4-strand Hamstring Research Articles

Radiographic Osteoarthritis, Clinical Outcomes and Re-Injury 20 Years after ACL Reconstruction

Objective:This prospective longitudinal study compares the outcome of isolated endoscopic ACL reconstruction utilizing 4-strand hamstring tendon (HT) and patellar tendon (PT) autograft over a 20-year period.Method:Observational Series. 90 consecutive patients with isolated ACL rupture were reconstructed with a PT autograft and 90 patients received HT autograft, with an identical surgical technique. Patients were assessed at 2, 5, 7, 10, 15 and 20 years. Assessment included the IKDC Knee Ligament Evaluation including radiographic evaluation, KT1000, Lysholm Knee Score, kneeling pain, and clinical outcomes.Results:Subjects who received the PT graft had significantly worse outcomes compared to those who received the HT graft at 20 years for the variables of radiologically detectable osteoarthritis (59% v 39%, p=0.01), kneeling pain (38% v 20%, p=0.02), and incidence of contralateral ACL injury (30% v 14%, p=0.04). There was no significant difference between the HT and PT groups in overall IKDC grade (p=0.23), or IKDC subjective score (p=0.18). Subgroup gender differences were identified. The female PT group had significantly lower mean IKDC subjective scores (p=0.05), and more difficulty with kneeling (p=0.04) compared to the other subgroups. ACL graft rupture occurred in 18% of HT and 10% of the PT (p=0.13), and was associated with males (Hazard Ratio(HR)=3.9, p=0.007), age <18 years (HR=4.6, p=0.003), and non ideal radiological tunnel placement (HR=3.6, p=0.02). Contralateral ACL injury was associated with age <18 years (HR=3.4, p=0.001), and the PT graft (HR=2.2, p=0.02).Conclusion:At 20 years both HT and PT autografts continue to provide good subjective outcomes and objective stability. However, ACL reconstruction using the PT graft is associated with persisting kneeling pain and radiological osteoarthritis, compared to the HT graft. Risk factors for ACL graft rupture include males, young age, and those with tunnel malposition. This information may help in the counseling of patients undergoing this procedure and stratifying their individual risk of re-injury.

The Natural History of Biointerference Screw Cyst and New Bone Formation in Anterior Cruciate Ligament Reconstruction

Background: A variety of fixation devices are available for anterior cruciate ligament reconstruction (ACLR). Bioabsorbable screws allow imaging postoperatively without image artefact, as with magnetic resonance imaging (MRI). There is also the perceived benefit of screw resorption and subsequent host tunnel bone ingrowth. Purpose/Hypothesis: The purpose of this study was to document the natural history of poly L-lactic acid (PLLA) bioabsorbable interference screws. Manufacturers claimed that screws would be resorbed and replaced by new bone within 2 years. The hypothesis was that these screws take considerably longer to achieve this claim. Study Design: Case series; Level of evidence, 4. Methods: Ten consecutive patients undergoing routine ACLR with a PLLA bioabsorbable RCI screw (Arthrex) and a standard 4-strand hamstring graft technique were assessed via MRI and telephone questionnaire at 1, 2, 4, 7, 10, and 16 years postoperatively. Results: At 4-year follow-up, no resorption of the screw or bone formation had occurred. At 7-year follow-up, absorption of 7 screws was complete, cyst formation had occurred in 3 patients, and 5 patients had new bone formation. At 10-year follow-up, all screws were reabsorbed, cyst formation was evident in only 2 cases, and 7 patients had evidence of new bone formation. At 16-year follow-up, cyst formation was only present in 1 patient, and all patients had evidence of new bone formation. All patients had an intact anterior cruciate ligament and had returned to preinjury sporting activity. Conclusion: PLLA bioabsorbable screws take longer to resorb than previously thought by the manufacturers (ie, 2 years). New bone formation is evident in 100% of patients by 16 years. Cyst formation does not occur in all patients with a bioabsorbable screw implant. In the 3 patients demonstrating the presence of a cyst, no associated adverse effects were found with regard to anterior cruciate ligament graft survival or instability.

