
29. Millett PJ, Wickiewicz TL, Warren RF. Motion loss after ligament injuries to the knee. part I: causes. Am J Sports Med. 2001;29(5):664-75.
30. ShermanMF, Lieber L, Bonamo JR, Podesta L, Reiter I. The long-term followup of primary anterior cruciate ligament repair. Defining a rationale for augmentation. Am J Sports Med. 1991;19(3):243-55.
https://doi.org/10.1177/036354659101900307
31. Halinen J, Lindahl J, Hirvensalo E, Santavirta S. Operative and nonoperative treatments of medial collateral ligament rupture with early anterior cruciate ligament reconstruction: a prospective randomized study. Am J Sports Med. 2006;34(7):1134-40.
32. Fleming BC, Carey JL, Spindler KP, Murray MM. Can suture repair of ACL transection restore normal anteroposterior laxity of the knee? An ex vivo study. J Orthop Res. 2008;26(11):1500-5.
https://doi.org/10.1002/jor.20690
33. Murray MM, Fleming BC. Use of a bioactive scaffold to stimulate anterior cruciate ligament healing also minimizes posttraumatic osteoarthritis after surgery. Am J Sports Med. 2013;41(8):1762-70
34. Johnson RJ, Eriksson E, Haggmark T, Pope MH. Five-to ten-year follow-up evaluation after reconstruction of the anterior cruciate ligament. Clin Orthopaed Related Res. 1984;1(183):122-40.
https://doi.org/10.1097/00003086-198403000-00021
35. Li GX, Li Q, Li ZY. Double-bundle reconstruction of anterior cruciate ligament using hamstring auto graft under arthroscopy. China J Orthopaed Traumatol. 2012;25(11):923-7.
36. VSM VP, Gupta S, Joshi GR. Anterior cruciate ligament reconstruction with bone patellar tendon bone graft through a mini arthrotomy. Med J Armed Forces India. 2004;60(1):15-9.
https://doi.org/10.1016/s0377-1237(04)80150-3
37. Krüger-Franke M, Reinmuth S, Kugler A, Rosemeyer B. Concomitant injuries with anterior cruciate ligament rupture. A retrospective study. Der Unfallchirurg. 1995;98(6):328-32.
https://doi.org/10.1007/s001130050580
38. Nellaiyappan B, Karthik K. Role of Scaffolds in the Reconstruction of Anterior Cruciate Ligament of Knee-Systematic Review. Int J Orthopaed. 2016;3(3):564-70.
https://doi.org/10.17554/j.issn.2311-5106.2016.03.108
39. Ibrahim SA, Al-Kussary IM, Al-Misfer AR, Al-Mutairi HQ, Ghafar SA, El Noor TA. Clinical evaluation of arthroscopically assisted anterior cruciate ligament reconstruction: patellar tendon versus gracilis and semitendinosus autograft. J Arthroscop Related Surg. 2005;21(4):412-7.
https://doi.org/10.1016/j.arthro.2004.12.002
40. Marder RA, Raskind JR, Carroll M. Prospective evaluation of arthroscopically assisted anterior cruciate ligament reconstruction: patellar tendon versus semitendinosus and gracilis tendons. Am J Sports Med. 1991;19(5):478-84.
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