Hamstring Autograft Research Articles

Thessaly Graft Index: An Artificial Intelligence-Based Index for the Assessment of Graft Integrity in ACL-Reconstructed Knees.

Magnetic resonance imaging (MRI) has proven to be a valuable noninvasive tool to evaluate graft integrity after anterior cruciate ligament (ACL) reconstruction. However, MRI protocols and interpretation methodologies are quite diverse, preventing comparisons of signal intensity across subsequent scans and independent investigations. The purpose of this study was to create an artificial intelligence (AI)-based index (Thessaly Graft Index [TGI]) for the evaluation of graft integrity following ACL reconstruction. The cohort study included 24 patients with an isolated ACL injury that had been treated with a hamstring tendon autograft and followed for 1 year. MRI was performed preoperatively and 1 year postoperatively. The clinical and functional evaluations were performed with use of the KT-1000 and with the following patient-reported outcome measures (PROMs): the Knee Injury and Osteoarthritis Outcome Score (KOOS), the International Knee Documentation Committee Subjective Knee Function form (IKDC), the Lysholm score, and the Tegner Activity Scale (TAS). An AI model, based on the YOLOv5 Nano version, was designed to compute the probability of accurately detecting, in the sagittal plane, a healthy ACL (on a percentage scale) and was trained on healthy and injured knees from the KneeMRI dataset. The model was used to assess the integrity of ACL grafts, with a maximum score of 100. The results were compared with the MRI assessment from an independent radiologist and were correlated with PROMs and KT-1000 laxity. The mean preoperative and postoperative TGI scores were 64.21 ± 8.96 and 82.37 ± 3.53, respectively. A mean increase of 15% in the TGI scores was observed between preoperative and postoperative images. The minimum threshold for TGI to categorize a graft as healthy on the postoperative MRI was 79.21%. Twenty-two grafts were characterized as intact and 2 as reruptured, with postoperative TGI scores of 71% and 42%. The radiologist's assessment was in total agreement with the TGI scores. The correlation of the TGI ranged from moderate to good with the TAS (0.668), IKDC (0.516), Lysholm (0.521), KOOS total (0.594), and KT-1000 (0.561). The TGI is an AI tool that is able to accurately recognize an ACL graft rupture. Moreover, the TGI correlated with the KT-1000 postoperative values and PROM scores. Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Primary Anterior Cruciate Ligament Reconstruction in Level 1 Athletes: Factors Associated With Return to Play, Reinjury, and Knee Function at 5 Years of Follow-up.

Favorable outcomes after anterior cruciate ligament (ACL) reconstruction (ACLR) are often gauged by successful return to play (RTP), a low incidence of subsequent ACL injury, and positive patient-reported outcomes. Level 1 sports place the highest demands on the knee by requiring frequent pivoting, changes in direction, and jumping. To analyze the outcomes of primary ACLR in level 1 athletes and identify pre- and intraoperative factors associated with RTP, ipsilateral ACL reinjury, contralateral ACL injury, and International Knee Documentation Committee (IKDC) score at 5 years postoperatively. Cohort study; Level of evidence, 2. A consecutive cohort of 1432 patients who underwent primary ACLR by 2 orthopaedic surgeons were prospectively evaluated. The RTP rate, incidence of ipsilateral/contralateral ACL injury, and IKDC score were analyzed at 5 years. Comparative analysis of clinical variables was performed between those who achieved favorable outcomes and those who did not. Outcomes at 5 and 2 years were also compared. The mean age was 24.3 ± 7.3 years (males: 75%, females: 25%). Gaelic football was the predominant sport (40%), followed by soccer (19%). The RTP rate was 87.4%, with 59.8% of athletes still playing at an equivalent or higher level at 5 years. The incidence of ipsilateral reinjury for athletes who resumed level 1 sport was 4.3% for bone-patellar tendon-bone (BPTB) autografts with screw fixation and 19.7% for hamstring tendon (HT) autografts with EndoButton and screw fixation. The incidence of contralateral ACL injury was 13.7%. The mean IKDC score at 5 years (86.6 ± 10.9) was comparable to that at 2 years (86.8 ± 10.1). Patients were more likely to RTP with each year of decreasing age (OR, 1.06; P < .001), with a higher preoperative Marx score (OR, 1.08; P < .001) or a higher 5-year IKDC score (OR, 1.06; P < .001). The risk of ipsilateral ACL reinjury increased each year of decreasing age (OR, 1.11; P < .001) or when an HT autograft was used (OR, 5.56; P < .001). Younger age was also associated with contralateral ACL injury (OR, 1.1; P < .001). Female sex, older age, concomitant meniscal/chondral injuries, and lower preoperative Anterior Cruciate Ligament Return to Sport after Injury scores were associated with lower IKDC scores at 5 years. Most patients could return to level 1 sports, although their performance level was impacted. Those who returned to sport maintained their performance level over the 5 years. The ipsilateral reinjury rate for BPTB autografts with screws was significantly lower than that for HT autografts with EndoButton and screw fixation. Most ACL reinjuries occurred between 2 and 5 years of follow-up. Younger patients had an increased risk of a subsequent ACL injury to either knee, regardless of graft type. IKDC scores were lower in female patients, older patients, and those with concomitant meniscal/cartilage injuries. NCT02771548 (ClinicalTrials.gov identifier).

