Arthroscopically-Assisted vs. Open Surgery in Repairing Anterior Cruciate Ligament Avulsion

Abstract

The management of an Anterior Cruciate Ligament (ACL) avulsion is principally by surgery. There are two major techniques in this regard; fixation through open surgery (arthrotomy) or arthroscopically-assisted repair. These are not new in the literature; however, the debate regarding the better approach is still under debate. This study focused on comparing outcome and consequences of arthroscopically-assisted vs. open surgery in repairing ACL avulsion. In a randomized clinical trial, 44 patients with unilateral ACL avulsion were recruited in Tabriz Shohada teaching Centre during a 12 month period of time. These patients were randomized in two equal age and sex-matched groups underwent either arthroscopically-assisted or open ACL repair. The constructive technique was the same in both groups without using any graft. The minimum follow-up period was 6 months including 3 weeks, 3 months and 6 months postoperatively. Range of Motion (ROM), laxity, Anterior Drawer Test (ADT) result, duration of hospital stay, wound status, nonunion and return to previous work were compared between the two groups. Mean time of suture removal (p = 0.10), minimum and maximum ROM at months 3 (p = 0.43 and 0.22, respectively) and 6 (p = 0.73 and 0.77, respectively), ADT at months 3 and 6 (p = 0.16 for both), laxity at month 6 (p = 0.28) and wound status at week 3 (p = 0.35) were not significantly different between the two groups. There was no case of nonunion at month 6 in either group. The mean hospital stay was significantly shorter in the arthroscopy group (3.77 +/- 0.92 vs. 2.50 +/- 0.51 days; p < 0.001). The mean laxity score was significantly higher in the open surgery group at month 3 (4.82 +/- 0.59 vs. 4.45 +/- 0.60; p = 0.05). The rate of nonunion was significantly higher in the open surgery group at month 3 (40.9% vs. 9.1%; p = 0.02). Patients in the arthroscopically-assisted technique group returned sooner to previous work (17.41 +/- 1.53 vs. 14.82 +/- 0.96 weeks; p < 0.001). Based on our results, arthroscopically-assisted reconstruction of ACL avulsion is superior to open surgery.

Outcome Analysis of Arthroscopic Single Bundle Anterior Cruciate Ligament Reconstruction Using Semitendinosus and Gracilis as Quadrupled Graft in Adults – A Case Series Study

“…In some previous studies, Frank and Jackson [ 5 ] reported that arthroscopic reconstruction has better functional outcome in short-term but the outcomes were similar to open procedures in long-term. However, Barzegar et al [ 6 ] reported arthroscopic reconstruction is superior to a mini arthrotomy procedures in time taken to return to pre-injury working level. There are only few studies comparing arthroscopic procedure with an open procedure as arthroscopy offers minimally invasive and more cosmetic surgery and have overshadowed open procedures.…”

Functional evaluation of anterior cruciate ligament reconstruction with anatomical single bundle technique using quadrupled hamstring tendon

“…Cyril b Frank (10) reported that arthroscopic reconstruction has a better functional outcome in the short term but the outcomes are not significantly different in the long term. But Hamid Barzegar (11) reported arthroscopic reconstruction is superior to a mini arthrotomy procedure in the time taken to return to pre-injury working level.…”

Clinical Outcome, Return to Pre-injury Activities and Patients Satisfaction after Open ACL Reconstruction And Arthroscopic Reconstruction; An Experience From A Developing Country

“…Open ACL reconstruction and arthroscopic reconstruction are not new as lots of literature is available about these two but the debate regarding which approach is better is still going on. 9 In this retrospective analysis, our objective was to compare LKS scores following ACL reconstruction and arthroscopic reconstruction, and comparing with each other.…”