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Published in: Journal of Orthopaedic Surgery and Research 1/2016

Open Access 01-12-2016 | Research article

Immediate post-operative pain in anterior cruciate ligament reconstruction surgery with bone patellar tendon bone graft versus hamstring graft

Authors: Ravi Gupta, Dheeraj Kapoor, Love Kapoor, Anubhav Malhotra, Gladson David Masih, Anil Kapoor, Shweta Joshi

Published in: Journal of Orthopaedic Surgery and Research | Issue 1/2016

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Abstract

Background

Pain in the immediate post-operative period after anterior cruciate ligament (ACL) surgery, apart from an unpleasant experience for the patient, can act as a barrier for static quadriceps contractions and optimum execution of the initial rehabilitation protocol resulting in slow recovery and a later return to full function for a sportsperson. There is no report in the literature comparing pain in the immediate post-operative period after using the two most widely used autografts, bone patellar tendon bone (BPTB) graft and hamstring graft.

Methods

The present study compared the visual analogue scale (VAS) pain score in the immediate post-operative period after arthroscopic ACL reconstruction with the BPTB and hamstring autografts. Both groups consisted of 50 patients each. The mean age of the BPTB and hamstring cohorts was 26.9 ± 7.3 years (age range 18–59 years) and 26.7 ± 9.0 years (age range 17–52 years), respectively. Unpaired t test was applied to compare pain scores between the BPTB and hamstring cohorts.

Results

In the present study, patients in the BPTB cohort showed higher mean pain scores across all the post-operative time intervals except at 6 h. However, the difference in the mean VAS pain score at post-operative 6, 12,18, 24, 36 and 48 h in the two groups was statistically not significant (p value of 1, 0.665, 0.798, 0.377, 0.651 and 0.215 at 6, 12, 18, 24, 36 and 48 h, respectively).

Conclusions

Our study concludes that the arthroscopic ACL reconstruction with BPTB autograft and hamstring autograft is associated with similar pain in the immediate post-operative period. As a result, aggressive physiotherapy regime is not affected by the type of graft being used for ACL reconstruction, as the pain scores in the immediate post-operative period are similar for both techniques.

