[Reconstruction of the anterior cruciate ligament: arthrotomy versus arthroscopy]

The aim of this study was to compare the results of arthroscopic with open arthrotomy reconstruction of the anterior cruciate ligament, as treatment of chronic anterior laxity. 54 knees (among 63) were evaluated, 33 reconstructions were performed according to Kenneth Jones technique with arthrotomy (from 1990 to may 1993) and 21 were arthroscopically-assisted (from may 1993 to 1996). Meniscectomy was associated respectively in 22 and 7 cases. The average interval between initial injury and surgery was 18 and 18.6 months. Follow-up was one year at least. We evaluated mobility, amyotrophy and quadriceps and hamstrings muscular deficit: static at 1 month and using Cybex isokinetic tests at 2, 3 and 6 months and 1 year. Postoperative residual laxity and Arpege cotation were evaluated at 1 year. Student and Mann Whitney tests were used for statistical evaluation. As complication we noted respectively after arthrotomy and after arthroscopy: 7 (21.2 p. 100) and 4 (19 p. 100) algodystrophy, 1 (3 p. 100) and 1 (4., 7 p. 100) Cyclops syndrome, and 2 (6 p. 100) and 1 (4.7 p. 100) anterior knee pain. Lack of extension and flexion were respectively -5.4 degrees/130 degrees and -1.9 degrees/136 degrees at 3 months (p = 0.04) and -3.5/134 degrees and -1.5 degrees/138 degrees at 6 months (not significative). At 1 month, static hamstrings deficit was 41.3 p. 100 after open arthrotomy and 29.6 p. 100 after arthroscopic assisted (p = 0.05). At 2 months, isokinetic hamstrings deficit was lower after arthroscopic assisted (21.6 p. 100 at 60 degrees; 20.8 p. 100 at 180 degrees) than after open arthrotomy (32.8 p. 100; 32.5 p. 100) (p = 0.039 and 0.008). This difference was found for hamstrings until 3 months. At 6 months and 1 year, no difference was found for Cybex tests. In Arpege score, at 1 year, 73.3 p. 100 were very satisfied or satisfied after open arthrotomy and 77.7 p. 100 after arthroscopy. Global results were excellent or good in 66 p. 100 after open arthrotomy and 83 p. 100 after arthroscopy. Radiological laxity was less than 5 mm in 88 p. 100 after open arthrotomy and 92 p. 100 after arthroscopic assisted. So, after arthroscopically assisted procedure, the number of algodystrophy and anterior knee pain was lower, and until 3 months, range of motion was better and hamstrings deficit was lower. After 6 months, difference about range of motion or muscular deficit were not significative. At 1 year, after arthroscopic procedure, results seemed better with a lower rate of residual laxity and better global results, but the number of medial meniscectomies was lower in this group. In conclusion, the arthroscopic-assisted procedure seems to allow a faster rehabilitation.