Variations in functional outcome based on hamstring autograft thickness estimated using transportal technique in arthroscopic anterior cruciate ligament reconstruction

Objectives: We aimed to study the functional outcome difference in arthroscopic anterior cruciate ligament reconstruction (ACLR) using hamstring autograft thickness between more than 85% and ≤85%. Materials and Methods: In our study, 50 patients with anterior cruciate ligament (ACL) tears were operated with arthroscopic ACLR using an autologous hamstring graft. The anteroposterior diameter (APD) of the tibial footprint of ACL is measured using an arthroscopic ruler using a transportal and the graft thickness of more than 70% of the tibial footprint APD was used. The international knee documentation committee and knee society score (KSS) were compared between the groups in the 1st month, 6th month, and 12th month between autograft thickness of &gt;85% and ≤85%. Results: The mean IKDC scores of patients with graft thickness &gt;85% were higher compared to graft thickness ≤85% in the 6th and 12th post-operative months, with a statistically significant difference at the 12th post-operative month. The mean KSS scores of patients with graft thickness &gt;85% were higher compared to graft thickness ≤85% at the 3rd, 6th, and 12th post-operative months, with a statistically significant difference at the 12th post-operative month. Conclusion: The functional scores were better for autograft thickness of more than 85% compared to autograft thickness of ≤85% at short-term follow-up of the 3rd and 6th post-operative month with a statistical difference at long-term follow-up of the 12th month.

When is Anterolateral Complex Augmentation Indicated? Perspectives from the 2024 Freddie Fu Panther Sports Medicine Symposium.

To determine the trends and indications for anterolateral complex augmentation during anterior cruciate ligament reconstruction (ACL-R) among international orthopaedic sports surgeons. An electronically distributed survey was sent out to international surgeons with high-volume experience in complex ligament reconstructions and revision surgery attending the 2024 Freddie Fu Panther Sports Medicine Symposium. The survey was sent prior to the meeting with questions related to the use of lateral extra-articular tenodesis (LET) or anterolateral ligament reconstruction (ALL-R) during ACL-R. Sessions pertaining to anterolateral complex augmentation were held during the symposium to inform about current clinical practices among attendees. A total of 49 surgeons were identified from 5 different geographic regions prior to the meeting date and sent an electronic survey, of which 48 responded (98% response rate). Among surgeons who reported performing anterolateral complex augmentation procedures (n=45), a total of 39 (87%) respondents reported using only the LET technique, 2 (4%) using only the ALL-R technique, and 4 (9%) using both techniques during ACL-R. The most common indication for anterolateral complex augmentation was a high-grade pivot shift, which 39/43 (91%) of respondents ranked in their top 3 indications. In the setting of primary ACL-R, respondents added a LET when using hamstring tendon autograft in 38% of cases on average compared with 34% of cases when using either bone-patellar tendon-bone autograft or quadriceps tendon autograft. In the setting of revision ACL-R, a LET was added in an average of 68% of cases for a first-time revision ACL-R and 84% of cases for a multiple revision ACL-R. The most common indication for ACL-R with anterolateral complex augmentation was a high-grade pivot shift and most respondents preferred LET over ALL-R. Respondents performed LET in a comparable percentage of cases of primary ACL-R using hamstring tendon, bone-patellar tendon-bone and quadriceps tendon autografts and this number increased with the number of revision ACL-Rs. Based on the results of this survey, surgeons may consider adding a LET in cases of revision ACL-R or in patients with a high-grade pivot shift. Level V.