Greffe tendineuse courte aux ischio-jambiers augmentée par ligament artificiel LARS® versus greffe aux ischio-jambiers quatre faisceaux dans les reconstructions du LCA : résultats préliminaires

BackgroundThis retrospective study compares the results of reconstruction of isolated chronic anterior cruciate ligament rupture using augmented short and small sized hamstring tendon graft with ligament advanced artificial reinforcement system (LARS®) versus a four-strand hamstring tendon graft (4-SHG). Our hypothesis was that postoperative knee stability after using augmented short length or small diameter hamstring tendon graft with LARS® artificial ligament could be significant and satisfactory more than 4-strand hamstring tendon graft group. Materials and methodsBetween June 2007–July 2008, 72 patients were divided into a LARS® augmented group (n=27) and a 4-SHG group (n=45). ResultsMean FU is 5 years. KT 1000 examinations showed that the LARS® group had significantly less anterior displacement than the 4-SHG group (P=0.013). IKDC score demonstrated statistically significant differences (P=0.05). ConclusionsOur study indicates that early results of augmenting short length or small diameter harvested hamstring tendons with LARS® in ACL reconstruction provides satisfactory, comparable results and displayed higher knee stability compared to 4-SHG group. Level of evidenceLevel III (case control study).

Augmented short undersized hamstring tendon graft with LARS® artificial ligament versus four-strand hamstring tendon in anterior cruciate ligament reconstruction: preliminary results

BackgroundThis retrospective study compares the results of reconstruction of isolated chronic anterior cruciate ligament rupture using augmented short undersized sized hamstring tendon graft with ligament advanced artificial reinforcement system (LARS) versus a four-strand hamstring tendon graft (4-SHG). Our hypothesis was that postoperative knee stability after using augmented short length or small diameter hamstring tendon graft with LARS artificial ligament could be significant and satisfactory more than 4-strand hamstring tendon graft group. Materials and methodsBetween June 2007–July 2008, 72 patients were divided into a (LARS) augmented group (n=27) and a (4-SHG) group (n=45). ResultsMean FU is 5years. KT-1000 examinations showed that the LARS group had significantly less anterior displacement than the (4-SHG) group P=0.013. IKDC score demonstrated statistically significant differences (P=0.05). ConclusionsOur study indicates that early results of augmenting: short length or small diameter harvested hamstring tendons with LARS in ACL reconstruction provides satisfactory, comparable results and displayed higher knee stability compared to (4-SHG) group. Level of evidenceLevel III (case control study).

A prospective, randomized, controlled study on anterior cruciate ligament reconstruction with or without remnant preservation

Objective To compare the clinical outcomes of patients who underwent remnant-preserved anterior cruciate ligament (ACL) reconstruction with those who underwent conventional ACL reconstruction (ACLR). Methods From January 2010 to October 2012, 93 eligible patients suffered from ACL injuries were randomly allocated into remnant-preserved group (ACLR with remnant preservation; n=48; Male/Female=34/14; Left/Right=25/23) and conventional group (ACLR without remnant preservation; n=45; Male/Female=33/12; Left/Right=22/23). The mean age of patients, time from injury to surgery, rates of combined meniscal injuries, and medial collateral ligament injury all showed no significant difference between the two groups preoperatively. All the patients underwent ACL reconstruction using 4-strand hamstring autografts. The postoperative assessments included knee functional scales (IKDC grade classification and Lysholm score), stability examinations (Lachman, pivot-shift, and KT-1000 arthometer), proprioceptive evaluations, and second-look arthroscopy. Results The average follow-up time was 25.4 months for the remnant-preserved group and 25.2 months for the conventional group. For IKDC grade classification, there were 32 patients with grade A, 9 with grade B, 1 with grade C in remnant-preserved group, whereas 30 with grade A, 8 with grade B, 2 with grade C in conventional group, which showed no significant difference between the two groups. Moreover, the Lysholm score (95.9±5.2 vs. 95.4±1.7), Lachman test, pivot-shift test, KT-1000 arthometer (1.1±1.2 mm vs. 1.2±0.9 mm), proprioceptive evaluations (joint position sense: 3.6°±1.8° vs. 3.9°±2.2°) all showed no significant differences between the two groups. Additionally, the synovial coverage of grafted tendon under second-look arthroscopy was categorized as grade A in 11, grade B in 6, grade C in 2, grade D in 2 in remnant-preserved group, whereas grade A in 10, grade B in 5, grade C in 2, and grade D in 2 in conventional group, which still showed no significant difference. Conclusion In terms of the knee functional scales, stability examinations, joint position sense and graft synovial coverage, remnant-preserved ACLR group showed no superiority to the conventional ACLR group. Key words: Arthroscopy; Anterior cruciate ligament reconstruction; Randomized controlled trials as topic