Trial registration

Clinical Trials Registry-India, CTRI/​2016/​01/​006502
Literature
1.
go back to reference Freedman KB, D’Amato MJ, Nedeff DD, Kaz A, Bach BR. Arthroscopic anterior cruciate ligament reconstruction: a metaanalysis comparing patellar tendon and hamstring tendon autografts. Am J Sports Med. 2003;31:2–11.PubMed Freedman KB, D’Amato MJ, Nedeff DD, Kaz A, Bach BR. Arthroscopic anterior cruciate ligament reconstruction: a metaanalysis comparing patellar tendon and hamstring tendon autografts. Am J Sports Med. 2003;31:2–11.PubMed
2.
go back to reference Gobbi A, Mahajan S, Zanazzo M, Tuy B. Patellar tendon versus quadrupled bone-semitendinosus anterior cruciate ligament reconstruction: a prospective clinical investigation in athletes. Arthroscopy. 2003;19:592–601.CrossRefPubMed Gobbi A, Mahajan S, Zanazzo M, Tuy B. Patellar tendon versus quadrupled bone-semitendinosus anterior cruciate ligament reconstruction: a prospective clinical investigation in athletes. Arthroscopy. 2003;19:592–601.CrossRefPubMed
3.
go back to reference Jansson KA, Linko E, Sandelin J, Harilainen A. A prospective randomized study of patellar versus hamstring tendon autografts for anterior cruciate ligament reconstruction. Am J Sports Med. 2003;31:12–8.PubMed Jansson KA, Linko E, Sandelin J, Harilainen A. A prospective randomized study of patellar versus hamstring tendon autografts for anterior cruciate ligament reconstruction. Am J Sports Med. 2003;31:12–8.PubMed
4.
go back to reference Laxdal G, Kartus J, Hansson L, Heidvall M, Ejerhed L, Karlsson J. A prospective randomized comparison of bone-patellar tendon-bone and hamstring grafts for anterior cruciate ligament reconstruction. Arthroscopy. 2005;21:34–42.CrossRefPubMed Laxdal G, Kartus J, Hansson L, Heidvall M, Ejerhed L, Karlsson J. A prospective randomized comparison of bone-patellar tendon-bone and hamstring grafts for anterior cruciate ligament reconstruction. Arthroscopy. 2005;21:34–42.CrossRefPubMed
5.
go back to reference Biau DJ, Tournoux C, Katsahian S, Schranz PJ, Nizard RS. Bone-patellar tendon-bone autografts versus hamstring autografts for reconstruction of anterior cruciate ligament: meta-analysis. BMJ. 2006;332:995–1001.CrossRefPubMedPubMedCentral Biau DJ, Tournoux C, Katsahian S, Schranz PJ, Nizard RS. Bone-patellar tendon-bone autografts versus hamstring autografts for reconstruction of anterior cruciate ligament: meta-analysis. BMJ. 2006;332:995–1001.CrossRefPubMedPubMedCentral
6.
go back to reference Li S, Su W, Zhao J, Xu Y, Bo Z, Ding X, et al. A meta-analysis of hamstring autografts versus bone–patellar tendon–bone autografts for reconstruction of the anterior cruciate ligament. Knee. 2011;18:287–93.CrossRefPubMed Li S, Su W, Zhao J, Xu Y, Bo Z, Ding X, et al. A meta-analysis of hamstring autografts versus bone–patellar tendon–bone autografts for reconstruction of the anterior cruciate ligament. Knee. 2011;18:287–93.CrossRefPubMed
7.
go back to reference Wipfler B, Donner S, Zechmann CM, Springer J, Siebold R, Paessler HH. Anterior cruciate ligament reconstruction using patellar tendon versus hamstring tendon: a prospective comparative study with 9-year follow-up. Arthroscopy. 2011;27:653–65.CrossRefPubMed Wipfler B, Donner S, Zechmann CM, Springer J, Siebold R, Paessler HH. Anterior cruciate ligament reconstruction using patellar tendon versus hamstring tendon: a prospective comparative study with 9-year follow-up. Arthroscopy. 2011;27:653–65.CrossRefPubMed
8.
go back to reference Bonamo JJ, Krinick RM, Sporn AA. Rupture of the patellar ligament after use of its central third for anterior cruciate reconstruction: a report of two cases. J Bone Joint Surg Am. 1984;66:1294–7.PubMed Bonamo JJ, Krinick RM, Sporn AA. Rupture of the patellar ligament after use of its central third for anterior cruciate reconstruction: a report of two cases. J Bone Joint Surg Am. 1984;66:1294–7.PubMed
9.
go back to reference Marumoto JM, Mitsunaga MM, Richardson AB, Medoff RJ, Mayfield GW. Late patellar tendon ruptures after removal of the central third for anterior cruciate ligament reconstruction. A report of two cases. Am J Sports Med. 1995;24:698–701.CrossRef Marumoto JM, Mitsunaga MM, Richardson AB, Medoff RJ, Mayfield GW. Late patellar tendon ruptures after removal of the central third for anterior cruciate ligament reconstruction. A report of two cases. Am J Sports Med. 1995;24:698–701.CrossRef
10.
go back to reference Pinczewski LA, Deehan DJ, Salmon LJ, Russell VJ, Clingeleffer A. A five-year comparison of patellar tendon versus four-strand hamstring tendon autograft for arthroscopic reconstruction of the anterior cruciate ligament. Am J Sports Med. 2002;30:523–36.PubMed Pinczewski LA, Deehan DJ, Salmon LJ, Russell VJ, Clingeleffer A. A five-year comparison of patellar tendon versus four-strand hamstring tendon autograft for arthroscopic reconstruction of the anterior cruciate ligament. Am J Sports Med. 2002;30:523–36.PubMed
