Preoperative planning in anterior cruciate ligament injuries

The high frequency of unsatisfactory results of treatment of knee joint instability against the background of anterior cruciate ligament (ACL) injurie causes renewed interest in its reinsertion. However, the use of this method should be accompanied by careful preoperative planning based on the evaluation of magnetic resonance imaging (MRI) of the knee.The purpose of this work was to determine the possibility and effectiveness of the restoration of the ACL against the background of its proximal ruptures, as well as the informativeness of MRI performed in the preoperative period to determine the optimal therapeutic tactics depending on the localization and nature of the damage to the ACL.Material and methods. The analysis of surgical treatment of 201 patients with instability of the knee joint on the background of the anterior cruciate ligament injurie was carried out. Of these, 117 patients made up a comparison group, where the analysis was carried out according to the protocols of MRI and protocols of operations. The main group included 84 patients who were under our direct supervision. Therapeutic tactics were determined based on an assessment of the location and nature of the ACL injurie according to MRI and the diagnostic stage of arthroscopy of the knee joint.Results. 1 year after the operation performed for ACL injurie, the average results on the questionnaire scales in both observation groups were in the "excellent" range, however, in the main group, where 40.5% of patients underwent ACL reinsertion, these indicators were still 2.2 points better (KOOS) and by 1.5 points (IKDS) higher than in the comparison group, where all underwent ligament replacement with autotransplant using a tendon of the semitendinosus muscle according to the standard All-inside technique. 97.1% of patients in the main group rated the result as good or excellent, which confirms the correctness of the chosen tactics. The knee joint stability was restored, no complications were noted.Conclusion. Clarification of the localization and nature of the ACL injurie during preoperative planning allows us to determine the indications for its reinsertion and obtain the best results 1 year after this operation. This operation can be recommended for proximal ruptures of the ACL (type I or II by Sherman) in combination with the absence of pronounced dislocation of the ligament stump (group A or B by Ateschrang). At the same time, the final decision on surgical tactics should be made on the basis of the data of the diagnostic stage of arthroscopy, during which more severe ACL injurie may be detected, requiring changes in the operational plan and the implementation of auto-transplantation.