Abstract
At least 10–20% of all ACL reconstructions require additional cartilage repair. The aim of this study was to compare the activity recovered by patients after one-stage open ACL reconstruction and osteochondral autologous grafting of articular cartilage lesions and after isolated open ACL reconstruction. The study group included 21 patients with chronic ACL deficiency and grade III or IV cartilage lesion according to the ICRS scale who were treated with combined ACL reconstruction and osteochondral grafting in one step. The control group included 32 patients with chronic ACL insufficiency and no chondral deficit higher than grade I on the ICRS scale who underwent isolated reconstruction of the ligament. For the assessment, the Lysholm and Gillquist (L&G) score and the functional Marshall score were used. Both groups displayed a statistically significant improvement in the L&G score and the Marshall score between the preoperative and 12-month assessments. The mean gain in L&G score over this period was 30.66±7.79 in the study group and 31.65±6.96 in the control group. The difference between the control group and the study group was not significant. The difference between 12 months and initial assessment was counted. The mean gain in Marshall score was 9.05±3.81 in the study group and 10.71±3.43 in the control group. The difference between the initial and the 12-month evaluation was statistically significant (p=0.49). Return to normal activity was slower and patient satisfaction was lower during the first year after operation in the study group than in the control group, however the overall advantage of the one-step operation outweighs the slightly inferior functional results at 12 months.
Résumé
Au moins 10 à 20% des reconstructions de ligament croisé antérieur nécessitent un geste sur le cartilage. Le but de ce travail était de comparer la fonction des patients après ligamentoplastie et autogreffe de cartilage en un temps et après ligamentoplastie isolée. Le groupe d'étude comprenait 21 patients avec des lésions cartilagineuses de grade III ou IV selon l'échelle ICRS et le groupe de contrôle, traité avec une ligamentoplastie isolée, comprenait 32 patients avec des lésions cartilagineuses ne dépassant pas le grade I. Pour l'évaluation le score de Lysholm et de Gillquist ainsi que le score fonctionnel de Marshall ont été utilisés. Les deux groupes ont eut une amélioration significative dans ces scores entre l'état préopératoire et celui 12 mois après. Pour le premier, le gain moyen en points était de 30,66+−3,43 dans le groupe d'étude et de 31,65+−6,96 dans le groupe de contrôle, sans différence statistique notable. Pour le deuxiéme, le gain moyen du groupe d'étude était de 9,5+−3,81 et celui du groupe de contrôle était de 10,71+−3,43, avec une différence significative (p=0,49). Le retour à une activité normale et la satisfaction des patients dans la première année après l'opération est moins bonne dans le groupe d'étude que dans le groupe de contrôle.
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Gawęda, K., Walawski, J., Węgłowski, R. et al. Rehabilitation after one-stage anterior cruciate reconstruction and osteochondral grafting. International Orthopaedics (SICO 30, 185–189 (2006). https://doi.org/10.1007/s00264-005-0041-3
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DOI: https://doi.org/10.1007/s00264-005-0041-3