11.
go back to reference Mastrokalos DS, Springer J, Siebold R, Paessler HH. Donor site morbidity and return to the preinjury activity level after anterior cruciate ligament reconstruction using ipsilateral and contralateral patellar tendon autograft a retrospective, nonrandomized study. Am J Sports Med. 2005;33:85–93.CrossRefPubMed Mastrokalos DS, Springer J, Siebold R, Paessler HH. Donor site morbidity and return to the preinjury activity level after anterior cruciate ligament reconstruction using ipsilateral and contralateral patellar tendon autograft a retrospective, nonrandomized study. Am J Sports Med. 2005;33:85–93.CrossRefPubMed
12.
go back to reference Roe J, Pinczewski LA, Russell VJ, Salmon LJ, Kawamata T, Chew M. A 7-year follow-up of patellar tendon and hamstring tendon grafts for arthroscopic anterior cruciate ligament reconstruction differences and similarities. Am J Sports Med. 2005;33:1337–45.CrossRefPubMed Roe J, Pinczewski LA, Russell VJ, Salmon LJ, Kawamata T, Chew M. A 7-year follow-up of patellar tendon and hamstring tendon grafts for arthroscopic anterior cruciate ligament reconstruction differences and similarities. Am J Sports Med. 2005;33:1337–45.CrossRefPubMed
13.
go back to reference Li S, Chen Y, Lin Z, Cui W, Zhao J, Su W. A systematic review of randomized controlled clinical trials comparing hamstring autografts versus bone-patellar tendon-bone autografts for the reconstruction of the anterior cruciate ligament. Arch Orthop Trauma Surg. 2012;132:1287–97.CrossRefPubMed Li S, Chen Y, Lin Z, Cui W, Zhao J, Su W. A systematic review of randomized controlled clinical trials comparing hamstring autografts versus bone-patellar tendon-bone autografts for the reconstruction of the anterior cruciate ligament. Arch Orthop Trauma Surg. 2012;132:1287–97.CrossRefPubMed
14.
go back to reference Gifstad T, Sole A, Strand T, Uppheim G, Grøntvedt T, Drogset JO. Long-term follow-up of patellar tendon grafts or hamstring tendon grafts in endoscopic ACL reconstructions. Knee Surg Sports Traumatol Arthrosc. 2013;2:576–83.CrossRef Gifstad T, Sole A, Strand T, Uppheim G, Grøntvedt T, Drogset JO. Long-term follow-up of patellar tendon grafts or hamstring tendon grafts in endoscopic ACL reconstructions. Knee Surg Sports Traumatol Arthrosc. 2013;2:576–83.CrossRef
15.
go back to reference Canale ST and Beaty JH, editors. Campbell’s operative orthopaedics, 12th ed. Elsevier 2015 p. 2427-32. Canale ST and Beaty JH, editors. Campbell’s operative orthopaedics, 12th ed. Elsevier 2015 p. 2427-32.
16.
go back to reference Canale ST and Beaty JH, editors. Campbell’s operative orthopaedics, 12th ed. Elsevier 2015 p. 2432-34. Canale ST and Beaty JH, editors. Campbell’s operative orthopaedics, 12th ed. Elsevier 2015 p. 2432-34.
17.
go back to reference Burckhardt CS, Jones KD. Adult measures of pain: the McGill Pain Questionnaire (MPQ), Rheumatoid Arthritis Pain Scale (RAPS), Short‐Form McGill Pain Questionnaire (SF‐MPQ), Verbal Descriptive Scale (VDS), Visual Analog Scale (VAS), and West Haven‐Yale Multidisciplinary Pain Inventory (WHYMPI). Arthritis Care Res. 2003;9:96–104.CrossRef Burckhardt CS, Jones KD. Adult measures of pain: the McGill Pain Questionnaire (MPQ), Rheumatoid Arthritis Pain Scale (RAPS), Short‐Form McGill Pain Questionnaire (SF‐MPQ), Verbal Descriptive Scale (VDS), Visual Analog Scale (VAS), and West Haven‐Yale Multidisciplinary Pain Inventory (WHYMPI). Arthritis Care Res. 2003;9:96–104.CrossRef
18.
go back to reference Mitra S, Kaushal H, Gupta RK. Evaluation of analgesic efficacy of intra-articular bupivacaine, bupivacaine plus fentanyl, and bupivacaine plus tramadol after arthroscopic knee surgery. Arthroscopy. 2011;27:1637–43.CrossRefPubMed Mitra S, Kaushal H, Gupta RK. Evaluation of analgesic efficacy of intra-articular bupivacaine, bupivacaine plus fentanyl, and bupivacaine plus tramadol after arthroscopic knee surgery. Arthroscopy. 2011;27:1637–43.CrossRefPubMed
21.
go back to reference Contreras-Dominguez V, Carbonell-Bellolioa P, Ojeda-Greciet A, Sanzana E. Femoral nerve block for postoperative analgesia after anterior cruciate ligament reconstruction: comparison of 2 concentrations of bupivacaine with clonidine in 3 modes of administration. Rev Esp Anestesiol Reanim. 2006;53:626–32.PubMed Contreras-Dominguez V, Carbonell-Bellolioa P, Ojeda-Greciet A, Sanzana E. Femoral nerve block for postoperative analgesia after anterior cruciate ligament reconstruction: comparison of 2 concentrations of bupivacaine with clonidine in 3 modes of administration. Rev Esp Anestesiol Reanim. 2006;53:626–32.PubMed
22.
