Functional outcome of arthroscopic ACL Reconstruction Vs open single incision ACL Reconstruction: A Prospective Comparative study

INTRODUCTION: ACL reconstruction is one of the more common procedure performed with an estimated 100,000 surgical reconstruction performed annually in United States1 In the 1980s orthopaedic sports medicine community focused on injury to ACL as major cause of athletic disability and open autograft ACL Reconstructions were thought to require post-surgical protracted immobilization resulted in joint stiffness and articular damage. During the last 25 years, ACL has been one of the most studied structures in musculoskeletal system. In recent times awareness of the ACL injuries are far reaching and people of all walks of life seek treatment for ACL deficiency indeed most of our patients are from sub-urbs and rural areas around Chennai with awareness and willingness towards ACL Reconstruction. At International level Internet based review of NLM catalogue in 2005 for key word ACL resulted in 6383 hits, one of its highest signifying its importance. In our prospective study we have undertaken ACL Reconstruction with the gold standard BPTB graft the most studied graft through arthroscopy assisted reconstruction and assessed its functional outcome using Lysholm knee score and compared it with the study of open technique ACL Reconstruction done earlier in our Institute. AIM: The aim of our prospective study is to assess the functional outcome of 18 cases of Arthroscopic ACL Reconstruction done over a period of 23 months (January 2006-November 2007) at The Department of Orthopaedics, Government Royapettah Hospital, Kilpauk Medical College, Chennai- 14 and compare it with 18 cases of ACL Reconstruction done by Open technique done earlier in our institution. MATERIALS AND METHODS: Our study is a prospective study of 18 cases of Arthroscopic ACL reconstruction done, in the Department of Orthopedics, Government Royapettah Hospital, Kilpauk Medical College, and Chennai – 14. Our study was done over a period of 23 months, between (January 2006 to November 2007) Age group: 18-50 years, Mean age: 29.4 years. In our study group majority were males with only a single female patient. Only two cases had associated meniscal tear and both were of lateral meniscus. Our study also followed the protocol of open group as ACL Reconstruction was done as early as 2 months post injury to as late as 23 months post injury. Patients with clinically Lachman test, anterior drawers test, MRI or arthroscopy positive for ACL rupture were included in our study. Patients with bony ACL avulsion, other associated fractures were excluded from our study. The bone patella tendon bone auto graft was used for all the cases, for ACL reconstruction. Interference screws were used for fixation. RESULTS: Our results are excellent in 9 patients, good to excellent in 8 cases and fair in 1 case. The last one being a diabetic patient developed wound dehiscence and a delayed rehabilitation affected the outcome. On comparison with the Open trans tibial method of ACL Reconstruction, the data did not follow normal distribution so we applied “Mann-Whitney U test” for difference in medians and the resultant “p”(p – Value = 0.000177) is statistically very significant indicating arthroscopic ACL reconstruction has better outcome with p – Value comparable to literatures (ref.- Study by Dublajanin et al54 has a p- value