Comparison of hamstring tendon autograft and tibialis anterior allograft in arthroscopic transtibial single-bundle posterior cruciate ligament reconstruction.

To compare the outcomes between hamstring tendon autograft and tibialis anterior allograft in arthroscopic transtibial single-bundle posterior cruciate ligament (PCL) reconstruction. Thirty-seven patients undergoing isolated single-bundle PCL reconstruction were enrolled in this study, and their data were retrospectively analyzed. They were divided into group A [4-strand hamstring tendon autograft (4SHG), n=18] and group B [2-strand tibialis anterior allograft (2STAG), n=19] and followed up for 2years at least. Several parameters including the International Knee Documentation Committee score, Lysholm knee score, Tegner activity rating and knee laxity arthrometer were evaluated, and physical examination was performed preoperatively and postoperatively, and postoperative complications were also observed in all patients. Meanwhile, the postoperative posterior instability was compared between the affected knee and the contra-lateral knee. Compared with preoperative knee laxity and function, both groups had significant improvement postoperatively (P<0.01). However, there were no significant differences in knee laxity and function between both groups (n.s.). Compared with contra-lateral knee, the posterior stability was worse in the affected knee (P<0.01). The outcomes were similar between 4SHG or 2STAG in PCL reconstruction. Compared with contra-lateral knees, the affected knees have slight residual knee laxity in both groups. Retrospective comparative study, Level III.

The sizing of hamstring grafts for anterior cruciate reconstruction: intra- and inter-observer reliability

The objective of this study was to establish the intra- and inter-observer reliability of hamstring graft measurement using cylindrical sizing tubes. Hamstring tendons (gracilis and semitendinosus) were harvested from ten cadavers by a single surgeon and whip stitched together to create ten 4-strand hamstring grafts. Ten sports medicine surgeons and fellows sized each graft independently using either hollow cylindrical sizers or block sizers in 0.5-mm increments—the sizing technique used was applied consistently to each graft. Surgeons moved sequentially from graft to graft and measured each hamstring graft twice. Surgeons were asked to state the measured proximal (femoral) and distal (tibial) diameter of each graft, as well as the diameter of the tibial and femoral tunnels that they would drill if performing an anterior cruciate ligament (ACL) reconstruction using that graft. Reliability was established using intra-class correlation coefficients. Overall, both the inter-observer and intra-observer agreement were >0.9, demonstrating excellent reliability. The inter-observer reliability for drill sizes was also excellent (>0.9). Excellent correlation was seen between cylindrical sizing, and drill sizes (>0.9). Sizing of hamstring grafts by multiple surgeons demonstrated excellent intra-observer and intra-observer reliability, potentially validating clinical studies exploring ACL reconstruction outcomes by hamstring graft diameter when standard techniques are used. III.

Management of acute knee injury – the role of the surgeon

ACL injury results in functional instability and the risk of increasing intra-articular pathology. In over 5000 ACL reconstructions, the incidence of secondary pathology with respect to the time between injury and surgery was examined. We found that the incidence of chondral damage and medial meniscal tears increases with increasing time after injury. Ideally and particularly in younger patients, ACL reconstruction should not be delayed beyond 4 months from injury. Acute surgical management of ACL injuries involves arthroscopic anatomic reconstruction using 4-strand hamstring tendon autograft.

