BPTB Graft Research Articles

Correlation between antropometric status with Hamstring graft Sizes for ACL reconstruction

Introduction: Preoperative prediction of hamstring tendon lengths and graft diameter for anterior cruciate ligament (ACL) reconstruction provide better preoperative planning. Hamstring graft is one of most common used graft, and gained wide popularity as it provides comparable stiffness and tensile properties in addition to better cosmesis and decreased donor site morbidity compared to BPTB graft which caused anterior knee pain, and kneeling discomfort. Since graft strength is directly related to cross-sectional area of the graft, a minimum size of 8 mm of graft diameter has been recommended for the success of ACL reconstruction and reduce the risk of graft failure. A preoperative planning to determine Hamstring Graft sizes is important to achieve a successful ACL reconstruction. Material and Methods: An anthropometric data of total 100 samples was collected. The patient which included in this study is patients with ACL rupture confirmed by MRI and undergo primary arthroscopic ACL reconstruction using hamstring tendon autograft. The antropometric data which was collected from patients are height, weight, body mass index, and thigh circumference. The collected data was being analyze with IBM SPSS Statistics (version 24), Pearson’s test was used to identify correlations between anthropometric measurements and graft sizes. Discussion: There is a positive correlation between the patient height (p value 0.004) and thigh circumference (p value 0.017) with semitendinosus and gracilis graft length. There is also positive correlation between height (p value 0.00) and thigh circumference (p value 0.010) with graft diameter. Mean ACL length in this study was 27.11 mm and mean ACL width in this study was 8 mm. Conclusion: This study shows a positive correlation between patient height and thigh circumference with the hamstring graft length and diameter.

One type of graft for reconstruction of the ACL does not suit all patients based on their characteristics and sports: a scoping review.

The selection of graft type for anterior cruciate ligament reconstruction remains a topic of debate, taking into consideration patient characteristics, as well as the type and level of sports involvement. The aim of this scoping review was to investigate patient characteristics that might influence the selection of graft type for anterior cruciate ligament reconstruction. PubMed and Scopus were searched to identify articles for inclusion. All included studies focused on one or more patient characteristics involved in the decision-making process regarding anterior cruciate ligament reconstruction autograft, including the hamstrings tendon (HT), patellar tendon (BPTB) and quadriceps tendon (QT). Out of the 1,977 initial studies, 27 studies were included in this review. The BPTB graft seems to be the preferred choice in young patients, females, and athletes-especially those engaged in pivoting sports. The HT graft seems to be the preferred choice in less active and older patients, along with those involved in sports where knee extensors are vital. The HT graft is not preferable in patients with a small body height and graft diameter. Moreover, surgeon preferences were also of importance for graft selection. The success of a specific graft type in anterior cruciate ligament reconstruction is highly dependent on the patient's characteristics and type of sport. Patient characteristics such as age, gender, body height, graft diameter, and the patient's activity level should all be considered when choosing the appropriate graft type.

Poster 365: Impact of Graft Type and Meniscal Status on Patellofemoral Cartilage Early after ACL Reconstruction

