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Anatomic single-bundle anterior cruciate ligament reconstruction improves walking economy: hamstrings tendon versus patellar tendon grafts.

ΤίτλοςAnatomic single-bundle anterior cruciate ligament reconstruction improves walking economy: hamstrings tendon versus patellar tendon grafts.
Publication TypeJournal Article
Year of Publication2017
AuthorsIliopoulos, E., Galanis N., Zafeiridis A., Iosifidis M., Papadopoulos P., Potoupnis M., Geladas N., Vrabas I. S., & Kirkos J.
JournalKnee Surg Sports Traumatol Arthrosc
Volume25
Issue10
Pagination3155-3162
Date Published2017 Oct
ISSN1433-7347
Λέξεις κλειδιάAdult, Anterior Cruciate Ligament Injuries, Anterior Cruciate Ligament Reconstruction, Bone-Patellar Tendon-Bone Grafting, Energy Metabolism, Gait, Hamstring Tendons, Humans, Male, Patellar Ligament, Treatment Outcome, Walking
Abstract

PURPOSE: Anterior cruciate ligament (ACL) injury is associated with a pathologic gait pattern and increased energy cost during locomotion. ACL reconstruction could improve the gait pattern. Hamstrings tendon (HAM) and bone-patellar tendon-bone (BPTB) grafts are usually used for reconstruction. The aim of this study was to compare the efficacy of anatomic ACL reconstruction with HAM and BPTB grafts on improving and normalizing the energy cost and physiologic reserves during flat, uphill, and downhill walking.METHODS: Twenty male subjects with unilateral ACL injuries were randomly assigned to ACL reconstruction with a HAM (n = 10) or BPTB (n = 10) graft. Ten matched controls were also enrolled. All participants performed three 8-min walking tasks at 0, +10, and -10 % gradients before and 9 months after surgery. Energy cost (oxygen consumption, VO), heart rate (HR), and ventilation (VE) were measured. Lysholm/IKDC scores were recorded.RESULTS: Pre-operatively, VO, HR, and VE were higher in the HAM and BPTB groups than in controls during walking at 0, +10, and -10 % gradients (p < 0.001-0.01). Post-operatively, both HAM and BPTB groups showed reduced VO, HR, and VE during the three walking tasks (p < 0.001-0.01). Although the post-operative VO in both surgical groups reached 90-95 % of the normative (control) value during walking, it remained elevated against the value observed in controls (p < 0.001-0.01). The HAM and BPTB groups showed no differences in post-surgical VO or HR during walking at all three gradients.CONCLUSION: Anatomic ACL reconstruction with either HAM or BPTB graft resulted in similar short-term improvements in energy cost and nearly normalized locomotion economy and cardiorespiratory reserves during flat, uphill, and downhill walking. The improved locomotion economy is an additional benefit of anatomic ACL reconstruction, irrespective of the type of graft used, that the orthopaedic surgeons should consider.LEVEL OF EVIDENCE: II.

DOI10.1007/s00167-016-4229-4
Alternate JournalKnee Surg Sports Traumatol Arthrosc
PubMed ID27371291

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