Diferencias funcionales y clínicas entre el autoinjerto de tendón después de la reconstrucción del ligamento cruzado anterior

Resumen

Anterior cruciate ligament (ACL) injury is a common knee injury with an incidence of between 32 and 80 cases per 100,000 inhabitants every year worldwide. Reconstruction of the ACL is the standard surgical method that aims to repair knee stability, improve both clinical and functional outcomes, achieve a rapid return to sport (RTS) and reduce the potential risk of knee osteoarthritis. Quadriceps tendon autografts (QTA) have become more popular in the last 20 years because of their advantages over knee stability and muscle strength recovery . Patellar tendon autografts (PTA) and hamstring tendon autografts (HTA) are the most commonly used autografts. Therefore, choosing ACL reconstruction autografts remains controversial because of their advantages and disadvantages. Consequently, a series of objective were proposed , divided into four objectives: The first phase of this doctoral thesis mainly aimed 1) To review the literature and compare isokinetic strength tests, functional outcomes, and knee anteroposterior laxity between QTA and HTA or PTA after ACL reconstruction. And the second phase aimed, 2)To analyse the sociodemographic and clinical characteristics of patients with injured ACLs before reconstruction surgeries. 3) To compare the difference of PROM, CROM and FROM between patients following ACL reconstruction with BQTB, QTA, or HTA at three evaluation periods (Pre – 3 months, Pre – 6 months, and Pre – 12 months) after rehabilitation protocol. 4) To compare the difference of CROM and FROM between the injured side and non-injured side of all ACL reconstruction patients at 12 months of follow up. To achieve the objectives of the both phases, two methodology were caried: A systematic review and meta-analysis for the first phase and Randomized Control Trail for the second phase of the doctoral thesis. The results of this doctoral thesis were; 1) The first phase of the thesis adds further quantitative data analysis to previously published systematic reviews. The QTA showed better and significant results in knee flexion strength compared with HTA and similar results to PTA at 3-, 6-, and 12- months. HTA showed better and significant results in knee extension strength at 6 months and similar results at 12 months compared to QTA. 2) The BQTA showed the major disadvantage in terms of surgery failure due to intraoperative patella fracture and therefore the delay of rehabilitation process and return to sport. 3)All of the three groups (BQTA, QTA, and HTA) showed a similar result in terms of PROM during all of the evaluation times. However, all patients showed massive improvement between pre-surgery and the final follow-up. 4)All of the three groups (BQTA, QTA, and HTA) showed a similar result in terms of knee anteroposterior laxity, sonographic measurements, PPT, and VAS. However, the HTA group showed better improvement of thigh girth measurement during the 3 - and 6-months follow-up test. Moreover, all patients showed huge improvement between 3 - and 12-months follow-up. 5)The HTA group showed better improvement of knee extension muscle strength during the first 6 months. The three groups showed similar knee extensions muscle strength results at 12 months follow-up. A similar result was found for all groups in terms of knee flexion muscle strength and SLHT. The RTS criteria was in favour of HTA at 6 months and similar between all groups at 12 months. Furthermore, both sides showed an improvement regarding the FROM. 6)The side-to-side comparison showed similar results regarding knee anteroposterior laxity, sonographic measurements, PPT, and VAS. However, the non-injured side had better results in terms of thigh girths measurements and knee flexion and extension isokinetic test.