Objectives: Anterior cruciate ligament reconstruction (ACLR) restores passive knee stability but does not reduce the rate of osteoarthritis (OA). Meniscal status, requiring repair or meniscectomy, is a known component of degenerative progression. Regarding the patellofemoral joint (PFJ) specifically, traditional imaging modalities have shown some evidence that patellar tendon autograft (BPTB) is associated with an increased risk of OA. T2 relaxation time using quantitative MRI (qMRI) is an established method to identify early cartilage changes. However, T2 relaxation in the PFJ as a function of graft type and meniscal status has not been previously evaluated. We aimed to evaluate the effect of autograft type (BPTB, hamstring [HT] and quadriceps tendon [QT]) as well as concomitant meniscal surgery (repair or meniscectomy) at the time of ACLR on T2 relaxation time in PFJ cartilage. We hypothesized that BPTB grafts, concomitant meniscal repair, and meniscectomy would result in higher (worse) T2 relaxation times at 6 months after ACLR. We also evaluated the effect of abnormal joint loading during gait on the PFJ cartilage. We hypothesized that T2 relaxation times would not differ in any group after controlling for knee joint loading during walking. Methods: Thirty-four participants aged 15-35 years were enrolled prospectively within 1 month of ACL injury. Exclusion criteria included prior knee injury or surgery, concomitant grade III tear to other knee ligaments that was symptomatic or required surgical intervention and presence of chondral damage. Sagittal qMRIs were obtained within 1 month of injury (but prior to ACLR) and 6 months after ACLR. Articular cartilage of the PFJ was manually segmented using ITK-SNAP software (Penn Image Computing and Science Laboratory, University of Pennsylvania) and was confirmed for accuracy by a board-certified, fellowship-trained musculoskeletal radiologist (Figure 1). Mean T2 relaxation times were extracted from the trochlear and patellar cartilage. Non-physiological T2 relaxation times less than 10 ms and greater than 90 ms were excluded. Gait biomechanics were captured using two in-ground force plates (Bertec Corporation, Columbus, OH) sampled at 1,080 Hz and retroreflective markers with an 8-camera motion capture system (Qualisys, Göteborg, Sweden) sampled at 120 Hz. Data was processed using Visual 3D software (C-motion, Bethesda, MD). Using an inverse dynamic approach, joint angle and force plate data were used to calculate the knee flexion moment (KFM) impulse normalized to mass and height during the stance phase. Separate one-way ANOVAs were used to evaluate the relationship between graft type and concomitant meniscus surgery with the percent change in T2 relaxation time in PFJ cartilage from baseline to 6 months after ACLR. To determine the influence of gait biomechanics on T2 relaxation time across groups, general linear models were used with the interlimb ratio (involved/uninvolved) of KFM impulse as a covariate. Results: The 34 participants had a mean age of 19.0±4.7 years, and 21 (61.8%) were female. Grafts used during ACLR included 22 BPTB, 4 HT and 8 QT. Seventeen participants (50.0%) had a concomitant meniscus repair and 3 (8.8%) had a meniscectomy. Overall, T2 relaxation time increased 8.7±7.3% in the patellar cartilage (pre-ACLR: 39.1±2.6 ms, 6 months: 42.4±3.6 ms, p<0.001) and 7.1±7.3% in the trochlear cartilage (pre-ACLR: 46.3±2.6 ms, 6 months: 49.5±2.7 ms, p<0.001). The change in T2 relaxation time 6 months after ACLR did not differ based on graft type in either the patellar (p=0.729) or trochlear cartilage (p=0.525) (Figure 2). Group differences remained insignificant after controlling for knee loading (KFM impulse) during gait (patellar: p=0.594; trochlear: p=0.222). Meniscal status was also not associated with a change in T2 relaxation time in either the patellar (p=0.392) or trochlear cartilage (p=0.190) (Figure 3) although there was a trend toward higher T2 relaxation times in those with a concomitant meniscus repair or meniscectomy. Group differences remained statistically insignificant after controlling for the KFM impulse during gait (patellar: p=0.400; trochlear: p=0.197). Conclusions: Our findings provide insufficient evidence that graft type is associated with worse quantitative chondral changes within the PFJ at 6 months following ACLR. While meniscal status is a known risk factor for increased contact pressure in the involved compartment and subsequent degenerative progression, our data does not demonstrate statistically significant changes to the PFJ cartilage when meniscal tears were present, likely due to the limited sample size and large variation within groups. Future work with larger cohorts is needed to confirm our findings and further investigate the role that graft type and meniscal status may play within the PFJ after ACLR. [Figure: see text][Figure: see text][Figure: see text]

Poster 332: Return to Sport, Post-Operative Performance Testing, and Re-injury Rates Among Athletes Treated with Hamstring, Quadriceps, and Patellar Tendon Autograft ACL Reconstruction

Objectives: Anterior Cruciate Ligament (ACL) tears are a common sporting injury and optimal graft choice is of concern for both patients and surgeons. Few comparative studies have evaluated return to sport and reinjury rates across graft types. The purpose of the present study was to evaluate return to sport rates and reinjuries among hamstring tendon (HT), quadriceps tendon (QT), and patellar tendon (BPTB) ACL reconstructions. Methods: Recreational and competitive athletes ages 13-24 from 2010-2022 that underwent primary or revision ACL reconstruction were included. There were 837 total athletes comprised of 341 HT, 358 BPTB, and 138 QT autografts, of which 729 were primary and 108 were revision surgeries. Return to sport (RTS) rates, RTS testing results, clearance time, and reinjury rates were collected. RTS testing data included isokinetic testing of quadricep and hamstring strength and functional movement screening. A Kruskal-Wallis test was used to detect differences among continuous variables. A GLIMMIX procedure was completed for multivariate analysis to detect differences between groups after adjusting for age and activity level. Chi-square statistics and Fisher’s exact test were used for categorical variables. Odds ratio, adjusted odds ratio, and 95% confidence intervals were provided by logistic regression. All statistical analyses were performed using SAS 9.4 (Cary, NC). Statistical significance was measured at p<0.05. Results: The median ages were 18 for HT and BPTB and 17 for QT (p= 0.0001). Females comprised 50.73% of HT grafts, 42.86% of BPTB grafts, and 41.30% of QT grafts. Return to previous level of play was observed in 118/130 (90.77%) HT, 124/136 (91.18%) BPTB, and 39/52 (75.00%) of QT grafts (p=0.0045); BPTB remained statistically more likely to return to previous level of play than QT after adjusting for age and activity level. RTS testing was completed in 28/341 (8.21%) HT, 142/358 (39.66%) BPTB, and 80/138 (57.97%) QT grafts (p<0.001); after adjusting for age and activity level, the results remained significant. Median isokinetic quadriceps testing at 300 degrees per second was 92% for 26 HT athletes, 83% for 134 BPTB athletes, and 87% for 77 QT athletes (p= 0.0006); results remained significant following age and activity level adjustment. Median isokinetic hamstring testing at 60 degrees per second was 89% for 24 HT athletes, 101% for 135 BPTB athletes, and 100% for 79 QT athletes (p=0.0007); results remained significant after adjustment for age and activity level. The median single- leg hop ratio was 98% for 5 HT athletes, 85% for 12 BPTB athletes, and 96% for 14 QT athletes (p=0.044); after adjusting for age and activity level, results remained significant. Time to be cleared for RTS was 25.89 weeks for 179 HT athletes, 34.75 weeks for 186 BPTB athletes, and 35.74 weeks for 75 QT athletes (p <0.0001) with the results remaining statistically significant following adjustment for age and activity level. ACL retear rates were 12.02% for HT, 3.07% for BPTB, and 5.07% for QT (p<0.0001) with hamstring grafts remaining significantly more likely to suffer an ACL retear than BPTB grafts after adjusting for age and activity level. Conclusions: After adjusting for age and activity level, BPTB ACL autografts demonstrated a lower reinjury risk when compared to HT autografts. When comparing QT and BPTB, return to sport testing 6-9 months post-op was superior in the QT group; however, BPTB patients were more likely to return to sport. This data can help influence surgeon and patient shared decision-making models in athletes with ACL injuries.