Anatomy of the anterior cruciate ligament related to hamstring tendon grafts. A cadaveric study

BackgroundThe aim of modern techniques for anatomic reconstruction of the ACL is to reproduce ACL footprints, in order to restore anatomy and therefore normal biomechanics. Is there an oversizing of the hamstring grafts related to ACL dimensions? MethodsTwenty-two paired cadaver knees were dissected. ACL dimensions at mid-portion and ACL footprints were measured after removing the synovial membrane.Hamstrings were harvested and prepared in a quadruple strand graft in order to measure the mean circumference. ResultsThe average ACL tibial and femoral insertion site areas of the ACL were 117.9mm2 (range, 90 to 130mm) and 96.8mm2 (range, 80 to 121mm), respectively.The average diameter and cross sectional area of the ACL tendon at mid-portion were 6.1mm (range, 5 to 7mm) and 29.2mm2 (range, 20 to 38.9), respectively. The average diameter and cross-sectional area of the 4-stranded hamstring tendons were 6.7 (range, 5 to 8) and 35.3mm2 (range, 20 to 50), respectively.There was a correlation between the 4-stranded hamstring grafts and ACL dimensions (footprints, ligament at mid substance, p<0.01). The cross sectional area of hamstring tendon was significantly larger than the ACL area at mid-portion (mean 20.9%, p<0.05). ConclusionWith current ACL reconstruction techniques, the graft is oversized at a mean of 21%, despite a good correlation between the ACL and the hamstring tendon, especially among small subjects and women. The question arises whether the anatomic reconstruction of the ACL should fill ACL footprints or mimic the ligament itself. Clinical relevanceHamstrings grafts are significantly larger than native ACL.

Anatomic single‐bundle anterior cruciate ligament reconstruction in Asian population

Non-anatomic tunnel placement, which leads to failure in double-bundle anterior cruciate ligament (ACL), has focused greater attention on single-bundle ACL reconstruction. However, single-bundle ACL with 2- to 4-strand autogenous hamstring tendon graft always showed weak graft strength. To solve this problem, single-bundle ACL with 6-strand autogenous hamstring tendon graft was performed on 32 Asian patients in this study. At 24 months post-operatively, all patients were evaluated with Lysholm knee scores, Tegner activity level and KT-1000 examinations. The results demonstrated that no patients showed knee extension limitation. Of the 32 patients, there were 26 negative and 6 positive 1° in Lachman test; 31 negative and 1 positive 1° in pivot-shift test. There were four patients with a 5° flexion limitation. The median Lysholm score increased from 45 preoperatively to 92 post-operatively (P < 0.001). The median Tegner sport level score increased from 1 preoperatively to 4 post-operatively (P < 0.001). KT-1000 examination revealed that the median anterior laxity at 25° of flexion was 6.3 mm preoperatively and 1.7 mm post-operatively (P < 0.001). The data showed that arthroscopic central anatomic single-bundle ACL reconstruction with 6-strand autogenous hamstring tendon graft is a reliable method to restore stabilization and function of the knee.

Anterior cruciate ligament reconstruction with 4-strand hamstring autograft and accelerated rehabilitation: a 10-year prospective study on clinical results, knee osteoarthritis and its predictors

