Prospective study of functional outcome of Arthroscopic ACL reconstruction using semitendinosus tendon graft with a periosteal strip from anteromedial tibia

Abstract

Background: Semitendinosus tendon is considered one of the best grafts for ACL reconstruction. Only if the semitendinosus graft is inadequate in length or diameter the need for gracilis tendon occurs. Harvesting the semitendinosus tendon along with a 1.5 to 2 cm periosteal strip from anteromedial tibia will increase the graft dimensions. The purpose of this study is to assess the functional outcome of ACL reconstruction with this modified form of semitendinosus graft. Materials and methods: Twenty patients with symptomatic ACL tear underwent arthroscopic ACL reconstruction using quadrupled semitendinosus tendon along with a strip of periosteum from the anteromedial tibia. No patient required gracilis tendon and all had a graft diameter of 8mm and above with a length greater than 7.5cm. Seventeen patients completed a period of one year follow up. Results: The average preoperative score was 61.24 (S.D.=5.8). After surgery, the average Tegner Lysholm score at one year was 87.76 (S.D.=4.1). This shows a significant improvement in the score (p value <0.01). Fourteen of the 17 patients had the entire range of knee motion restored. Two of them had 20 degrees loss of flexion and one had a fixed flexion deformity of 5 degrees. Two patients had superficial infection which subsided with antibiotics. One patient had graft impingement which was noticed intraoperatively and notchplasty was done. There was no graft failure for any of them. Conclusion: Harvesting semitendinosus tendon along with a strip of periosteum from the anteromedial tibia will improve the dimensions of the graft making it sufficient for ACL reconstruction. This will decrease the need for gracilis tendon and the morbidity associated with its harvest Keywords: ACL; Hamstring tendon; Semitendinosus; Gracilis