The Clinical Effect Of Sartorial Fascia Suturing On High Local Tissue Pressure After Hamstring Tendon Graft Harvest For ACLR

Purpose:To identify the effect of sartorial fascia suturing on high local tissue pressure after hamstring tendon graft harvest in patients undergoing anterior cruciate ligament reconstruction(ACLR)and to improve their post-operative satisfaction.Patients and Methods:We performed a double-blinded,randomized controlled trial.Fifty-four patients were separated into two groups;24 underwent total suturing of the sartorial fascia during ACLR,and 30 underwent partial suturing of the sartorial fascia.Calf circumference(CC)and skin temperature(ST)were recorded the day before surgery and 1 day to 1 week after surgery to evaluate pre-tibial swelling and local inflammation.An increase or decrease of calf circumference was recorded as follows:CC△1(Increase or decrease of calf circumference at the first day after surgery)=CC1(calf circumference at the first day after surgery)-CCO(pre-operative calf circumference).CC△2=CC2-CCO,CC△3=CC3-CC.An increase or decrease of skin temperature was recorded the same way.A visual analogue scale(VAS)was used to evaluate pain 1 day to 1 week after operation and recorded as VAS-1,VAS-2,......VAS-7.Every patient underwent isokinetic muscle strength testing(60°/s and 180°/s)before and 1 year after the operation.Peak torque,peak torque per body weight,peak torque angles,average work,and average power were used to evaluate the recovery of muscle.The deficit(%)was calculated as follows(taking peak torque as an example):([1 year after operation peak torque of the involved side-pre-operation peak torque of the involved side]/pre-operation peak torque of the involved side)×100%.The International Knee Documentation Committee(IKDC)questionnaire and Lysholm Knee Scoring Scale were administrated 1 year after operation.Results:A total of 54 patients(47 male and 7 female)underwent ACLR.The total suturing group got more increase of calf circumference and higher VAS score within a week after operation.On the first day to fifth day after operation,the increase of calf circumference and VAS score were significantly higher in total suturing group.There was no difference of change of calf circumference and VAS score between groups at the sixth day(pcc=.20,pvas=.15)and 1 week(pcc=544,pvas=.083)after operation.There was no significant difference between the two groups with respect to skin temperature,IKDC score,Lysholm Scale score,or the flexion and extension deficit of peak torque,peak torque per body weight,average work,and average power.At 1 year after the operation,recovery of muscle and knee function were good.The mean ± SD Lysholm Score of total suturing group was 86.6±7.6 compared to 87.5±7.0 in partial suturing group.The mean ± SD IKDC scores of total suturing group and partial suturing group were 84.8±5.6 and 84.8±7.4,respectively.Conclusion:Patients who underwent total suturing of the sartorial fascia after hamstring tendon graft harvesting for ACLR had more pre-tibial swelling and pain after surgery.The recovery of knee function and muscle strength were almost equivalent between the two groups 1 year after operation,indicating partial suturing’s safety.