Addition of Adductor Canal Block to Local Infiltration Analgesia Does Not Reduce Postoperative Opioid Use Following ACL Surgery.

This propensity-matched cohort study aimed to determine if adding adductor canal block (ACB) to local infiltration analgesia (LIA) reduces immediate postoperative opioid use in ACL reconstruction and assess variations based on graft type. This retrospective study analyzed ACL reconstructions performed from 2019 to 2021. Patients were included if they received either LIA alone or a combination of LIA and ACB. Patients were propensity-matched based on demographic and surgical factors, and perioperative opioid consumption was assessed. Subgroup analysis was conducted based on autograft type (hamstring, quadriceps tendon, and patellar bone-tendon-bone). No significant differences were observed in intraoperative, post-anesthesia care unit (PACU), or total perioperative opioid consumption between the ACB + LIA group (27.76 ± 14.01 mg) and the LIA-only group (28.58 ± 12.56 mg). This finding was consistent across all autograft types. However, in the hamstring autograft subgroup, the addition of ACB led to a statistically significant reduction in PACU opioid consumption (30.99 vs. 26.45 mg, p = 0.039), though this difference was not deemed clinically significant. Additionally, the ACB + LIA group experienced a significantly longer mean time to discharge (495 ± 113 minutes) compared to the LIA-only group (463 ± 116 minutes; p = 0.017). Our findings suggest that adding ACB to LIA does not provide additional opioid-sparing benefits in ACL reconstruction, except in patients with hamstring grafts, where the difference observed may not be of clinical significance. The increased discharge time with ACB highlights the need to balance benefits with operational efficiency.

Regional Anesthesia and Pain Outcomes After Anterior Cruciate Ligament Reconstruction Surgery in Pediatric Patients: Society of Pediatric Anesthesia Improvement Network.

Optimal perioperative pain management is unknown for adolescent patients undergoing anterior cruciate ligament reconstruction (ACLR). The study aimed to determine the association of nerve blocks with short- and long-term pain outcomes and factors influencing self-reported neurological symptoms. We performed a multisite, prospective observational study of adolescent patients undergoing ACLR. Perioperative data included demographics, block details, anesthetic, and surgical techniques. Self-reported surveys documented pain scores, medication use, and neurological symptoms at various time points after the surgery (postoperative day [POD] 1, POD 3, week 6, and month 6). Associations between different groups of peripheral nerve blocks (PNBs) and the absence of a block were analyzed for their effects on acute postoperative pain outcomes. In addition, factors influencing self-reported neurological outcomes were determined using both univariate and multivariate regression. Data from 519 subjects (aged 15 years, 55.7% female) showed that 23.9% of patients with anterior plus posterior nerve blocks (A+P PNB) reported severe postanesthesia care unit (PACU) pain scores, compared to 40% with no PNB and 38.3% with anterior PNB (A-PNB). Patients receiving A-PNB or A+P PNB had significantly lower intraoperative morphine equivalents (MEs) (0.49 mg/kg and 0.46 mg/kg, respectively) vs no block patients (0.61 mg/kg). Total PACU MEs were lower for any patient who received a PNB. Multivariable logistic regression analysis showed that patients who received A+P PNB or a hamstring autograft had lower POD 1 severe pain scores (odds ratio [OR] = 0.35; 95% confidence interval [CI], 0.15-0.84 and OR = 0.35; 95% CI, 0.15-0.83, respectively). Patients with PNBs with local anesthesia concentration (LAC) greater than 0.25% reported higher POD1 pain scores (OR = 2.14; 95% CI, 1.1-4.16) compared to those with lower LAC. Patients with PNB catheters had reduced POD 1 pain. Multivariable logistic regression analysis for numbness at week 6 revealed a greater odds of numbness for A-PNB with LAC >0.25% (OR = 5.13; 95% CI, 1.27-20.8). At month 6, patients receiving PNB with perineural steroid adjuvant were more likely to report numbness (dexamethasone OR = 5.93; 95% CI, 1.61-21.9, methylprednisolone OR = 11.3; 95% CI, 2.16-58.6). Patients who received A+P PNB had lower postoperative pain scores than those who received no block. Additional studies are necessary to discern how PNB type, graft harvest site, LAC, and adjuvants influence pain control, persistent numbness, and weakness.

