Jornal de Trauma e Tratamento

The Effect of ACL Graft Size on Post-operative Knee Extension

Abstract

Sheldon M

Introduction: Understanding factors that cause loss of extension post Anterior Cruciate Ligament (ACL) reconstruction may assist surgeons in preventing this problem. The aim of this clinical trial is to determine the effect of reconstructed ACL graft size on postoperative range of motion in ACL reconstruction in human subjects.

Methods: This therapeutic comparative cohort study consisted of a retrospective analysis of prospectively collected data. Participants either received an autologous double bundle ACL graft (Control) or a combined autologous/synthetic graft (Hybrid), which increased graft cross-sectional area. Femoral notch width was measured preoperatively by Magnetic Resonance Imaging. Range of motion was determined using goniometry at two years post reconstruction. Stepwise logistic regression and bivariate correlation was used to analyse data.

Results: 54 participants were included in analysis, 22 Control and 32 Hybrid. Hybrid group had a significantly larger reconstructed graft cross-sectional area (× (Hybrid)=71 ± 9.30 mm²; × (Control)=59 ± 12.26 mm², t=4.76, p<0.05). Mean notch size was smaller in Control group (1.83 ± 0.18 cm) compared to Hybrid group (1.91 ± 0.27 cm). Hybrid group had significantly fewer cases of postoperative knee extension loss (χ2=3.90, p<0.05), defined as loss of passive range ≥ 3° at 2 years post-surgery. Increased graft cross-sectional area was not a significant predictor of loss of extension. There was also no relationship between notch width and extension range of movement. (r=0.01, p=0.80).

Conclusion: A 20% increase in ACL graft cross-sectional area was not a significant predictor of postoperative extension loss.