Description
Objectives
To investigate pain and sensory changes in 75 athletic patients who underwent various anatomic arthroscopic ACLr (Anterior Cruciate Ligament reconstruction) surgical techniques. These patients were divided into three cohorts: the bone-patellar tendon-bone autograft cohort (BTB), the quadruple strand semitendinosus and gracilis autograft cohort (4ST/G), and the quadruple strand semitendinosus autograft all-inside cohort (All-Inside).
Methods
In this study, we undertook a retrospective cohort analysis focusing on the most common complications: pain and sensory abnormalities. All participants adhered to a standardized rehabilitation regimen, with a minimum follow-up duration of 2 years. Pain was assessed based on its duration and anatomical localization, while sensory deficits were examined in terms of their duration and the affected region. Additionally, patients underwent subjective evaluations using three distinct assessment tools: the KWT, LKSS, and IKDC-SKF.
Results
The average duration of AKP varied among the three cohorts, with a mean of 1.8 ± 4.5 months. Notably, the 4ST/G cohort exhibited significantly shorter AKP durations. In the BTB cohort, most patients reported pain localized to the patellar tendon, whereas patients in the 4ST/G and All-Inside cohorts described more diffuse pain.
At the 15-day post-surgery mark, 42 patients reported hypoesthesia, with a significantly higher incidence in the BTB cohort and a lower occurrence in the All-Inside cohort. Remarkably, at the 2-year follow-up, no patients in the All-Inside cohort experienced hypoesthesia. Within the BTB cohort, sensitive alterations were confined to the area innervated by the IPBSN.
In contrast, the 4ST/G cohort reported hypoesthesia in the infrapatellar branches of the saphenous nerve (IPBSN) innervated area and the lateral sural cutaneous nerve (LSCN) region. The All-Inside group primarily noted sensitive alterations in the LSCN region.
Pain related to the KWT was prevalent in patients from the BTB and 4ST/G cohorts, whereas the All-Inside cohort reported no pain in this regard, recording a 0% incidence. However, no statistically significant differences were observed in the IKDC-SKF and LKSS tests across the cohorts.
Conclusions
In all patient cohorts, there were reported instances of referred pain and sensory changes. Notably, patients who underwent arthroscopic ACL reconstruction with BTB autograft exhibited a higher incidence of anterior knee pain and hypoesthesia during medium-term post-operative follow-up, with a more frequent occurrence of positive KWT. Conversely, the 4ST/G group experienced the shortest duration of anterior knee pain. Patients in the All-Inside cohort generally reported fewer complaints and a shorter duration of symptom persistence, particularly in relation to sensory deficits during the postoperative period.
