スポーツ医学およびドーピング研究ジャーナル

Purpose: The most frequently used grafts for intra-articular anterior cruciate ligament (ACL) reconstruction are the autologous patellar tendon (PT) or doubled semitendinosus and gracilis tendons (STG) autografts. There are still controversies about graft selection for primary ACL reconstruction.

Methods: A prospective, randomized study was conducted on 57 patients who underwent arthroscopically assisted ACL reconstruction between January 2010 and February 2011. In 29 patients ACL reconstruction was performed with hamstring tendon autograft (STG group), and in 28 patients the ACL reconstruction was performed with patellar tendon autograft (PT group). At 6 months follow-up, all patients have performed the isokinetic extensor and flexor muscles strength and KT-1000 measurements.

Results: At 6 months after surgery, we found significantly lower average isokinetic quadriceps peak torque in the PT group compared to the STG group at angular velocity of 60°/s. However, at the same time we did not find significant difference in flexor muscle power comparing both groups. The manual maximum KT-1000 arthrometer side-to-side difference was 1.7 ± 1.7 mm for the PT group and 1.9 ± 1.6 mm for the STG group (P=0.398). No significant correlation was found between the knee objective stability (KT-1000 measurements) and the isokinetic thigh muscle strength (extensors, Spearman’s rho=0.057, P=0.671; flexors, Spearman’s rho=0.094, P=0.489).

Conclusions: Both hamstring and patellar tendon autografts provided good objective stability at 6 months after surgery In addition, regardless of which graft was used, a considerable percentage of patients continue to have strength deficits. In our opinion, the ACL-reconstructed leg should have 85% or greater return to the strength of the normal leg as one criterion before release to full sports activities. We were particularly intrigued to find only half of the competitive athletes achieved this goal at 6 months after surgery.

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Background: Despite the plethora of published articles relating to anterior cruciate ligament injuries, little evidence exists regarding the subject of simultaneous bilateral anterior cruciate ligament reconstruction (SBACLR) and its rehabilitation challenges. Case Report: This case study presents a 17-year-old female athlete who underwent a rare surgical procedure: a SBACLR and suturing of the medial collateral ligament of one knee. A relatively new innovative computerized air-insole auditory biofeedback system (Smartstep™) was used as an adjunct in the evaluation and promotion of weight-bearing in the early stages of rehabilitation. Results: Following intensive rehabilitation over a seven-week period, the athlete progressed in all functional activities of daily living, with a gradual bilateral improvement in weight-bearing abilities. After completion of her rehabilitation program, she returned symptom-free to all previous functional and sporting activities. Conclusions: This case study highlights the fact that although a SBACLR is still a relatively uncommon knee surgical procedure, the possibility exists for an athlete to return to full functional activities of daily living. The Smartstep™ system proved to be a useful objective and accurate adjunct during the rehabilitation process.