Quantifying Muscle Volume Deficits Among 38 Lower Extremity Muscles in Collegiate Football Athletes After Anterior Cruciate Ligament Reconstruction.

Quadriceps dysfunction is ubiquitous after anterior cruciate ligament (ACL) reconstruction (ACLR). Addressing quadriceps dysfunction is crucial to improve function, reduce the reinjury risk, and maintain long-term knee health. While deficits specific to the quadriceps are well documented, less is known about the effect of an ACL injury on other lower extremity muscle groups. The purpose of this exploratory analysis was to quantify and rank lower extremity muscle volume deficits using magnetic resonance imaging in collegiate football athletes after ACLR. It was hypothesized that the quadriceps muscles would present with the greatest deficits and that compensatory hypertrophy of muscles at adjacent joints such as the hip and ankle would be observed. Cross-sectional study; Level of evidence, 3. This study is a secondary analysis from an ongoing multicenter prospective cohort study involving Division I collegiate football athletes. Athletes who underwent primary unilateral ACLR (1 [3%] allograft, 2 [7%] quadriceps tendon autograft, 22 [73%] bone-patellar tendon-bone autograft, 5 [17%] hamstring tendon autograft) and magnetic resonance imaging were included. Muscle volumes (mL·kg-1·m-1) were quantified bilaterally from 38 lower extremity muscles using machine learning technology. Paired-samples t tests were performed between limbs for each muscle, which were then ranked and visualized in a forest plot based on standardized mean differences (surgical - nonsurgical limb). A total of 30 athletes (mean time from surgery, 27.9 ± 19.0 months) were included. The largest muscle volume deficits in the surgical limb were seen in the 3 uniarticular quadriceps muscles, followed by the biarticular triceps surae muscles. The rectus femoris and soleus did not show significant differences between limbs. Conversely, the fibularis muscle group had a greater muscle volume in the surgical limb compared with the nonsurgical limb. Most other muscle groups did not present significant differences between limbs. Persistent quadriceps atrophy in a cohort of high-level athletes over 2 years after ACLR was highlighted in this study. Deficits in the gastrocnemius muscles, but not in the soleus, were also identified. This comprehensive approach examining various lower extremity muscles revealed latent muscle volume deficits present after ACLR.

Comparing Clinical Outcomes of Five-Strand Hamstring Tendon Autograft and Quadrupled Hamstring Tendon Autograft for Single Bundle Anterior Cruciate Ligament Reconstruction in Filipinos

Background: Anterior cruciate ligament (ACL) tears are common, especially in athletes, and are often treated with hamstring tendon autografts using a single-bundle technique. Graft diameter is crucial, with evidence showing that larger grafts reduce failure risk. Asian populations typically have smaller graft diameters. This study compares the clinical outcomes of the five-strand versus the quadrupled technique in a Filipino Asian population to assess potential benefits in graft thickness and knee stability. Objective: To compare the functional outcomes, graft sizes, failure rates, and time to return to sports between five-strand and quadrupled hamstring tendon autografts in ACL reconstruction. Methodology: This ambi-directional cohort study involved Asian Filipino patients aged 18–50 with unilateral ACL tears who underwent single-bundle ACL reconstruction with either quadrupled or five-strand hamstring autografts between January 2022 and August 2023. Data on graft dimensions, IKDC scores, and time to return to sports were collected pre- and postoperatively. The analysis included descriptive statistics, Fisher’s exact test, t-tests, and ANOVA, with significance at p &lt; 0.05. Result: The study included 18 patients, showing no significant differences in demographic characteristics such as age (24.78 vs. 27.67 years, p = 0.202), height (1.71 vs. 1.64 meters, p = 0.146), weight (84.43 vs. 74.98 kg, p = 0.252) or body mass index (28.95 vs. 27.98 kg/m², p = 0.714); average return to sports (10.63 vs. 11.83 months, p = 0.642). There was no significant difference in thicknesses (p = 0.089) and lengths (p = 0.885) of the graft. IKDC scores showed no significant differences between the two groups in pre- or postoperative outcomes at six months and one year. Complications were minimal, with no significant difference found. Conclusion: Both the five-strand and quadrupled techniques demonstrated similar demographics, graft dimensions, and clinical outcomes, indicating comparable functional results and safety profiles.

