Online ISSN: 2515-8260

Keywords : ACL

Comparison of Functional outcome of Arthroscopic ACL reconstruction between Quadruple Hamstring, Peroneus Longus and BPTB Autograft in Indian Population

Dr Raja Yadav ,Dr Rohit bansal , Dr Gopal Rao M

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 141-147

The Anterior Cruciate ligament (ACL) is the primary stabilizer of the knee and its deficiency affects Knee stability, resulting in giving way symptoms in daily and sports activities with increased the risk of intra-articular damage. To prevent the deterioration of the existing lesions ACL reconstruction is necessary. Arthroscopic reconstruction of the injured ACL has become the “gold standard” method for treatment of ACL tear. However there is a controversy in literature regarding the best graft option is to replace the injured graft. The present study was aimed to study and compare the functional outcome of single bundle arthroscopic ACL reconstruction by Hamstring , Peroneus Longus and BPTB autografts  using Lysholm Knee Activity Score.

Assessment of femoral tunnel after arthroscopic anterior cruciate ligament reconstruction

Dr. Mihir Patel, Dr. Mahesh Shinde, Dr. Ushma Butala, Dr. Lakshya Bhardwaj, Dr. Karthik HK, Dr. Saif Ansari

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 5, Pages 272-280

Background: The knee joint is the most commonly injured of all joints and the anterior cruciate ligament (ACL) is the most commonly injured ligament. Anatomical graft placement is one of the major challenges in ACL reconstruction. Three-dimensional (3D) reconstruction of computed tomography (CT) images is currently the best method to determine whether the ACL tunnel and graft is positioned correctly. This study was done to calculate parameters of femoral tunnel in terms of femoral tunnel diameter, femoral tunnel length, femoral tunnel position based on Bernard and Hertel grid (Quadrant method) and the angle between a line drawn along the femur diaphysis and the femoral tunnel (femoral tunnel-femur diaphyseal angle/coronal angle/coronal obliquity) and to compare the results of femoral tunnel parameters measured with current literature.
Aims and Objectives: To Evaluate the Femoral Tunnel After Arthroscopic Anterior Cruciate Ligament Reconstruction.
Materials and Methods: This is an observational cross-sectional study conducted in the Department of Orthopaedics, H.B.T. medical college and Dr. R.N. Cooper municipal general hospital, Mumbai, on 39 patients of age group of 19-52 year who underwent arthroscopic ACL reconstruction over a period of 1 year.
Results: Most of patients had femoral tunnel diameter between 7.5-8.5 mm and length of 3-4 cm and femoral tunnel-femur diaphyseal angle of 30-40 degree. Most patients had position of femoral tunnel along high to low axis of 28-34% and position of femoral tunnel along deep to shallow axis of >27%. Femoral tunnel position along high to low axis and deep to shallow axis warren anatomical.
Conclusion: Low percent of ACL reconstruction were in recommended anatomical position. CT scan is a very good tool to analyse tunnel position after ACL reconstruction.


Anvesh Gattu, Biju Raveendran, Yeddula Yoga Abhinai Reddy

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2612-2620

Background: Lacerations of anterior cruciate ligament (ACL) ligament in the knee is the supreme cause of ineptitude in sports like athletics, football, volleyball, rugby etc. owing to various multidirectional strain full movements. Bulk of patients electing for surgery to revamp and easy return back to their routine. Despite of their complications like graft rupture, residual laxity, and donor-site morbidity, conventional methods of ACL reconstruction is the gold standard procedure. There is therefore a requirement for further research into newer, innovative surgical techniques which can decrease complication rates. The goals of the ACL reconstruction are to restore stability to the knee; easy return back to regular activities and to delay the onset of osteoarthritis with associated recurrent injuries to the articular cartilage and loss of meniscal functions. This study is to compare the results of ACL Reconstruction using Bone-Patellar-Bone by means of Miniarthrotomy technique.
Materials and Methods: This study was conducted in Narayana Medical College/ Hospital, at from May 2020 to May 2022. During this period 60 cases of adult patients with ACL deficiency were selected according to the inclusion criteria. Prospective Study of ACL Reconstruction using Bone-Patellar-Bone grafts by Miniarthrotomy technique in terms of Post-operative knee stability, Subjective Knee functions, Patient satisfaction, Graft site morbidity, Range of motion. In this study, an effort was made to weigh the advantages over arthroscopic approach.
Results: A total of 60 patients were seen and treated. In the present study mean age group was 28.2 ± 4.5 years. 50.11% of patients were with ACL tear alone, about 65.01% of the study subjects were undertook ACL reconstruction along with part meniscectomy. At the time of 1.5 year follow up, 93.33% had lack of flexion of less than 5 degrees. The anterior drawer’s test during follow up at 1.5 year 98.33% showed 0-2 mm after 1.4 year follow up. The IKDC score at 1.5 year follow up showed predominantly 98.33% patients were fell grade B followed by 5.01% and 1.66% of cases were under grade A and grade C respectively. Lachman’s test at the end of 1.5 years follow up 96.66% subjects showed 0-2 mm displacement and 3.33% showed 3-5mm displacement. At 1.5 year follow up, none of the patients had shown any pathological findings. About 93.33% had shown 90% of functional hop test results and 51.66% of the subjects were with 77 – 90 indicates significant statistical difference between pre and post-operative Lysholm scores. Follow up arthroscopy showed a stable ligament at 1.5 year follow up. While follow up X-ray showed mild arthrosis and few complications like infection, calcification of ligament and arthrofibrosis were observed in one patient.
Conclusion: This study is of clinical relevance as it shows alleviation of pain after surgical treatment of the torn ACL which has been described as the stabiliser of the knee and guardian of the Meniscus. This technique allows achieving good self-reported assessments and clinical ligament evaluation up to 1.5 years. Advantages of this technique include safe clinical practice, enables patients to return to preinjury activities including high-risk sports, unlimited bone-to-bone healing, cost effectiveness, avoidance of disadvantages associated with hardware, and ease for revision surgery.

