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Outcomes of single bundle arthroscopic anterior cruciate ligament reconstruction in a limited resource setting
  1. Binod Sherchan1,
  2. Saroj Rai1,
  3. Nira Tamang2,
  4. Siddhartha Dhungana1,
  5. Laxmi Kanta Sharma1,
  6. Rudra Prasad Marasini1,
  7. Janith Lal Singh1,
  8. Kiran Khanal1
  1. 1Orthopaedics and Trauma Surgery, National Trauma Center, National Academy of Medical Sciences, Kathmandu, Nepal
  2. 2Nursing, Norvic International Hospital, Kathmandu, Nepal
  1. Correspondence to Dr Saroj Rai, Orthopaedics and Trauma Surgery, National Trauma Center, National Academy of Medical Sciences, Kathmandu 44600, Nepal; mesaroz{at}


Objectives Despite various challenges, orthopaedic sports surgeons are still providing the arthroscopic service in low-income and middle-income countries like Nepal; however, it is hardly being reported. The main purpose of this study was to compare the clinical outcomes and complications of patients undergoing arthroscopic anterior cruciate ligament reconstruction (ACLR) in the urban group and that of the rural group.

Methods We evaluated a total of 194 patients, including 98 patients in the urban group and 96 patients in the rural group, undergoing arthroscopic ACLR between August 2015 and February 2018, and had completed a minimum of 2-year follow-up. Subjective evaluations were performed using the Tegner-Lysolm score and International Knee Documentation Committee (IKDC) subjective knee evaluation form. Laxity assessments were performed using the Lachman test and the Pivot-shift test. Functional evaluation included the range of motion, single-leg hop test and overall IKDC score. Radiological assessment was performed according to the IKDC guidelines. SPSS was used for data analysis.

Results There was statistically significant differences in the subjective assessments between 2 groups. No statistically significant differences existed between 2 groups in terms of laxity and functional assessments. However, the proportion of laxity, in terms of Lachman test and Pivot-shift test, was higher in the young and active individuals and the proportion of abnormal and severely abnormal in all parameters of functional outcomes was higher in the older female in the rural group. Graft failure occurred in 19 (17.6%) knees in the urban group and 17 (16.8%) knees in the rural group. Graft failure in the urban group was higher in young and active male patients, whereas failure in the rural group was more in female patients. Similarly, overall infection occurred in 13 (6.2%) knees, including 5 (2.3%) deep infections and 8 (3.8%) superficial infections.

Conclusion We advised similar rehabilitation protocol for all the patients; however, the outcomes were significantly lower in patients living in rural areas as they are found to have poor compliance with the rehabilitation protocol. The overall graft failure rate was 17.2%; however, the reoperation rate was higher in the urban group than the rural group. The rate of deep infection was higher in the rural group as compared with the urban group.

Level of evidence Level III, retrospective comparative study.

  • arthroscopy
  • anterior cruciate ligament

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  • Contributors BS: supervision, manuscript writing, final draft approval. SR: manuscript design, manuscript writing, final draft approval. NT: data entry, manuscript polishing. SD: data analysis. LKS: data collection. JLS: manuscript design, language polishing. RPM: supervision, final draft approval. KK: manuscript design, final draft approval.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. The data sets supporting the conclusion of this article are included within the article.

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