Follow-up Evaluation 2 Years After ACL Reconstruction With Bone–Patellar Tendon–Bone Graft Shows That Excessive Tibial Rotation Persists


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Abstract

ObjectiveTo investigate in vivo if the increased tibial rotation found in anterior cruciate ligament (ACL)-deficient patients before surgery is restored 2 years after the reconstruction, during 2 high-demanding activities.DesignProspective follow-up study.SettingA gait analysis laboratory.ParticipantsNine subjects with unilateral ACL rupture, reconstructed with a bone–patellar tendon–bone (BPTB) graft, and 10 healthy control subjects.InterventionsAll the ACL-deficient patients underwent a unilateral ACL reconstruction after prereconstruction data acquisition.Main Outcome MeasurementsUsing a 6-camera motion analysis system, kinematics were collected as subjects (1) descended from a stair and, after foot contact, pivoted on the landing leg at 90°; and (2) jumped from a platform, landed with both feet on the ground and, after foot contact, pivoted on the right or left leg at 90° in a similar fashion. The dependent variable examined was the maximum range of motion of tibial rotation during the pivoting period.ResultsFor both activities, no significant differences were found between the control healthy knee and the intact knee of the patient group before and 2 years after the ACL reconstruction. Significant differences were found between the control healthy knee and the affected knee of the patients group for both activities, both before and 2 years after the ACL reconstruction.ConclusionThe increased tibial rotation found in the ACL-deficient knees was not restored with reconstruction using a BPTB graft, even 2 years postoperatively. The authors propose that this excessive tibial rotation over time may lead to further deterioration of the knee resulting from abnormal loading at areas of the cartilage that are not commonly loaded in a healthy knee.

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