MRI evaluation of cruciate ligaments and associated injuries in knee joint

Dr. Gaurav Kant Sharma, Dr. Jai Chowdhary, Dr. Vineet Mishra, Dr. Sanyukta Gupta

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 2051-2057

The knee joint is one of the most frequently injured joints in the body. Since it is a weight bearing joint, it is consistently exposed to substantial force. The anterior and posterior cruciate ligaments play a vital role in stabilization of the knee joint. Loss of these restraints leads to substantial morbidity and can result in secondary dysfunction of other structures of the knee.
MR imaging of the knee is an excellent modality that detects lesions not always evident on arthroscopy and helps in planning and treatment of meniscal &ligament injuries. The aim of our study is to assess the accuracy of MR imaging in evaluation of cruciate ligament injuries of knee joint. To study and categorize the patterns of cruciate ligament injuries and associated bone and surrounding soft tissues on MRI. Also, to correlate the clinical profile of cruciate and associated ligament injuries with magnetic resonance imaging findings.
Fifty patients were examined on a 1.5 T GE MR system at Mahatma Gandhi Medical College, Jaipur for a time period of eighteen months from December 2019 to May 2021.
Conclusion of our study is that MRI is an excellent modality to detect the lesions in an injured knee. It has great capability in diagnosing meniscal tear and classifying them into grades. According to our study MRI is more sensitive than clinical tests to detect the cruciate ligaments and associated lesions. MRI is unique in its ability to evaluate the internal structure as well as the peripheral meniscal tears, and inferior surface tears. MRI being noninvasive does not involve morbidity associated with other tests like arthroscopy.

To measure the tibial and femoral footprint of ACL in Indian patients (with and without ACL injury) using MRI of normal patients, during (ACLR) and during TKR

Dr Irphan Shaikh, Dr Sameer Chaudhari, Dr Abhay Narvekar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 1, Pages 1412-1423

Aim: To measure the tibial and femoral footprint of ACL in Indian patients (with and
without ACL injury) using MRI of normal patients, during (ACLR) and during TKR.
Materials and Methods: The present prospective study was conducted at PD HINDUJA
hospital and medical research center, Mumbai from March 2015 to November 2015
among 100 patients of Indian origin undergoing arthroscopy, TKR and MRI in our
hospital. We have taken three separate patients group undergoing different procedure
related to knee i.e. Group 1 (Arthroscopic ACL reconstruction), Group 2 (Total knee
replacement) and Group 3 (Diagnostic MRI). As MRI are done in extension of knee,
femoral footprint was in vertically oval plane, so calculating length of maximum
Supero-inferior measurement on MRI sequence of femoral footprint was giving us
length of femoral footprint. All above-mentioned readings were added in tabular form
in excel sheet master chart and was statistically analyzed using SPSS software version

Comparison of functional outcome of arthroscopic anterior cruciate ligament reconstruction using an autologous fourstrand single semitendinosus tendon versus semitendinosus and gracilis tendon graft

Sagar Goel,Manoj Kumar,Keshav Vijan,Varun Gautam,Nikhil L Gore

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 4, Pages 2766-2779

Background: There is no consensus about the optimal graft choice for anterior cruciate
ligament (ACL) reconstruction. The present study was aimed to compare the clinical and
functional results of reconstruction of ACL by using an autologous four strand
semitendinosus tendon versus semitendinosus and gracilis graft.
Methodology and Results: Patients were randomized to undergo ACL repair either by
autologous four strand ST tendon or a ST and gracilis tendon graft. Baseline characteristics of
patients in the two study groups were similar. In the present study, 58 patients were included.
Mean age of the patients in the ST group was 27.34 ± 6.28 years and that in the STG group
was 26.34 ± 5.19 years. Road traffic accident was the most common mode of injury and most
common symptom at presentation was knee pain. It was found that among all patients
included in the study, 48.3% had 4 to 8 months since the time of injury. Mean time since
injury was 6.59 ± 2.7 months in the ST group and 6.42 ± 2.2 months in the STG group. LKSS
and IKDC values were significantly higher in the ST group as compared to STG group at 2
and 8 weeks post-operatively. Later on, at all follow up points, the mean LKSS and IKDC
were similar in the two study groups. Anterior drawer and Lachman test showed no statistical
difference between the two study groups.
Conclusion: Since ACL reconstruction using quadrupled ST is more technically demanding
than doubled STG and with there being no difference in outcomes, no compulsory advice
should be made on the former technique.