Preoperative predictors for return to physical activity following anterior cruciate ligament reconstruction (ACLR): a systematic review

BackgroundRates of return to physical activity after anterior cruciate ligament reconstruction surgery are sub-optimal. Optimising presurgical treatment may improve return rates. The purpose of this systematic review was to identify modifiable preoperative predictors for return to physical activity after anterior cruciate ligament reconstruction.MethodsSeven electronic databases (CINAHL, MEDLINE and SPORTDiscus via EBSCOhost, AMED, PsycINFO and EMBASE via OVID and Web of Science) were searched from inception to 31 March 2023. The population of focus was adults aged 18–65 who had undergone primary anterior cruciate ligament reconstruction. Studies needed to identify at least one potential modifiable preoperative predictor variable and the relationship between the predictor(s) and return to physical activity. All time-points of assessment and study designs were included. Data extraction was completed by one reviewer and verified by a second reviewer. Two reviewers completed the risk of bias assessment using the Quality in Prognostic Studies tool and Grading of Recommendations Assessment, Development and Evaluation system.ResultsThe search identified 2281 studies, eight met the inclusion criteria. Five studies scored ‘high’, and three studies scored ‘moderate’ risk-of-bias. All preoperative predictors were of very low-quality evidence. Five different outcome measures were used to assess return to physical activity including Tegner, Marx, Physical Activity Scale, return to play at the elite level and return to preinjury level (undefined). This was measured between 1- and 10-years post-surgery. Nine preoperative physical, six psychosocial and five demographic/clinical factors were assessed and four were found to be predictive. These included quadriceps strength, psychological profile, patient estimated ability to return and graft type (patella tendon, BPTB).ConclusionVery-low level evidence suggests that increasing quadriceps strength, managing patient expectations of their treatment outcomes, improving motivation to resume preinjury activity levels and considering the use of a BPTB graft will support return to physical activity after ACLR.Trial registrationThis study was prospectively registered in PROSPERO: CRD 42020222567.

Are Hamstring Grafts a Predisposing Factor to Infection in R-ACL Surgery? A Comparative In Vitro Study.

The objective of the present study was to evaluate the formation of biofilms in bone patellar tendon bone grafts (BPTB grafts), and to compare it to the formation of biofilm formation in quadrupled hamstring anterior cruciate ligament grafts (4×Ht graft). A descriptive in vitro study was conducted. One 4×Ht graft and one BPTB graft were prepared. They were then contaminated with a strain of S. epidermidis. Later, a quantitative analysis was conducted by means of microcalorimetry and sonication with plating. Additionally, a qualitative analysis was conducted by means of electron microscopy. No significant differences were found between the bacterial growth profiles of the 4×Ht graft and the BPTB graft in microcalorimetry and colony counting. In the samples analyzed with electron microscopy, no specific biofilm growth pattern was identified upon comparing the BPTB graft to the 4×Ht graft. There were no significant differences found at either the quantitative or qualitative level when comparing bacterial growth in the BPTB graft to that in the 4×Ht graft. Therefore, the presence of sutures in the 4×Ht graft cannot be established as a predisposing factor for increased biofilm growth in this in vitro study.