go back to reference Williams BA, Kentor ML, Vogt MT, Irrgang JJ, Bottegal MT, West RV, et al. Reduction of verbal pain scores after anterior cruciate ligament reconstruction with 2-day continuous femoral nerve block: a randomized clinical trial. Anesthesiology. 2006;104:315–27.CrossRefPubMed Williams BA, Kentor ML, Vogt MT, Irrgang JJ, Bottegal MT, West RV, et al. Reduction of verbal pain scores after anterior cruciate ligament reconstruction with 2-day continuous femoral nerve block: a randomized clinical trial. Anesthesiology. 2006;104:315–27.CrossRefPubMed
23.
go back to reference Woods GW, O’Connor DP, Calder CT. Continuous femoral nerve block versus intra-articular injection for pain control after anterior cruciate ligament reconstruction. Am J Sports Med. 2006;34:1328–33.CrossRefPubMed Woods GW, O’Connor DP, Calder CT. Continuous femoral nerve block versus intra-articular injection for pain control after anterior cruciate ligament reconstruction. Am J Sports Med. 2006;34:1328–33.CrossRefPubMed
24.
go back to reference Mayr HO, Entholzner E, Hube R, Hein W, Weig TG. Pre-versus postoperative intraarticular application of local anesthetics and opioids versus femoral nerve block in anterior cruciate ligament repair. Arch Orthop Trauma Surg. 2007;127:241–4.CrossRefPubMed Mayr HO, Entholzner E, Hube R, Hein W, Weig TG. Pre-versus postoperative intraarticular application of local anesthetics and opioids versus femoral nerve block in anterior cruciate ligament repair. Arch Orthop Trauma Surg. 2007;127:241–4.CrossRefPubMed
25.
go back to reference Parker RD, Streem K, Schmitz L, Martineau PA. Efficacy of continuous intra-articular bupivacaine infusion for postoperative analgesia after anterior cruciate ligament reconstruction: a double-blinded, placebo-controlled, prospective, and randomized study. Am J Sports Med. 2007;35:531–6.CrossRefPubMed Parker RD, Streem K, Schmitz L, Martineau PA. Efficacy of continuous intra-articular bupivacaine infusion for postoperative analgesia after anterior cruciate ligament reconstruction: a double-blinded, placebo-controlled, prospective, and randomized study. Am J Sports Med. 2007;35:531–6.CrossRefPubMed
26.
go back to reference Armellin G, Nardacchione R, Ori C. Intra-articular sufentanil in multimodal analgesic management after outpatient arthroscopic anterior cruciate ligament reconstruction: a prospective, randomized, double-blinded study. Arthroscopy. 2008;24:909–3.CrossRefPubMed Armellin G, Nardacchione R, Ori C. Intra-articular sufentanil in multimodal analgesic management after outpatient arthroscopic anterior cruciate ligament reconstruction: a prospective, randomized, double-blinded study. Arthroscopy. 2008;24:909–3.CrossRefPubMed
27.
go back to reference de Lima e Souza R, Correa CH, Henriques MD, de Oliveira CB, Nunes TA, Gomez RS. Single-injection femoral nerve block with 0.25% ropivacaine or 0.25% bupivacaine for postoperative analgesia after total knee replacement or anterior cruciate ligament reconstruction. J Clin Anesth. 2008;20:521–7.CrossRefPubMed de Lima e Souza R, Correa CH, Henriques MD, de Oliveira CB, Nunes TA, Gomez RS. Single-injection femoral nerve block with 0.25% ropivacaine or 0.25% bupivacaine for postoperative analgesia after total knee replacement or anterior cruciate ligament reconstruction. J Clin Anesth. 2008;20:521–7.CrossRefPubMed
28.
go back to reference Matava MJ, Prickett WD, Khodamoradi S, Abe S, Garbutt J. Femoral nerve blockade as a preemptive anesthetic in patients undergoing anterior cruciate ligament reconstruction a prospective, randomized, double-blinded, placebo-controlled study. Am J Sports Med. 2009;37:78–86.CrossRefPubMed Matava MJ, Prickett WD, Khodamoradi S, Abe S, Garbutt J. Femoral nerve blockade as a preemptive anesthetic in patients undergoing anterior cruciate ligament reconstruction a prospective, randomized, double-blinded, placebo-controlled study. Am J Sports Med. 2009;37:78–86.CrossRefPubMed
29.
go back to reference Macdonald SA, Heard SM, Hiemstra LA, Buchko GM, Kerslake S, Sasyniuk TM. A comparison of pain scores and medication use in patients undergoing single-bundle or double-bundle anterior cruciate ligament reconstruction. Canadian J Surg. 2014;57:98.CrossRef Macdonald SA, Heard SM, Hiemstra LA, Buchko GM, Kerslake S, Sasyniuk TM. A comparison of pain scores and medication use in patients undergoing single-bundle or double-bundle anterior cruciate ligament reconstruction. Canadian J Surg. 2014;57:98.CrossRef
Metadata
Title
Immediate post-operative pain in anterior cruciate ligament reconstruction surgery with bone patellar tendon bone graft versus hamstring graft
Authors
Ravi Gupta
Dheeraj Kapoor
Love Kapoor
Anubhav Malhotra
Gladson David Masih
Anil Kapoor
Shweta Joshi
Publication date
01-12-2016
Publisher
BioMed Central
Published in
Journal of Orthopaedic Surgery and Research / Issue 1/2016
Electronic ISSN: 1749-799X
DOI
https://doi.org/10.1186/s13018-016-0399-5

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