Presentation

1. WELCOME TO THESIS PROGRESSION
Dr. Md. Rakiz Khan
MS (Orthopaedic Surgery) Phase B, Resident
National Institute of Traumatology and
Orthopaedic Rehabilitation (NITOR)

2. Thesis Title
Outcome of Arthroscopic Anterior Cruciate Ligament
Reconstruction by Semitendinosus and Gracilis Tendon
Graft through Modified Transtibial Technique

3. GENERAL INFORMATION
Investigator : Dr. Md. Rakiz Khan
MS (Orthopaedic Surgery) Phase B Resident
Guide : Professor Dr. Monaim Hossen
Professor & Academic Director.
Co Guide : Dr. A. M. Farid Uddin Ahmed
Assistant Professor, Orthopaedic Surgery
Institute : National Institute of Traumatology and Orthopaedic
Rehabilitation (NITOR)
Duration : September’ 2018 - November’ 2019.
December ‘ 2021 - April’ 2023.

4. INTRODUCTION
• Anterior Cruciate Ligament (ACL) is the most
commonly injured ligament in the knee. The
incidence is 1:3000 in general population.
• There are many methods of arthoscopic ACL
reconstruction. Anatomic positioning of femoral
tunnels has proved to be better in terms of knee
rotational stability and graft function.

5. • Development of modified transtibial, transanteromedial
portal and outside-in techniques facilitate anatomic
positioning of femoral tunnel.
• Anteromedial portal and outside-in methods have risk of
posterior wall damage, relatively weak graft fixation, and
thus, in long term, leads to tunnel expansion and failure of
ACL reconstruction.

6. • Modification of familiar, traditional trans-tibial
technique allows near anatomic femoral tunnel
poisoning through same skin incision (tibial tunnel)
and provides press-fit fixing technique that promotes
swift soft tissue bone healing.

7. • Modified transtibial technique consists of simple
maneuvers during femoral tunnel guide insertion for
anatomic positioning of the tunnels. This technique
also allows sufficient tunnel length to be obtained for
fixation, and the tunnel widening is minimal. The
overall duration of surgery is shorter.

8. • Quadrupled semitendinosus and gracilis tendon grafts
have sufficient diameter, and are comparable to native
ACL. It has lower donor site morbidity, anterior knee
pain, extensor strength deficit and osteoarthritis, as
well as can be harvested through a relatively small
skin incision.

9. • Therefore, present study was aimed to evaluate the
outcome of arthroscopic ACL reconstruction by
semitendinosus and gracilis graft through modified
transtibial technique in our context at NITOR.

10. RATIONALE OF THE STUDY
• Anatomic positioning of tunnels has proven to be better in
terms of knee stability and graft function compared with
isometric and vertical positioning of tunnels.
• Modification of familiar transtibial technique allows ACL
reconstruction by near anatomic femoral tunnel
positioning results in stable and functional knee, and
avoid risk of tunnel blowout and tunnel widening.

11. RESEARCH QUESTION
What are the functional outcomes of arthroscopic
reconstruction of ACL by semitendinosus & gracilis
tendon graft in modified transtibial technique?

12. OBJECTIVES
General objective:
To assess the outcome of arthroscopic ACL
reconstruction by semitendinosus and gracilis tendon
graft in modified transtibial technique.

13. OBJECTIVES (Cont.)
Specific objectives:
1. To assess the clinical outcome.
2. To find out the functional outcome.
3. To identify the complications of the treatment.

14. Materials & Methods
Study design: Quasi experimental study.
Study place: NITOR.
Study period: September’ 2018 - November’ 2019 and
December ‘ 2021 - April’ 2023.
Sampling technique: Purposive non-randomized
sampling.
Sample size: 36.

15. Selection criteria
Inclusion criteria:
• Diagnosed case of ACL injury.
• Age between 20 to 40 years.
• BMI < 40 kg/m2.

16. Exclusion criteria:
• Multiple ligament injuries of knee.
• Associated complex meniscus injury.
• Presence of fractures around the knee.
• Previous surgery for knee injuries.
• Presence of osteoarthritis of knee.

17. STUDY VARIABLES
Demographic Variables
 Age
 Sex
 Occupation

18. Clinical Variables
 Side of injury.
 Mechanism of injury.
 Duration of injury to operation.
 Duration of hospital stay.

19. Outcome Variables
∙ Ligamentous stability of knee by Lachman test and
anterior drawer test.
∙ Lysholm knee score.
∙ Range of motion of knee.
∙ Post-operative complications (if any).

20. Sample size determination:
Sample size calculated by using following formula
Here,
n = Sample size
z= Value of standard normal distribution at a given level of
significance or at a given confidence level (e.g.at 5% level of
significance or 95% confidence level, Z=1.96).
p= % of expected outcome. According to Rhatomy et al. (2019)
Lysholm knee score at final follow up = 89.7 = 0.0897%
q= 1-p=1-0.0897=0.103
d= Acceptable error 10%=0.1 [10/100]
n = 35.49 = 36. So, finally sample size = 36

21. CASE-1

22. CASE-1