A prospective study to evaluate the functional and clinical outcome of anterior cruciate ligament reconstruction with standard hamstring autograft

Background: The anterior cruciate ligament (ACL) is the primary stabilizer of the knee and prevents the knee against anterior translation. It is also important in counteracting rotational and valgus stress. The arthroscopically aided approach has the advantages of smaller skin and capsular incisions, improved viewing of the intercondylar notch for placement of the tunnel and attachment sites, less postoperative pain, fewer adhesions, earlier motion, and easier rehabilitation. The advantages with semitendinosus grafts are the availability of a greater sectional area and the unaffected integrity of the extensor mechanism. Moreover, the tensile strength of quadrupled hamstring is found to be even better than a normal ACL. The rate of complications such as extension loss, anterior knee pain, and surgical site infections was also lower than in other procedures such as in BPTB grafts. Cortical suspension devices have the necessary biomechanical properties with regard to ultimate failure strength, displacement, and stiffness for the initial fixation of soft tissue in the femoral tunnel for ACL reconstruction. The aperture fixation methods such as the interference screws allow for early firm fixation and heal with a tight bone–tendon interface. Objective: A prospective study to evaluate the functional and clinical outcome of ACL reconstruction with standard hamstring autograft. Materials and Methods: The study results included 30 patients admitted with clinical and radiological deficiency of ACL from September 2019 to March 2021 using endobutton and bioabsorbable interference screw in terms of range of motion, postoperative knee stability, subjective knee functions, and prospective assessment of functional outcome using Tegner Lysholm knee scoring system. Results: Sports injuries were the most common mode of injury (n = 17, 56.7%). The mean size of graft used was 8.2 ± 0.39 mm. Postoperatively at 2-year follow-up, 30 cases (100%) had 0 grade pivot-shift test, 0 grade Lachman test, and anterior drawer test. The mean postoperative Lysholm score improved from preoperative score of 62.83 ± 5.2–91.0 ± 5.54. The overall satisfactory result (excellent + good) at 6-month follow-up was (excellent – 30 and good – 70) 100%. Out of this, 27 (90%) patients had returned to preinjury level of activity in 1 year. In this study, one patient had superficial infection and two patients had knee pain. Conclusion: Arthroscopy-assisted ACL reconstruction using hamstring tendon autograft provides a stable knee, reduces postoperative morbidity, and enables early rehabilitation.

A Minimally Invasive and Simple Technique of Superficial Quadriceps Tendon Graft Harvesting

Quadriceps tendon (QT) graft is a versatile graft for anterior and posterior cruciate ligament reconstruction. Advantages of quadriceps tendon autograft are the superior quality of graft, customization of graft size, reduced anterior knee pain, reduced risk of neurovascular injury, reduced incidence of arthrofibrosis compared to BPTB graft, preservation of ACL agonists, i.e., hamstrings, implantation of thicker graft and better patella mobility. Considering its advantages over other available autografts, its popularity is now increasing among surgeons. Conventionally, quadriceps tendon graft is harvested by an open technique, which produces an ugly scar and delays rehabilitation. In this article, we describe a minimally invasive technique of quadriceps tendon graft harvesting with a 2-2.5-cm vertical skin incision. Our technique does not require any specialized instrumentation, unlike other reported minimally invasive QT graft harvesting techniques, as we harvest the graft with a close tendon stripper.

Prospective study of surgical management of anterior cruciate ligament injury using bone patellar tendon bone graft

Background: Anterior knee instability associated with rupture of anterior cruciate ligament (ACL) is a disabling clinical problem in general and especially in athletic individuals. ACL has a poor capacity of healing. The need for surgical correction of ACL injuries arises because, untreated complete injury to the ligament leads to progressive symptomatic instability leading to recurrent injury and damage to the menisci and articular cartilage thus resulting in early osteoarthritis. The bone-patellar tendon-bone auto graft has been widely accepted as the gold standard for ACL reconstruction with a high success rate. Aim: To study the functional outcome of ACL reconstruction using BPTB graft, various advantages and complications following ACL reconstruction using BPTB graft.Methods: The present study was carried out at Department of orthopaedics, Navodaya Medical College and Hospital, Raichur. It is a Descriptive observational study. All patients (30) with diagnosis of ACL tear are included during the period of September 2017 to August 2019.Results: Majority of the patients i.e. 12 (40%) were from 15-25 years age group Male predominance was found in our study. 24 (80%) patients were males and 1 (20%) patient were females. Male to female ratio was 4:1.Right knee involvement was seen in 18 patients i.e. 60% and left sided knee involvement was seen in 12 (40%). In majority of the patients i.e 15 (50%), sports was the commonest mode of injury. Knee pain was commonest symptom in 15 i.e. 50% patients. Instability was complained by 9 (30%), knee pain with instability by 4 (13.3%) and locking by 2 (6.7%). Mean score at 3 months was 80.2±12.3. At 6 months was 85.3±9.2. At 1 year was 91.1±8.7. At 18 months was 94.2±8.1 and at 2 years it was 95.8±7.1. When we compared the mean XIV score at different follow up periods, it was found to be statistically significant (p

