A randomized controlled trial comparing bone mineral density changes of three different ACL reconstruction techniques

Area of Science:

• Orthopedic surgery
• Biomedical engineering
• Sports medicine

Background:

• Anterior cruciate ligament reconstruction (ACLR) aims to restore knee function.
• Understanding bone mineral density (BMD) changes after ACLR is crucial for long-term outcomes.
• Comparing different ACLR techniques provides insights into surgical impact.

Purpose of the Study:

• To compare BMD changes following three ACLR techniques: bone-patellar tendon-bone (BPTB), single-bundle hamstring (HT-SB), and double-bundle hamstring (HT-DB).
• To assess the association between BMD and early clinical and functional outcomes after ACLR.

Main Methods:

• Prospective, parallel randomized study of 62 male adult patients undergoing primary ACLR.
• BMD measurements at the proximal tibia, distal femur, femoral neck, and trochanteric region at 1 day, 3 months, 5 months, and 1 year.
• Clinical and functional assessments included KT-1000, Lysholm, IKDC, one-leg hop test, and Lachman test at baseline and 1 year.

Main Results:

• Significant bone loss occurred at the injured knee and hip at 3 and 5 months, with knee bone loss reversing by 1 year, but hip bone loss remaining.
• No significant differences in bone loss were observed among the surgical techniques, except for femoral neck BMD loss.
• A positive correlation was found between distal femur BMD and single-leg hop distance at 1 year post-surgery.

Conclusions:

• The three ACLR techniques demonstrated similar transient bone loss in the knee and irreversible bone loss in the hip up to 1 year.
• Early clinical and functional outcomes were comparable across the techniques.
• Distal femur BMD is positively associated with single-leg hop performance, highlighting its importance in functional recovery.