Use of Anthropometric Data for the Prediction of Four-Strand Hamstring Graft Size in White Caucasian Population

Background/Objectives: The purpose of this study was to preoperatively estimate the four-strand hamstring graft size in a White Caucasian population, using anthropometric data. Methods: This was a prospective study of a consecutive series of fifty patients with anterior cruciate ligament (ACL) rupture, who were scheduled for reconstruction using hamstring autografts; however, one of them was ultimately not enrolled according to the exclusion criteria (49 patients in total). Preoperatively, age, sex, weight, body mass index (BMI), length, and diameter of the contralateral thigh, length of the harvested gracilis/semitendinosus tendons, and length and thickness of the four-stranded graft were recorded. Graft diameter and length were dependent variables, measured via a graft sizer and a ruler, respectively. Quantitative variables were described with mean ± SD (correlated in a pairwise manner with Pearson’s r correlation). Qualitative variables were described with an absolute count (relative % percent) per categorical level, and their dependency on any quantitative (dependent) variable was assessed via Student’s t-test. Results: The mean lengths of the gracilis and semitendinosus were 25.6 ± 3.2 cm and 28.4 ± 3.3 cm, respectively, and they were positively correlated with the length of the four-strand hamstring graft along with the patients’ height and thigh length. Conclusions: The use of anthropometric data can assist in the prediction of the hamstring autograft size, aiding the selection of an appropriate graft type. The four-strand hamstring graft length was related to the gracilis, semitendinosus, and thigh length. The patients’ height was related to the graft length and diameter.

Correlation of Hamstring Tendon Auto Graft Size with Patient Height, Weight, Femur Length and Body Mass Index in ACL Reconstruction

Correlation of Hamstring Tendon Auto Graft Size with Patient Height, Weight, Femur Length and Body Mass Index in ACL Reconstruction

Return to Sport and Graft Failure Rates After Primary Anterior Cruciate Ligament Reconstruction With a Bone-Patellar Tendon-Bone Versus Hamstring Tendon Autograft: A Systematic Review and Meta-analysis.

Anterior cruciate ligament (ACL) tears are frequent injuries in athletes that often require surgical reconstruction so that patients may return to their previous levels of performance. While existing data on patient-reported outcomes are similar between bone-patellar tendon-bone (BTB) and hamstring tendon (HT) autografts, the literature regarding return to sport (RTS), return to previous levels of sport activity, and graft failure rate remains limited. To compare rates of RTS, return to previous activity levels, and graft retears among athletes undergoing primary ACL reconstruction using a BTB versus HT autograft. Systematic review and meta-analysis; Level of evidence, 4. The MEDLINE, Embase, and Cochrane Library databases were queried, and studies reporting on RTS after primary ACL reconstruction using a BTB or HT autograft were included. Exclusion criteria included revision reconstruction, ACL repair, quadriceps tendon autografts, allografts, graft augmentation, or double-bundle autografts. Rates of RTS, return to previous levels of activity, and retears were extracted and analyzed across included studies. A total of 33 articles met inclusion criteria, with a patient cohort of 4810 athletes. The overall RTS rate for all athletes was 80.4% (95% CI, 75.3%-84.6%) at a mean follow-up of 35.7 months, with 54.6% (95% CI, 48.5%-60.6%) returning to preinjury levels of activity. No significant difference was found between BTB and HT autografts with respect to rates of RTS, return to preinjury activity levels, or reruptures. The overall RTS rate in patients after primary ACL reconstruction with a BTB autograft was 83.3% (95% CI, 77.0%-88.2%), with 56.1% (95% CI, 49.3%-62.7%) returning to preinjury levels of activity. Conversely, the overall RTS rate in patients after primary ACL reconstruction with an HT autograft was 77.9% (95% CI, 70.3%-84.0%), with 53.5% (95% CI, 42.8%-63.9%) returning to preinjury levels of activity. The overall graft rerupture rate for the entire patient cohort was 3.6% (95% CI, 2.5%-5.1%), for patients with BTB grafts was 3.2% (95% CI, 1.9%-5.3%), and for patients with HT grafts was 4.4% (95% CI, 2.8%-6.8%). Primary ACL reconstruction using BTB autografts demonstrated similar rates of RTS, return to previous activity levels, and reruptures compared with reconstruction using HT autografts.