POST-OPERATIVE COMPLICATIONS FOLLOWING ARTHROSCOPIC ACL RECONSTRUCTION USING VARIOUS GRAFTS; A PROSPECTIVE STUDY

Anterior cruciate ligament tear is a common occurrence and with advent of arthroscopic ligament reconstruction, the surgery is minimally invasive with good functional outcomes. The aim of this study is to evaluate the post-operative complications following arthroscopic ACLreconstruction. In this study we tried to analyse the post-operative complications in patients with arthroscopic ACL reconstructions using various autografts. The autografts used in this study were Bone patellar tendon bone graft, hamstring graft and peroneus graft. 26 patients were included in the study. 2 patients lost to follow up. The study result comprised of 24 patients. there were 45.8% of the patients who were below the age of 25 years whereas 54.2% patients were older than 25 years. Only 3 females were recruited in the present study, accounting for 12.5% of the total patients of the study. Majority 87.5% were males. Majority of the recruited patients were having right sided knee injury (54.2%) whereas remaining (45.8%) were having left sided injury. Majority of the patients were treated using hamstring and peroneus grafts (41.7%). 16.7% patients were treated with BPTB graft. There were 16.7% patients who developed deep infection after the surgery. Out of these, 30% were with hamstring grafts and 25% were with BPTB graft. 41.7% patients didn't develop any complications afterwards. 12.5% patients complained of post-operative knee pain. 16.7% patients reported occurrence of supercial infection. There are no signicant differences among complications for different grafts used in this study. The study concluded that arthroscopic ACL reconstruction is a safe surgical procedure with no signicant differences for various autograft options in terms of complications. The study is limited by small sample size and short follow up.

Evaluation of the Outcome of Arthroscopic ACL Reconstruction by Quadrupled Hamstring Tendon Graft and Fixation with Biodegradable Screw in ACL Injury

Background: The BPTB graft and quadruple graft of semitendinosus and gracilis are the two most popular options for anterior cruciate ligament reconstruction. Objective: To assess the efficacy of arthroscopic ACL reconstruction with semitendinosus and gracilis tendon grafts and biodegradable screw fixation in ACL injury. Methodology: This prospective interventional study was carried out at Dhaka Medical College Hospital and a private hospital in Dhaka from July 2014 to May 2016. Thirty-one (31) patients with ACL injuries were treated with arthroscopic reconstruction of the ACL using a quadrupled hamstring autograft of semitendinosus and gracilis tendon, as well as a rehabilitation protocol. Patients were routinely followed up on and an outcome evaluation was performed at 24 weeks. Subjective and objective evaluations were performed using the IKDC and Lysholm knee scoring scales to compare preoperative and postoperative outcomes. Results: All patients had either a grade II or a grade III positive Lachman test before surgery. There was a statistically significant improvement after surgery, with 87 percent (27 patients) having a negative Lachman test and only 13 percent (4 patients) having a positive Lachman test. The pre-operative Lysholm knee score was 53, and the postoperative Lysholm knee score was 90, indicating a significant improvement (p0.05). Excellent results (>94–100 points) were obtained in 12 (38.7 percent) patients, good results (>84–94 points) in 15 (48.4 percent) patients, fair results (>64–84 points) in 2 (6.5 percent) patients, and poor results (64 points) in 2 (6.5 percent) patients, according to the Lysholm knee scoring scale. Conclusion: Quadrupled Arthroscopic ACL Reconstruction ACL injury patients can benefit from a hamstring graft of semitendinosus and gracilis tendon and fixation with a biodegradable.

Psychological, physical and social factors influence decision to return to sport after revision ACL reconstruction with BPTB graft.

There is limited evidence in literature regarding the patient-reported factors that influence their return to sport (RTS) in revision anterior cruciate ligament reconstruction (ACLR). The medium-term results of a prospective consecutive cohort of patients undergoing single- and two-stage revision ACLR with bone patellar tendon bone graft (BPTB) and patient-reported factors that influence their decision to return to sport are presented in this study. Seventy-two patients were included in this prospective study. Single- or two-stage revision with BPTB graft was performed based on pre-operative planning. Iliac crest bone graft was used. Pre-operative and follow-up Lysholm and Tegner activity scores and RTS, level of sport and patient-reported factors affecting RTS were recorded. The mean follow-up was 9years (SD 2.7years). Single-stage revision ACLR was performed in 61 patients. In 11 patients (15%), revision ACLR was performed in two stages. There was a significant improvement in Lysholm score from mean 51.1 to 86.7 (p < 0.001). The incidence of re-rupture in this cohort was 0%. The median Tegner score was 6 (range 2-9). Twenty-five patients (34.7%) did not return to anysport at final follow-up. Twenty-nine (40.2%) patients returned to their pre-injury level of sport. Fear of reinjury (79%, p < 0.001) and persistent knee symptoms (35.8%, p = 0.03) were the most common factors limiting RTS in non-returners. Psychological and social factors may have an influence on RTS in addition to physical factors. Level III.

