2021 ISAKOS Biennial Congress Paper
Concurrent Treatment Of A Displaced Bucket Handle And Anterior Cruciate Ligament Reconstruction: A Higher Risk Of Stiffness?
Etienne Deroche, MD, Lyon, Auvergne Rhône-Alpes FRANCE
Cécile Batailler, MD, PhD, Lyon, Rhône Alpes FRANCE
John Swan, MBBS, Lyon FRANCE
Sebastien Lustig, MD, PhD, Lyon, Rhône Alpes FRANCE
Elvire Servien, MD, PhD, Prof., Lyon, Rhône Alpes FRANCE
Orthopaedics surgery and Sports Medicine Department, FIFA medical center of excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, Auvergne-Rhône-Alpes, FRANCE
FDA Status Cleared
Summary
There is an increased risk of revision for arthrolysis after simultaneous treatment of DBH and ACL reconstruction.
Abstract
Objectives: Postoperative stiffness is feared after anterior cruciate ligament (ACL) reconstruction. A bucket handle meniscal tear associated with an ACL tear requires urgent surgical treatment and may delay full range of motion (ROM) recovery. We hypothesize that the concurrent treatment of a displaced bucket handle (DBH) meniscal tear and ACL reconstruction is associated with an increased risk of revision for arthroscopic arthrolysis.
Methods
A retrospective case-control study of consecutive patients with ACL reconstruction performed between January 2009 and December 2018. Group A (cases) involved all patients who underwent simultaneous ACL reconstruction and DBH meniscal tear treatment, and patients in group B (2 controls for each case) underwent isolated ACL reconstruction. Groups were matched for age, sex, body mass index. The primary outcome was re-operation rate for arthrolysis <12 months after surgery. Other outcomes were stiffness in flexion and extension at 6 weeks and 6 months after surgery.
Study Design: Case-control study, Level of Evidence: Level 3
Results
69 patients were included in group A, 40 men (58%) and 29 women (42%) and 139 patients in group B, 68 men (49%) and 71 women (51%). Mean age was 29 +/_ 11.2 years in group A and 30 +/_ 10.4 years in group B. The revision rate for arthrolysis was higher in group A compared to group B, 7 (10.1%) and 4 (2.9%) patients respectively (p=0,044), with a survival rate of 89.7% (CI95% 82.7-97.2) and 97.1 (CI95% 94.3-99.9) respectively (p=0.023). There was more stiffness in flexion and in extension in group A after 6 weeks and after 6 months (p>0.05). The risk for arthrolysis was not statistically different regarding the delay from accident to surgery for the global series (p=0.421) and in group A specifically neither (p=0.887). The DBH was sutured for 39 patients (56.5%), with 3 failures (7.7%) after 12 months follow-up. Arthrolysis was performed for 6 patients treated by meniscal suture (15.4%) and for only one patient treated by meniscectomy (3.3%) (p=0.128).
Conclusion
Our study confirms an increased risk of revision for arthrolysis after simultaneous treatment of DBH and ACL reconstruction. The influence of the delay for surgery after ACL rupture and the type of DBH treatment (suture or meniscectomy) on postoperative stiffness has not been demonstrated.