Analysis of long-term clinical and radiological outcomes after anterior cruciate ligament (ACL) reconstruction with special attention to knee osteoarthritis and its predictors. A prospective, consecutive case series of 100 patients. Arthroscopic transtibial ACL reconstruction was performed using 4-strand hamstring tendon autografts with a standardized accelerated rehabilitation protocol. Analysis was performed preoperatively and 10 years postoperatively. Clinical examination included Lysholm and Tegner scores, IKDC, KT-1000 testing (MEDmetric Co., San Diego, CA, USA) and leg circumference measurements. Radiological evaluation included AP weight bearing, lateral knee, Rosenberg and sky view X-rays. Radiological classifications were according to Ahlbäck and Kellgren & Lawrence. Statistical analysis included univariate and multivariate logistic regressions. RESULTS CLINICAL OUTCOME: A significant improvement (p < 0.001) between preoperative and postoperative measurements could be demonstrated for the Lysholm and Tegner scores, IKDC patient subjective assessment, KT-1000 measurements, pivot shift test, IKDC score and one-leg hop test. A pivot shift phenomenon (glide) was still present in 43 (50%) patients and correlated with lower levels of activity (p < 0.022). Radiological outcome: At follow-up, 46 (53.5%) patients had signs of osteoarthritis (OA). In this group, 33 patients (72%) had chondral lesions (≥grade 2) at the time of ACL reconstruction. A history of medial meniscectomy before or at the time of ACL reconstruction increased the risk of knee OA 4 times (95% CI 1.41-11.5). An ICRS grade 3 at the time of ACL reconstruction increased the risk of knee OA by 5.2 times (95% CI 1.09-24.8). There was no correlation between OA and activity level (Tegner score ≥6) nor between OA and a positive pivot shift test. Transtibial ACL reconstruction with 4-strand hamstring autograft and accelerated rehabilitation restored anteroposterior knee stability. Clinical parameters and patient satisfaction improved significantly. At 10-year follow-up, radiological signs of OA were present in 53.5 % of the subjects. Risk factors for OA were meniscectomy prior to or at the time of ACL reconstruction and chondral lesions at the time of ACL reconstruction. II.

Bio-interference screw cyst formation in anterior cruciate ligament reconstruction—10-year follow up

PurposeThis study used serial MRI to assess the absorption of a poly l-lactide Bioabsorbable interference screw used in the anterior cruciate ligament reconstruction with a 4-strand hamstring technique. MethodsA consecutive series of ten patients undergoing anterior cruciate ligament reconstruction a 4-strand hamstring technique were assessed with magnetic resonance imaging (MRI) scans at 1, 2, 4, 7 and 10years postoperatively. ResultsNo resorption had occurred after 4years in any of the patients. By 7years screw absorption was complete in seven patients and had progressed in three. New cyst formation occurred in 3 patients between 5 and 7years. Half the patients displayed small fluid collections within the tibial tunnels. At 10years all screws were fully absorbed; however cyst formation was common, including the development of a new cyst in the period between 7 and 10years in one patient. None of the patients had instability, persistent effusions, or clinically detectable adverse reactions to the screws. ConclusionsThis study has shown that poly l-lactide bioabsorbable screws take longer to resorb than initial in vitro data suggested. It is unclear whether ganglion formation within the tibial tunnel is related to screw resorption or the hamstring graft. The theoretical advantages of bioabsorbable screws must be weighed against these findings.

Antero-medial portal vs. transtibial techniques for drilling femoral tunnel in ACL reconstruction using 4-strand hamstring tendon: A cross-sectional study with 1-year follow-up

SummaryBackgroundAntero-medial portal (AMP) and trans-tibial (TT) techniques are the most widely used methods for drilling femoral tunnel in ACL reconstructions; yet, debate continues about the preferred method. This study seeks to compare these 2 techniques in patients with ACL tears.Material/MethodsIn this comparative study, all cases of isolated ACL reconstruction using 4-strand hamstring tendon in 2006–2010 were evaluated for eligibility. Of 266 patients, 124 cases (60 TT and 64 AMP), with the mean age of 28.48±8.3, met the inclusion criteria. Both groups were compared in 8 follow-ups from the point of view of time of: return to post-surgical activities (including walking without crutches, normal life activity, jogging, and exercising), maximum range of passive movements, knee instability (Lachman test), functional condition (subjective IKDC and Lysholm knee scores), therapeutic outcomes, and patient’s satisfaction with treatment (VAS).ResultsAMP technique significantly accelerates patients’ return to activity. AMP patients achieved full range of motion much sooner than TT cases (P<0.0001). After 1-year follow-up, S-IKDC scores were 94.8±3.9 and 89.2±4.1 and S-LKS scores were 96.1±3 and 92.2±4.1 for AMP and TT groups, respectively (P<0.0001). Knee stability was similar in both groups on Lachman test (P=0.25). AMP group patients (VAS mean score: 9.78±0.4) had greater satisfaction compared to TT group patients (VAS mean score: 9.53±0.5) (P=0.003).ConclusionsAMP technique leads to reduction in time to return to routine activities, better therapeutic outcomes and higher satisfaction rates.