Arthroscopic ACL reconstruction-functional outcome with BPTB graft with interferential screws

Background: Anterior cruciate ligament (ACL) tear is the most common serious ligamentous injury to the knee joint. The ACL is the primary stabilizer against anterior translation of the tibia on the femur and is important in counteracting rotation and valgus stress. Anterior cruciate ligament deficiency leads to knee instability. This results in recurrent injuries and increased risk of intra articular damage, especially the meniscus. The goals of the ACL reconstruction are to restore stability to the knee, allow the patient to return to normal activities, including sports and to delay the onset of osteoarthritis. The bone patellar tendon bone graft is one of the most commonly used autograft for reconstruction and this study evaluates the functional outcome in a prospective study.Materials and Methods: This was a prospective study comprised of 30 diagnosed cases of ACL tear confirmed by clinical evaluation, MRI scanning and diagnostic arthroscopy in patients who have come with complains of knee instability/pain to KIMS hospital and research centre from February 2018 to February 2019. Patients between the age groups 18 years to 40 years were taken as test subjects and were managed by arthroscopic ACL reconstruction with BPTB graft and interferential screw and were followed for an average period of 8 months and the findings were recorded and compared pre op and post op using IKDC and Lysholm scoring scales.Results: There were significant improvements in IKDC and LYSHM scores and functional outcome of patients before and after the operation. During the average follow-up period, 100% of patients had varying degrees of symptomatic relief. No patient needed any additional modality of treatment or reoperation for recurrence of symptoms.

Comparison of Therapeutic Results of Open and Arthroscopic Surgery on Functional Level, Duration of Return to Daily Activity and Satisfaction with Treatment in Patients with ACL Rupture

Bone-Patellar Tendon-Bone autograft (BPTB) and four-strand semitendinosus-gracilis (hamstring) graft are the most common methods for reconstructing anterior cruciate ligament but there is still controversy over the best method. The aim of this study was to compare the therapeutic results of two methods of BPTB and four-strand semitendinosus-gracilis (hamstring) grafts using arthroscopic treatment in patients with anterior cruciate ligament (ACL) rupture. This retrospective study was performed on 85 patients with ACL rupture aged 17-45 years who referred to Imam Khomeini Hospital in Ahwaz from the beginning of 2016 to the end of 2017 who had undergone two years of ACL reconstruction surgery, either by bone-patellar tendon-bone autograft (BPTB) (open surgery) (n=23) or four-strand hamstring autograft (semitendinosus-gracilis) (by arthroscopy) (n=25). Lysholm score was used for knee functional status assessment, Lachman test for tendon laxity, and pivot shift test for strength evaluation. The 36-Item Short-Form Health Survey questionnaire (SF-36) was also completed and compared at the last follow-up. Patients were also evaluated by type of daily activity (heavy or light activity). There was no significant difference between the two groups in the Lysholm score (P&gt;0.05) and both groups were classified as “Good”. There was no significant difference between the frequency distribution of patients based on Lachman test results and pivot shift results (P&gt;0.05). None of the patients in the two groups had any rupture within two years after treatment. Both groups had good satisfaction with treatment and quality of life and there was no statistically significant difference between the mean SF-36 scores (P&gt;0.05). There was no significant difference between the two groups in the light and heavy activity groups. Although complication in short-term follow-up was more in patients undergoing open surgery, the functional level and treatment satisfaction in patients treated by open surgery (bone-patellar tendon-bone autograft) and arthroscopy (four-strand hamstring autograft) were not significantly different after two years. Therefore, according to the surgeon's diagnosis or the patient's choice, both methods can be selected; method with acceptable therapeutic outcomes in reconstructing the anterior cruciate ligament.

Comparison of Short-term Biodex Results After Anatomic Anterior Cruciate Ligament Reconstruction Among 3 Autografts

