Effect of haemarthrosis on the rehabilitation of anterior cruciate ligament reconstruction- single bundle versus double bundle

Abstract

BackgroundHaemarthrosis and pain adversely affects the functional outcome of ACL reconstruction, especially in case of DB ACL reconstruction due to more extensive procedure. The purpose of the study was to evaluate the effect of haemarthrosis on the rehabilitation of DB ACL reconstruction versus SB ACL reconstruction.Methods100 patients were divided into two groups, of SB ACL and DB ACL reconstruction consisting of 50 patients each. An intra-articular drain was put in every patient. The pain was evaluated till week 8 using VAS (Visual Analog Scale). The Functional outcomes were evaluated using the Isokinetic Dynamometer at 3 and 6 months in both the groups. Muscle bulk and Range of motion were also noted in each group.ResultsThe results showed that there was statistically significant difference between the drain amount (n = 60.3 ml in SB ACL group vs. n = 94.2 ml in the DB ACL group) and haemarthrosis (n = 0.7 in SB ACL vs n = 1.5 in DB ACL) at week 1 post-operatively. Also the pain outcome improved on SB ACL after day 3 (VAS, n = 1.8) as compared to the DB ACL group (VAS, n = 3.7). The isokinetic muscle strength was found to be statistically significantly (p value < 0.05) better in the SB ACL group in the quadriceps muscle (both concentric and eccentric) at the end of the 3rd month. In the SB ACL group the Quadriceps Concentric strength deficit was 22.32% as compared to 34.12% in the DB ACL group. Both the groups had comparable flexor muscle strength at end of 3rd month. Both the groups had comparable muscle strength after 6 months of post-operative rehabilitation in both quadriceps and Hamstring muscle group.ConclusionWe noted that rehabilitation of DB ACL reconstruction group lags behind that of SB ACL reconstruction during the first 3 months due to post-operative haemarthrosis & its effects, but show comparable results after 6 months. The muscle strength measured isokinetically and the muscle bulk were found to be greater in the SB ACL group initially after 3 months but was found to be similar after 6 months.

Postoperative complications of anterior cruciate ligament reconstruction after ambulatory surgery

“…We recommend emphasizing the multimodal management of postoperative pain by using locoregional blocks, 22 as well as early diagnosis and treatment of postoperative hemarthrosis which could compromise the functional results. 23 Collaboration of multidisciplinary teams and involving non-medical healthcare staff in the process of arthroscopic ligamentoplasty of the ACL by OSP are essential.…”

The comparative efficacies of intravenous administration and intra-articular injection of tranexamic acid during anterior cruciate ligament reconstruction for reducing postoperative hemarthrosis

“…Arthroscopically assisted ACL reconstruction (ACLR) is a common, reproducible and minimally invasive procedure. However, after ACLR, hemarthrosis and its associated pain a ict patients and can disrupt rehabilitation programs [2]. Postoperative hemarthrosis has a 3-10% incidence after ACLR [2].…”

“…However, after ACLR, hemarthrosis and its associated pain a ict patients and can disrupt rehabilitation programs [2]. Postoperative hemarthrosis has a 3-10% incidence after ACLR [2]. Hemarthrosis creates many adverse effects, including increased susceptibility to infection, potential toxic effects to the cartilage, possible subsequent synovitis and arthro brosis, the onset of fever episodes, delayed rehabilitation, and prolonged hospital stay [2,3].…”

“…Postoperative hemarthrosis has a 3-10% incidence after ACLR [2]. Hemarthrosis creates many adverse effects, including increased susceptibility to infection, potential toxic effects to the cartilage, possible subsequent synovitis and arthro brosis, the onset of fever episodes, delayed rehabilitation, and prolonged hospital stay [2,3]. Arthrocentesis is sometimes necessary to alleviate capsular tension, pain and joint effusion for severe hemarthrosis, but arthrocentesis is an invasive procedure that may lead to an increased risk of septic arthritis [4].…”

“…Arthrocentesis is sometimes necessary to alleviate capsular tension, pain and joint effusion for severe hemarthrosis, but arthrocentesis is an invasive procedure that may lead to an increased risk of septic arthritis [4]. These aspects negatively affect the outcomes of patients and result in increased costs [2,5]. Minimizing postoperative intra-articular hemarthrosis may be potentially advantageous for recovery in ACLR patients.…”