Estudio comparativo de reconstrucción de ligamento cruzado anterior con y sin lesiones condrales; resultados funcionales a largo plazo

Resumen

Introducción La lesión del ligamento cruzado anterior (LCA), es una patología frecuente, y el éxito de la reconstrucción depende de diversos factores, tales como la técnica quirúrgica empleada, la edad del paciente, índice masa corporal, nivel de actividad y lesiones asociadas. El objetivo de este estudio es comparar los resultados funcionales a largo plazo de pacientes con lesiones condrales tratadas y sin lesiones condrales sometidos a la reconstrucción de LCA (RLCA), con autoinjerto semitendinoso-gracilis (ST-G).

Materiales y Métodos Estudio analítico retrospectivo. Cuarenta y nueve pacientes (34 hombres y 15 mujeres), fueron sometidos a la RLCA con autoinjerto ST-G. Se compararon dos grupos. Grupo RLCA + LC: 24 pacientes con lesiones condrales ICRS grado III y IV tratadas en el mismo acto quirúrgico y grupo RLCA: 25 pacientes sin lesiones condrales concomitantes. Las edades promedio fueron de 32 y 28 años en cada grupo respectivamente. La funcionalidad de los pacientes a largo plazo fue evaluada con el test de Lysholm, IKDC y retorno deportivo. Se compararon los promedios de los scores funcionales según cada grupo con Test de Mann-Whitney. La asociación entre ambos grupos y el retorno deportivo se analizó con Test de Chi2. Los análisis estadísticos se realizaron con Stata IC 13.

Resultados El seguimiento promedio fue de 106,8 meses (rango: 86–125). Los resultados funcionales obtenidos al comparar el grupo RLCA + LC vs grupo RLCA fueron significativamente peores en el primero, con un promedio del score de Lysholm de 84,87 vs 94,52 (p = 0.0001) e IKDC de 84,43 vs 92,08 (p = 0,004), respectivamente. El retorno deportivo de cada grupo fue de 70,8% y 88% (p = 0,136).

Conclusión La funcionalidad a largo plazo de los pacientes con una RLCA y que tengan alguna LC profunda tratada concomitante, es significativamente inferior que aquellos pacientes con RLCA aislada. No existen diferencias significativas en el porcentaje de retorno deportivo entre ambos grupos. Nivel de evidencia: tipo IV

Abstract

Introduction Anterior cruciate ligament injury is a frequent sports injury, and successful reconstruction depends on diverse factors, such as surgical technique, age, body mass index, level of activity and other concomitant cartilage and meniscal lesions. The objective of this study is to retrospectively compare the long term clinical outcomes of ACL hamstring tendon autograft reconstruction with and without concomitant cartilage injuries.

Materials and Methods Forty nine patients (34 men and 15 women) underwent single bundle transtibial ACL reconstruction and were divided in two groups (Group 1: 24 patients with chondral lesions grade III and IV of the ICRS, and Group 2: 25 patients without chondral lesions). Mean age of both groups was 32 and 28 years, respectively. Clinical outcome was evaluated with Lysholm test, IKDC and return to previous level of sport activities. Mean values of of funcional outcome scores between both groups were compared with Mann-Whitney test. Return to previous level of activity in both groups was analyzed with Chi-2 test. The statistical analysis was performed with Stata IC 13.

Results The mean follow-up period was 106.8 months (range: 86–125). Mean Lysholm test for group 1 vs group 2 was 84.87 and 94.52 (p < 0.001), mean IKDC was 84.43 and 92.08 (p < 0.001), and return to previous sports was 70.8% vs 88% (p = 0.136) for each group.

Conclusion Long term clinical outcomes in patients with chondral lesions that underwent ACL reconstruction were significantly lower than patient with isolated ACL injuries. No statistical differences were found in the return to previous sport activities. Level of evidence: IV.

Palabras Clave

ligamento cruzado anterior - reconstrucción LCA - lesión condral

Keywords

anterior cruciate ligament - ACL reconstruction - chondral lesion

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