Background:An individualized approach to anterior cruciate ligament reconstruction (ACLR) typically includes criteria-based postoperative rehabilitation. However, recent literature has suggested residual quadriceps weakness up to 12 months after ACLR, especially with a quadriceps tendon (QT) autograft.Hypothesis:The QT would have poorer quadriceps strength symmetry at 5 to 8 months compared with the hamstring tendon (HS) and patellar tendon (BPTB), but there would be no significant difference at 9 to 15 months among all 3 groups.Study Design:Cohort study; Level of evidence, 3.Methods:Patients who underwent anatomic primary ACLR with an autograft were reviewed retrospectively. Isometric quadriceps and hamstring strength measurements were obtained clinically at 5 to 8 months and 9 to 15 months postoperatively. Return-to-running and return-to-play criteria included greater than 80% and 90% quadriceps strength symmetry, respectively.Results:A total of 73 patients with 5- to 8-month follow-up were identified, and 52 patients had 9- to 15-month data. The QT group had a significantly lower quadriceps index at 5 to 8 months (69.5 ± 17.4) compared with the BPTB (82.8 ± 14.6; P = .014) and the HS (86.0 ± 18.6; P = .001) groups. More patients with an BPTB autograft met criteria for return to running and return to play (60% and 47%, respectively) compared with the QT group (26% and 13%, respectively) at 5 to 8 months. Given the sample sizes available, we observed no significant difference in the quadriceps index and return-to-play and return-to-running criteria at 9 to 15 months among those undergoing ACLR with a QT, BPTB, or HS graft.Conclusion:Patients undergoing ACLR with a QT graft demonstrated clinically meaningful quadriceps asymmetry at 5 to 8 months and 9 to 15 months postoperatively. Additionally, fewer patients in the QT group met criteria for return to play and running at 5 to 8 months than the BPTB and HS groups. These data suggest that a longer time to return to play and specific rehabilitation protocols that emphasize quadriceps strengthening may be necessary because of residual quadriceps weakness after ACLR with a QT graft.

Ceramic Bone Graft Substitutes do not reduce donor-site morbidity in ACL reconstruction surgeries: a pilot study.

Introduction: Anterior knee pain is a major problem following Bone-patellar-tendon-bone graft (BPTB) use in anterior cruciate ligament (ACL) reconstruction. We hypothesized that filling the donor defect sites with bone-graft substitute would reduce the anterior knee symptoms in ACL reconstruction surgeries. Material and Methods: Patients operated for ACL-deficient knee between March 2012 and August 2013 using BPTB graft were divided into two treatment groups. The patellar and tibial donor-site bony defects were filled-up with Hydroxyapatite–Bioglass (HAP:BG) blocks in the study group (n = 15) and no filler was used in the control group (n = 16). At 2 years, the clinical improvement was assessed using International Knee Documentation Committee (IKDC) score and donor-site morbidity was assessed by questionnaires and specific tests related to anterior knee pain symptoms. Results: Donor-site tenderness was present in 40% patients in the study group and 37.5% patients in the control group (p = 0.59). Pain upon kneeling was present in 33.3% patients in the study group and 37.5% patients in the control group (p = 0.55). Walking in kneeling position elicited pain in 40% patients in the study group and 43.8% in the control group (p = 0.56). The mean visual analogue score for knee pain was 3.0 in the study group and 3.13 in the control group, with no statistically significant difference (p = 0.68). Unlike control group, where a persistent bony depression defect was observed at donor sites, no such defects were observed in the study group. Conclusion: Filling the defects of donor sites with HAP:BG blocks do not reduce the anterior knee symptoms in patients with ACL reconstruction using autogenous BPTB graft.

Determination of patellar tendon length for anterior cruciate ligament reconstruction using an anteroposterior knee radiograph

Background/ObjectiveGraft-tunnel length mismatch is a common intraoperative technical problem for anterior cruciate ligament reconstruction (ACLR) using a bone-patellar tendon-bone graft (BPTB). The patella-to-condyle and the patella-to-notch distances are two measurements in an anteroposterior knee radiograph. The objective of this study was to evaluate the sensitivities, specificities and reliabilities of those 2 measurements for detecting patients who had a patellar tendon length exceeding 45 mm. MethodsPreoperative plain radiographs of patients who underwent ACLR with a BPTB graft were evaluated independently by two orthopaedic surgeons 3 times each at 2-weekly intervals. The sensitivities and specificities of the two measurements for detecting patients who have a patellar tendon length exceeding 45 mm were calculated. The optimal cutoff point was estimated using Youden index, and the receiver operating characteristic (ROC) curve and area under the curve (AUC) were evaluated with a 95% CI. As for the inter- and intra-rater reliabilities, intraclass correlation coefficients (ICC) were determined. ResultsOne hundred and twenty-seven patients with an average age of 29.5 years old were evaluated. The mean patellar tendon length was 41.3 ± 5.0 mm. Patients with a length more than 45 mm (20 patients, 16%) had significantly higher patella-to-condyle and patella-to-notch distances, and more frequent use of bone staples for distal graft fixation than patients with a length ≤ 45 mm. To detect patients with a patellar tendon length over 45 mm, the optimal cutoff point for the patella-to-condyle distance was set at 14.5 mm, which had a sensitivity of 80%, specificity of 71%, and AUC of 0.76. In the case of the patella-to-notch distance, the cutoff point of 5.5 mm had a sensitivity of 80%, specificity of 66%, and AUC of 0.73. The intra- and inter-rater reliabilities of the two measurements were excellent, with ICCs of over 0.90. ConclusionsPreoperative measurements of the patella-to-condyle and the patella-to-notch distances in AP knee radiographs can be valuable tools, with good sensitivities and specificities, for the determination of the patellar tendon length when using a BPTB graft for an ACLR. They had an acceptable level of discrimination capability and excellent reliability.

