TO INVESTIGATE THE CLINICAL AND RADIOLOGICAL OUTCOMES OF ACL RECONSTRUCTION WITH QUADRUPLE HAMSTRING AUTO-TENDON GRAFTS USING FEMORAL TRANSFIX SCREW.

Introduction: An anterior cruciate ligament (ACL) injury of the knee is one of the most common sports/road accidents injuries. Surgery confirms a stable and a fully functional knee, preventing possible future complications such as repeated knee injuries and possible arthritis. Aims and objectives: The current study is done to measure the outcome of arthroscopic ACL reconstruction with quadruple hamstring auto-tendon grafts fixed with metal transfix screw on the femoral side and metal interference screw on tibial side of the graft. Materials and method: The study includes fifty patients with complete chronic ACL tear between the age group of 20-40 years. This study was conducted at Department of Orthopaedics, SSSIHMS. The study period had being from June 2007 to June 2010. This is a retrospective study of patients from a prospectively maintained database for a minimum period of 2 yrs. All patients underwent arthroscopic assisted ACL reconstruction with quadruple hamstring auto tendon graft fixed with titanium transfix screw on the femoral side and titanium interference screw on the tibial side. All patients underwent surgery performed by the same surgeon. The outcome of the study was statistically assessed using the Mann-Whitney test and Wilcoxon signed rank tests. Results: At the end of the two years of the follow up, 36 patients (72%) out of 50 were noted to have IKDC subjective assessment score between 85-95% and 6 patients (12%) were found to have the score between 95-100 %. Only 4 (8%) patients had score less than 80. All the patients were also assessed with Lysohlm score and were found to have improved post operatively. 40 patients (80%) were noted to have score between 80 to 95%. Discussion: Most common mode of ACL injury was noted to be sports injuries, while in our country, road traffic accidents also take significant share. Patients with good pre-operative muscle bulk were having good functional outcome. Associated intra-particular pathologies were also shown to alter the outcomes of the surgery, as evident by the lower outcome scores. Good compliance with the accelerated ACL rehabilitation protocol showed good outcomes of the surgery with respect to their progressive increase in functional scores at every follow up. Proper bone tunnel placement in femur and tibia were found to be playing key role in achieving excellent results. In spite of having grade 1 laxity post operatively, the functional outcomes were noted to be satisfactory. Conclusion: Performed under ideal conditions, we maintain ACL reconstruction with quadruple hamstring auto-tendon grafts using a femoral transfix screw fixation is a safe & effective approach in indicated patients.