ACL Reconstruction using Hamstring Autograft Plus Lateral Extra-articular Tenodesis and All-Soft Tissue Quadriceps Alone Have Lower Re-tear Rate and Pivot Shift Grade but Similar Outcome to Hamstring Autograft Alone in High Risk Patients.

The purpose of this study was to compare the surgical outcomes of anterior cruciate ligament (ACL) reconstruction using hamstrings autograft (HA) plus lateral extra-articular tenodesis (LET), isolated all-soft-tissue quadriceps autograft (QA), and isolated HA. A retrospective review was performed comparing high risk patients undergoing ACL reconstruction with isolated HA, isolated QA, or HA+LET from August 2013 to January 2023. High risk patients, as determined by high grade pivot shift or generalized ligament laxity, with at least 2 years of follow up were included. Lysholm and International Knee Documentation Committee (IKDC) scores were compared at 3, 6, 12, and 24 months postoperatively. Re-tear rate, postoperative pivot shift grade, return to sport, and complications were recorded. 159 patients (56 HA, 47 HA+LET, and 56 QA) were included. At 6 months postoperatively the HA IKDC score was significantly lower than the HA+LET and QA groups (p<0.0001). Similarly, the Lysholm score was significantly lower in the HA cohort at 6 months, 1 year, and 2 years postoperatively (p <0.0001-0.02). There was no difference in rate of achieving minimally important clinical difference between the cohorts for either of these outcome scores. The re-tear rate was significantly higher in the HA group (17.9%) compared to the HA+LET (4.3%) and QA (1.8%) cohorts (p=0.01). The rate of postoperative pivot shift of grade 2 or more was also higher in the isolated HA group (p=0.04). The use of an all-soft-tissue QA or HA+LET for ACL reconstruction both resulted in a lower re-tear rate and postoperative pivot shift grade compared to an isolated HA graft in high-risk patients at two years postoperatively. There was no difference in the rate of achieving minimal clinically important difference between the cohorts. The QA and HA+LET reconstruction options may improve stability and decrease the failure rate compared to HA reconstruction alone.

The single antegrade sling graft: a novel hamstring autograft technique for combined anterior cruciate ligament and anterolateral ligament reconstruction

IntroductionAs a result of increased incidence of anterior cruciate ligament (ACL) injury in young athletes, there is a rise in the indications surgical ACL reconstruction procedures. The value of anterolateral ligament (ALL) reconstruction emerges as a proposed solution to prevent graft failures and improve stability in this high demanding category of patients. The purpose of this study is to present our experience with a novel hamstring auto-grafting technique, the single antegrade sling graft (SASG), for combined reconstruction of both ACL and ALL using autologous gracilis (GR) and semitendinosus (ST) grafts utilizing a single femoral tunnel and double tibial tunnels.Materials and methodsFrom January 2020 to December 2021, 21 soccer players were operated utilizing the SASG technique, a modification of the technique of SANTI study group. Inclusion criteria were participating in pivoting sport, high-grade pivot shift examination (Grade 2–3), and evidence of a lateral femoral notch sign or Segond's fracture on preoperative imaging. Patients were assessed for 2 years postoperatively by Lachman’s test for anteroposterior laxity and pivot shift test for rotational laxity. The postoperative outcomes were assessed by Tegner-Lysholm and International knee documentation committee scores. Also, the postoperative complications such as stiffness, infection and graft failure were reported.Results21 male soccer players with a mean age 26.4 years were included in this study. After 2 years follow up there was a statistically significant improvement in the both post-operative functional scores, P value < 0.001. Fifteen patients (71.4%) could return to their preoperative sport activity level with no giving-way symptoms. Only one case of graft failure was reported in the follow up.ConclusionsThe single antegrade sling graft (SASG), for combined reconstruction of both ACL and ALL yielded good results in terms of stability and return to sports. The technique is reproducible, and results are comparable to the available published literature.