Clinical Results and Risk Factors for Reinjury 15 Years After Anterior Cruciate Ligament Reconstruction

Background: There is a lack of prospective studies comparing the long-term outcome of endoscopic anterior cruciate ligament (ACL) reconstruction with either a patellar tendon or hamstring tendon autograft. Purpose: This prospective longitudinal study compared the results of isolated endoscopic ACL reconstruction utilizing a 4-strand hamstring tendon (HT) or patellar tendon (PT) autograft over a 15-year period with respect to reinjury, clinical outcomes, and the development of osteoarthritis. Study Design: Cohort study; Level of evidence, 2. Methods: Ninety consecutive patients with isolated ACL rupture were reconstructed with a PT autograft, and 90 patients received an HT autograft, with an identical surgical technique. Patients were assessed at 2, 5, 7, 10, and 15 years. Assessment included the International Knee Documentation Committee (IKDC) knee ligament evaluation including radiographic evaluation, KT-1000 arthrometer testing, and Lysholm knee score. Results: Patients who received the PT graft had significantly worse outcomes compared with those who received the HT graft at 15 years for the variables of radiologically detectable osteoarthritis (grade A: 46% in PT and 69% in HT; P = .04), motion loss (extension deficit <3°: 79% in PT and 94% in HT; P = .03), single-legged hop test (grade A: 65% in PT and 92% in HT; P = .001), participation in strenuous activity (very strenuous or strenuous: 62% of PT and 77% of HT; P = .04), and kneeling pain (moderate or greater pain: 42% of PT and 26% of HT; P = .04). There was no significant difference between the HT and PT groups in overall IKDC grade (grade A: 47% of PT and 57% of HT; P = .35). An ACL graft rupture occurred in 17% of the HT group and 8% of the PT group (P = .07). An ACL graft rupture was associated with nonideal tunnel position (odds ratio [OR], 5.0) and male sex (OR, 3.2). Contralateral ACL rupture occurred in significantly more PT patients (26%) than HT patients (12%) (P = .02) and was associated with age ≤18 years (OR, 4.1) and the PT graft (OR, 2.6). Conclusion: Anterior cruciate ligament reconstruction using ipsilateral autograft continues to show excellent results in terms of patient satisfaction, symptoms, function, activity level, and stability. The use of HT autograft does, however, show better outcomes than the PT autograft in all of these outcome measures. Additionally, at 15 years, the HT graft–reconstructed ACLs have shown a lower rate of radiological osteoarthritis.

Anterior Cruciate Ligament Reconstruction Using 4-Strand Hamstring Autograft: Conventional Single-Bundle Technique Versus Oval-Footprint Technique

The purpose of this study was to compare short-term results of conventional anterior cruciate ligament (ACL) reconstruction with oval-footprint (modified) single-tunnel ACL reconstruction with 4-strand hamstring autograft. A prospective comparative study was performed in 74 consecutive subjects who underwent ACL reconstruction with the conventional technique (group I, 40 cases) or the modified technique (group II, 34 cases), in which the entrances of the femoral and tibial tunnels were more elongated, by use of 4-strand hamstring tendon. The Lachman test, pivot-shift test, range of motion, International Knee Documentation Committee classification, Lysholm score, and side-to-side differences were evaluated preoperatively and at the last follow-up. The Tegner activity scale was evaluated before injury and at the last follow-up. There were 38 patients in group I and 32 in group II who were followed up for at least 2 years (mean follow-up, 32.4 months). At the last follow-up, Lachman test results were negative in 34 in group I and 30 in group II (P = .624) and the pivot-shift test was negative in 32 in group I and 30 in group II (P = .397). Mean range of motion of the injured knee was 142.2° in group I and 141.9° in group II (P = .771). The International Knee Documentation Committee classification was A or B in 37 in group I and 31 in group II (P = .872). The median Lysholm score was 94 in group I and 96 in group II (P = .048). The mean side-to-side difference averaged 2.08 mm in group I and 2.07 mm in group II (P = .943). The median score on the Tegner activity scale was 6 in group I and 6 in group II (P = .968). The Lysholm score in the modified-technique group at the last follow-up was better than that in the conventional-technique group in terms of statistical significance, but this may not be clinically significant. Level II, prospective comparative study.

