PURPOSE OF THE STUDY In recent years attempts have been made again to repair anterior cruciate ligament (ACL) in order to maintain native kinematics and knee joint proprioception. The method of choice is the arthroscopic suture of the ligament using the InternalBrace ligament augmentation. This study presents the first experience gained with this surgical technique and the clinical outcomes. MATERIAL AND METHODS In the period from November 2016 to December 2018, a total of 46 patients with acute ACL rupture underwent the ACL repair using the InternalBrace ligament augmentation. This study includes only the patients followed up for a minimum period of 12 months postoperatively. For the evaluation of patients, the well-established clinical scores were used - the Tegner Activity Level Scale, the IKDC (International Knee Documentation Committee) subjective scale and the Tegner Lysholm Knee Scoring Scale. The measurements were taken preoperatively and at 6 and 12 months postoperatively. RESULTS The evaluations concerned 20 patients who had undergone surgery in the period from February 2017 to February 2018. In the aforementioned group of patients, there were 3 cases of reconstruction failure (15%), subsequently requiring the ACL reconstruction. The average preoperative Tegner Activity score was 8.2 (6-10; median 8.0). At six months postoperatively, the average value of this score was 7.35 (5-10; median 7), and at 12 months postoperatively it was 7.35 (4-10; median 7). The average preoperative Lysholm score was 66.4 (16-100; median 69). At six months postoperatively, the average value of this score improved to 90.70 (71-100; median 92) and at 12 months postoperatively to 91 (75-100; median 90). The average IKDC subjective score before the surgery was 49.8 (36-74; median 49). At six months postoperatively the average achieved score was 87.70 (71-99; median 90) and at 12 months postoperatively it was 88.9 (63-99; median 93). The differences between the preoperative values and the values at 6 months after the surgery were significant in all the followedup parameters. Conversely, the differences between the values at 6 and at 12 months were not significant. DISCUSSION The clinical outcomes of the patients after the ACL repair are valuable and comparable to the data published in literature. They were largely achieved within 6 months after the surgery. A fairly high percentage of failure of this method compared to literature (Jonkergouw 7.5%, McKay 1.5%) can partly be ascribed to the learning curve even though the surgeries were performed exclusively by experienced surgeons. A certain role could also be played by more challenging indication for this procedure or a faster return to postoperative load. CONCLUSIONS Anterior cruciate ligament suture with the InternalBrace ligament augmentation judging from the results achieved by our group of patients brings very good clinical outcomes already at 6 months postoperatively. This method allows the athletes to return to full load soon. It maintains the kinematics and knee joint proprioception, and thus can potentially contribute to the prevention of post-traumatic arthritis. Strict application of indication criteria is a precondition to success. A longer follow up and evaluation of a larger number of patients will, however, be necessary to definitely confirm the success of this surgical technique. Key words: arthroscopy, ACL rupture, ACL repair, InternalBrace, clinical evaluation.

• MeSH
• artroskopie MeSH
• interní fixátory MeSH
• lidé MeSH
• poranění předního zkříženého vazu chirurgie   MeSH
• rekonstrukce předního zkříženého vazu přístrojové vybavení   metody   MeSH
• ruptura MeSH
• šicí techniky přístrojové vybavení   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

PURPOSE OF THE STUDY: The aim of the study is to present a comparison of short-term results of double- versus single-bundle anatomical reconstruction of the anterior cruciate ligament (ACL) using hamstring endons and their fixation with absorbable interference screws. MATERIAL AND METHODS: A total of 110 patients with an isolated ACL lesion and the healthy contralateral knee who met the indication criteria for ACL double bundle reconstruction (TISL, 14 mm; ICNW, 12 mm) were intra-operatively allocated at random to either double-bundle group (DB, n=55) or single-bundle group (SB, n=55). At 12 months after surgery, 97 patients (DB group, n=49; SB group, n=48), comprising 68 men and 29 women, were evaluated; the average age was 29.1 years and the injury-to-surgery interval was 15.9 weeks. Pre- and post-operative subjective criteria involved the IKDC and Lysholm score. Objectively, the occurrence of graft failure, range of motion deficit, return to pre-injury sports activity, side-to-side difference in anterior laxity of both knees in 20° flexion on a GNRB laximeter at an applied pressure of 124 N and 250 N, and pivot shift phenomenon were assessed. RESULTS: No statistically significant difference was found in pre-operative values between the two groups. Post-operatively, there were no significant differences in the occurrence of complete graft failure (p=0.0755; DB group, n=0; SB group, n=3), range-of-motion deficit (p=0.2277-0.9788) or return to pre-operative sports activity (p=0.2322). In the DB group, side-to-side anterior tibial shifts at a pressure of 124 N (medians=1.3 mm and 2.1 mm for DB and SB groups, respectively; p=0.0007) and at a pressure of 250 N (DB group =2.1 mm; SB group = 3.1 mm; p<0.0001) were significantly different from the corresponding values in the SB group. Positive results for the pivot shift test (PST) were significantly less frequent in the DB than the SB group (Chi-square test =0.0112). The SB group patients had a 2.9-times (odds ratio, 2.8704) higher risk of positive postoperative PST results than the DB group patients. In both groups, a comparison of pre- and post-operative criteria showed significant improvement in both the subjective and the objective results. DISCUSSION: The results of this study, in accordance with other authors' conclusions, suggest that the double-bundle technique provides better control over rotational and anterior knee laxity and therefore restores knee biomechanics better. However, other literature data do not confirm any significantly better outcomes of this method. Since only short-term results have been obtained so far, the study will continue because only the long-term results can provide conclusive evidence of an advantage of one technique over the other. CONCLUSIONS: Our study showed significantly better restoration of knee rotational and anterior laxity in the patients undergoing anatomical reconstruction of the ACL by the double-bundle technique. The other evaluated criteria did not differ in relation to the technique used.

• MeSH
• biomechanika MeSH
• dospělí MeSH
• kolenní kloub chirurgie   MeSH
• lidé MeSH
• ligamentum cruciatum anterius MeSH
• nestabilita kloubu * diagnóza   etiologie   MeSH
• pooperační komplikace diagnóza   MeSH
• poranění předního zkříženého vazu MeSH
• rekonstrukce předního zkříženého vazu * škodlivé účinky   přístrojové vybavení   metody   MeSH
• rozsah kloubních pohybů MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• randomizované kontrolované studie MeSH