Anterior knee pain following BPTB graft harvest. Reality or overhyped

IntroductionThe patellar tendon graft has long been the gold standard for ACL reconstruction. Recently semitendinosus and gracilis tendons graft have been used increasingly. We hypothetise that the Bone-Patella Tendon-Bone graft is a good and economical graft for the Indian population with no adverse effects of anterior knee pain or patellar tendon shortening. We believe that the early squatting and cross-legged sitting causes early and constant stretching of the tendon in our patients. This is responsible for the lesser incidences of adverse effects in the Indian population. Material and MethodIn a retrospective study, the hospital database was scrutinized to shortlist patients who had undergone a bone-patella tendon-bone harvest for ACL or PCL reconstruction before 2013. Each patient was evaluated using the Lysholm score and the KOOS Score. VAS was also used, to evaluate for the amount of pain experienced by patients. The analysis of the quadriceps power along with the presence or absence of any extensor lag was made too. The modified Insall Salvati index was also calculated. ResultsForty-seven patients were shortlisted of which 25 patients were followed up with an average follow up of 94.5 months. Although some patients did complain of occasional pain with the average VAS score of 1.45; on analyzing the data it was evident that all our patients had excellent quadriceps power (5/5) with no extensor lag. The mean Lysholm score was 95.55, while the mean KOOS score was 94.17. The mean Insall index of 1.05 showed no significant patella baja in any of our patients. ConclusionIt is ascertained that no significant retro-patellar pain or shortening of the patellar tendon occurs following a bone patella tendon bone harvest. The bone patella bone tendon graft is a suitable graft for ligament reconstruction with good functional outcome, and no significant adverse effect of patella baja or anterior knee pain in the Indian patients. Level of EvidenceLevel IV.

A study on the functional outcome of arthroscopic anterior cruciate ligament reconstruction done with bone patellar tendon bone graft using the IKDC score

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; ACL injuries result in persistent recurrent instability and increased risk of meniscal tears and intra-articular damage, leading on to degenerative changes in the knee. There are many studies about ACL reconstruction using bone patellar tendon bone graft (BPTB) and its outcome, but there is not enough literature on the subjective assessment following reconstruction. We decided to do a study of the patient’s subjective outcome as per the International knee documentation committee score (IKDC) and other clinical parameters following ACL reconstruction using the BPTB graft.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This was a prospective study consisting of 50 patients who presented with ACL injury and underwent arthroscopic ACL reconstruction using BPTB graft in our hospital in the period from May 2008 to July 2010. Patients were followed at regular intervals at 4 weeks, 8 weeks, 3 months &amp;amp; 6 months and 1 year. Patients were assessed at every visit with clinical tests and IKDC subjective assessment score.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; 50 patients with ACL insufficiency underwent ACL reconstruction. Postoperative knee flexion improved; the mean flexion was 131.70 with standard deviation of 6.534, which was significant. The mean preoperative IKDC was 56.97 and standard deviation of 9.188 and postoperative IKDC score was 92.33 and standard deviation 5.198 which showed a marked improvement and was statistically significant. The complications included; 8 patents with anterior knee pain, 1 case of patellar fracture while harvesting graft, which healed with wiring and 2 patients, had re-rupture of ACL due to road traffic accident.&lt;/p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; ACL reconstruction with BPTB graft showed a significantly good subjective outcome on assessment using IKDC score. Isolated ACL reconstruction showed a better subjective outcome compared to the patients who had associated meniscal injury.

Functional outcome of anterior cruciate ligament (ACL) reconstruction: comparison of bone-patella tendon-bone (BPTB) vs. Hamstring graft

Introduction: This is a cross-sectional study to evaluate the functional outcome of ACL Reconstruction between BPTB and hamstring graft who underwent ACL Reconstruction between January to June 2012 at our institution. Methods: Functional IKDC scoring was done pre-operatively, at 6 months and one year. Arthrometric measurements were taken using KT2000. Lysholm score and SF-36 were assessed at one year. Resuts: All patients are male, mean age is 29 (21 to 37 years old). 21.4% patients from patella BPTB group and 13% of hamstring group had anterior knee pain. 50% of patients from both groups complained of numbness over operative site. Average time return to pre-injury sports activity for BPTB group was 7.9 months, whereas for hamstring group was 8.3 months. KT-2000 measurements revealed an average side to side laxity difference average of 6.6mm in BPTB group and 7.9mm in hamstring group. Pivot shift were negative at 6 months in all patients. IKDC knee scoring significantly improved from grade C or D to grade B in 82% of BPTB group and 63% in hamstring group one year post operatively. There were no difference between both groups in terms of SF-36, Lysholm score and knee range of motion. Conclusions: There are no difference in functional outcome and lysholm knee score between the two groups although there is a discrepancy of IKDC score and arthrometric measurement at one year. Although both groups have moderate anterior laxity after one year, but they are asymptomatic and able to go back to preinjury sports activities.