Augmentation technique for partial ACL ruptures using semitendinosus tendon in the over-the-top position

Abstract

The aim of this study is to present a surgical augmentation technique for partial ACL ruptures in which an isolated, autologous, double-bundle semitendinosus tendon graft is passed over the top of the femur, thus fully preserving the still-intact fibers of the ligament remnant. Between 1992 and 2006, 24 patients underwent ACL semitendinosus autograft reconstruction and were followed up for at least 2 years. The median follow-up was 6.2 years (2-15.6). At the last follow-up examination, the patients were evaluated using the International Knee Documentation Committee scale. Subjective and functional parameters were assessed using the Tegner activity scale and the Lysholm scale. Instrumental evaluation was carried out using the KT-1000 instrument. Sixteen of the 24 patients achieved an IKDC score of A. Of the remaining eight patients, six achieved an IKDC score of B, one an IKDC score of C, and one an IKDC score of D. According to the Tegner activity scale, the median pre-injury sports activity level was seven (5-9) and the median post-injury level was six (4-9), while the mean Lysholm scale score was 95 (90-100). Clinical and biomechanical studies have shown that reconstruction techniques that address both bundles of the ACL provide better rotational stability than techniques that address only a single bundle. Therefore, it seems logical than in patients with a partial rupture of the ACL, the intact bundle could be preserved and only the torn bundle would need to be reconstructed.