Patellar tendon autograft versus 4-strand hamstring autograft for endoscopic reconstruction of anterior cruciate ligament:a Meta-analysis

Objective To compare clinical outcomes of patellar tendon and 4-strand hamstring au- tografts in single-bundle endoscopic reconstruction of anterior cruciate ligament （ACL） . Methods The digital databases （PubMed, Embase, Cochrane Central Register of Controlled Trials, CBM）were searched for randomized controlled trials （RCTs） comparing patellar tendon with hamstring autografls for reconstruction of ACL. In addition, the reference lists from related original studies and review articles were hand-searched. The Coehrane Collaboration＇ s tool for assessing risk of bias and Cochrane collaboration＇s RevMan 5.0 software were used for assessing trial methodological quality and data analyses. Results Fourteen RCTs were included. There were 1232 participants who met inclusion criteria in all studies. Meta-analyses showed that no statistically significant differences were found in graft failure rate after single-bundle reconstruction of the ACL at mean follow-ups of 2 to 3 years （ RR = 0.69, 95% CI O. 34 to 1.38, P = 0. 29, of 5 years （ RR = 0. 37, 95% C]0.09 to 1,55, P=0. 18）, of 10 years （P=0.94） or when 3 subgroups combined （RR=0.71, 95% CI O. 39 to 1.31, P =0.28） . The difference in ~〉 5~ extensor deficit was not statistically significant between the 2 groups （ RR = 1.63, 95% CI O. 85 to 3.16, P = 0. 14）. Anterior knee pain and kneeling pain or discomfort showed significantly differences between the 2 groups at a mean follow-up of 2 years （ P 〈 0. 05）, but did not at follow-ups of 5 years and 10 years （ P 〉 0. 05）. Conclusions In single-bundle endoscopic ACL reconstruction, patellar tendon and 4-strand hamstring autografts have similar rates of graft failure and knee motion deficits. The patellar tendon autograft may have higher rates of anterior knee pain and kneeling pain or discomfort at an early stage after operation than the 4-strand hamstring autograft, but there may be no such differences on a long-term basis. Key words: Patella ligament; Anterior erueiate ligament; Meta-analysis; Hamstring

A fifteen year prospective comparison of patellar and hamstring tendon grafts for ACL reconstruction

Aim: The aim of this prospective study was to compare the long term results of isolated endoscopic ACL reconstruction utilizing 4-strand hamstring tendon (HT) or patellar tendon (PT) autograft over a 15-year period with respect to clinical outcomes and the development of osteoarthritis. Method: 90 consecutive patients with isolated ACL rupture were reconstructed with a PT autograft and a subsequent 90 patients received HT autograft, with an identical surgical technique for both groups. Patients were studied annually for 5 years and then at 7, 10 and 15 years.

