Abstract
Background: Anterior cruciate ligament (ACL) reconstruction is one of the most frequent procedures done by orthopedic surgeons. Successful reconstruction is founded on fast healing and incorporation of tendon graft which translates to earlier and aggressive rehabilitation and faster return to dynamic activities. Recent studies highlighted the importance of biologic strategies in the enhancement of the recuperation process of autologous grafts for reconstruction. Current literature theorized the concept of maintaining the hamstring graft (HG) insertion but was unable to explicitly conclude an advantage of maintaining the attachment of the hamstring graft. Method: A prospective, double-blinded, randomized controlled study was done comparing graft integration through MRI (Figueroa) scoring system, and clinical outcomes through IKDC scores between the detached HG (control group) versus preserved tibial attachment of HG (test group) both augmented with interference screw fixation for ACL reconstruction. Results and Conclusion: A total of 32 patients were enrolled, 18 for the control group, 14 for the test group. Preoperative IKDC scores were similar for both groups. Post-operatively, a significant earlier peak at 3 months and continued improvement at 6 months is in favor of the test group. Consistently, there is also a 2.78-fold increased likelihood of graft healing and its constituent graft integration and ligamentization in the test group. This suggests that preservation of the neurovascular attachment of the HG is a contributory factor for efficient ligamentization and subsequent pain control, activities of daily living and functional capacity.
Highlights
The anterior cruciate ligament (ACL) is the most frequently damaged structure in the knee requiring reestablishment, its reconstruction is one of the most often procedures done by orthopedic surgeons around the globe [1]
A total of 32 patients were enrolled, 28 males and 4 females with a mean age of 23 (18-40) years old. 18 patients were randomized on the control/detached hamstring graft group and 14 on the test/attached group
Informed consent was obtained for all patients and underwent the standard protocol of pre-operative assessment with the IKDC and subsequent post-operative evaluation
Summary
The anterior cruciate ligament (ACL) is the most frequently damaged structure in the knee requiring reestablishment, its reconstruction is one of the most often procedures done by orthopedic surgeons around the globe [1]. Failure of ACL reconstruction has been characteristically attributed to technical errors up to 70%, succeeded by trauma and biologic reasons Those claims were further substantiated and quantified in a recent cohort of 460 patients that a multimodal cause of failure (37%) was the culprit, followed by traumatic mechanisms (32%), technical errors (24%), biologic (7%) and infection (
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