Outcomes of Posterior Cruciate Ligament Treatment: A Review of the Evidence

The purpose of this systematic review is to assess the current recommendations in an evidence-based manner with regard to posterior cruciate ligament (PCL) reconstruction. We conducted a systematic review of multiple databases, evaluating studies on the outcomes of PCL treatment in isolation and in the multiligamentous injured knee. Twenty-one studies of isolated PCL reconstructions and 10 studies of combined PCL reconstruction were identified for inclusion. Eight studies reported graft failure as an outcome, with an overall rate of 11.6%. Three studies reported outcomes of single bundle PCL reconstruction using hamstring autograft; there were 12 graft failures in 96 reconstructions (12.5%). There were 2 graft failures in a total of 17 combined PCL/anterior cruciate ligament/posterolateral corner reconstructions (11.8%). In the combined PCL studies, return to preinjury activity level ranged from 19 to 68%. In the isolated PCL studies, 50 to 82% of patients were able to return to preinjury activity level. There were no significant differences in functional outcomes (Lysholm and IKDC). From 37% to 70% of patients in the combined PCL studies had a normal posterior drawer test at final follow-up. One study showed a significant difference in the mean posterior drawer test side-to-side difference between the 7-strand and 4-strand hamstring autograft groups (1.7 vs. 3.7 mm, P<0.05). Currently, firm recommendations on what treatment or technique to choose cannot be given based upon the available literature. There is a need for higher-quality clinical studies to guide treatment decisions. Generally good results are reported after PCL reconstruction, but the long-term studies available suggest that normal stability in the majority of patients is not restored.

Can We Predict ACL Hamstring Graft Sizes in the Asian Male? A Clinical Relationship Study of Anthropometric Features and 4-Strand Hamstring Graft Sizes

Introduction: This study was undertaken to investigate if such anthropometric measurements (i.e., height, weight and body mass index) can be used to predict graft diameters in 4 strand semitendinosus and gracilis hamstring autografts. Methods: The study sample consisted of 89 consecutive male patients who underwent ACL reconstruction using quadrupled semitendinosus and gracilis autografts. Intraoperative measurements of the fashioned quadrupled hamstring graft were performed using sizing tubes calibrated to 0.5mm. Correlation coefficients (Pearson r) analysis was used to determine the relationship between hamstring graft diameter and predictor variables: gender, height, mass, and body mass index. Results: The mean hamstring graft diameter, 7.90mm, was comparable with previously published studies. Weight (r=0.18) and body mass index (r=0.19) correlated positively with graft diameter. There was no correlation between graft diameter and height (r=0.01). Conclusion: In Asian male patients, height, weight and BMI cannot be used for preoperative identification of graft size.

Differentiation Between Intraoperative and Postoperative Bone Tunnel Widening and Communication in Double-Bundle Anterior Cruciate Ligament Reconstruction: A Prospective Study

The purpose of this study was to determine the amount of intraoperative and postoperative bone tunnel enlargement and communication in double-bundle (DB) anterior cruciate ligament (ACL) reconstruction. Twenty-four consecutive patients undergoing anatomic anteromedial (AM) and posterolateral (PL) 4-tunnel DB ACL reconstruction with a 5-strand hamstring graft and extracortical fixation were included in a prospective case series. Magnetic resonance imaging scans were performed on the second postoperative day and at 7 months' follow up to assess intraoperative and postoperative bone tunnel enlargement and communication. Tunnel widening was determined in different planes by digitally measuring the diameters of the AM and PL bone tunnels. Intraoperative communication of the AM bone tunnel with the PL bone tunnel caused by drilling was observed in 23.8% of patients on the tibia and in no case on the femur. At 7 months postoperatively, significant bone tunnel widening occurred at all 4 bone tunnels. It was a mean of 20% for the tibial AM bone tunnel, 38% for the tibial PL bone tunnel, 34% for the femoral AM bone tunnel, and 46% for the femoral PL bone tunnel. Postoperative communication of the AM and PL bone tunnels caused by postoperative bone tunnel widening was observed in 19% of patients on the tibia and femur. Intraoperative bone tunnel communication in anatomic DB ACL reconstruction was caused by drilling and occurred only on the tibia. Significant postoperative bone tunnel widening occurred at all 4 bone tunnels and was the highest for the PL bone tunnel. Postoperative bone tunnel communication developed in 19% of patients on the tibia and femur and was caused by bone tunnel widening. Level IV, therapeutic case series.