Kneeling tolerance when using quadriceps tendon autograft for anterior cruciate ligament reconstruction is superior to hamstring tendon autograft.

To investigate kneeling tolerance in patients undergoing hamstring (HT) versus quadriceps (QT) anterior cruciate ligament reconstruction (ACLR) and investigate correlation with patient-reported outcome measures (PROMs). After recruitment and randomisation, 112 patients (HT = 55; QT = 57) underwent ACLR. Patients were assessed at 6, 12 and 24 months using the Kneeling Tolerance Test, which evaluates patient-reported pain in a position of both 90 (KT90) and 110 (KT110) degrees of knee flexion. PROMs collected included the International Knee Documentation Committee (IKDC) questionnaire and the ACL Return to Sport after Injury (ACL-RSI) questionnaire. Kneeling tolerance at KT90 and KT110 improved (p < 0.05) for both graft types across all time points. There was no difference in KT90 scores between groups at 6 or 12 months. At 24 months, kneeling tolerance was superior in the QT group (mean HT 93 ± 9 vs. QT 98 ± 5; p = 0.003). For KT110 scores, a statistically significant difference was noted at 6 (mean HT 80 ± 25 vs. QT 89 ± 12; p = 0.027), 12 (mean HT 90 ± 13 vs. QT 95 ± 10; p = 0.040) and 24 months (mean HT 92 ± 10 vs. QT 97 ± 5; p = 0.003). The ACL-RSI was significantly correlated with KT90 and KT110 at 24 months (r = 0.40, p < 0.001; r = 0.40, p < 0.001). Other PROMs demonstrated significant weak-to-moderate correlations with kneeling tolerance. Patients undergoing ACLR with a QT versus HT autograft report superior kneeling tolerance up to 2 years postsurgery, more prominent in deeper (110°) knee flexion. A strong correlation with ACL-RSI was demonstrated at 2 years. ACTRN12618001520224p (Australian New Zealand Clinical Trials Registry). Level 1.

Association Between Autograft Choice and Psychological Readiness to Return to Sport After ACL Reconstruction.

It has been demonstrated that an athlete's psychological readiness contributes to one's ability to successfully return to sport (RTS) after anterior cruciate ligament (ACL) reconstruction. However, the effect of graft choice on psychological readiness is not yet understood. The purpose of this study was to evaluate the association between graft choice and an athlete's psychological readiness to RTS. It was hypothesized that similar ACL-Return to Sport after Injury (ACL-RSI) scores would be achieved among patients who underwent ACL reconstruction with quadriceps autograft (QA), hamstring tendon autograft (HA), and bone-patellar tendon-bone (BTB) autograft. Cohort study; Level of evidence, 3. Patients who underwent primary ACL reconstruction at a single institution between January 2017 and December 2018 were placed into separate cohorts depending on graft type (HA, BTB, or QA; n = 30 patients in each group), and the ACL-RSI, International Knee Documentation Committee subjective form, and Lysholm scores were compared between the different graft cohorts at 6 months postoperatively, at RTS, and at 2 years postoperatively. Also, the rate of patients who achieved an ACL-RSI score of ≥65 (predictive of return to preinjury sport at 2 years postoperatively) was calculated, as was the RTS rate and time. The QA group demonstrated significantly higher ACL-RSI scores than both the HA and BTB groups at 6 months postoperatively (P < .0001) and RTS (P = .011). The QA group also had a higher rate of achieving ≥65 on ACL-RSI than the other groups at 6 months postoperatively (P = .002) and RTS (P = .024). There was no significant difference in the RTS rate between the 3 groups, although the QA group demonstrated a significantly quicker return (QA, 8.1 months; BTB, 9.6 months; HA, 10.5 months; P < .001). Athletes undergoing primary ACL reconstruction with QA achieved a higher mean ACL-RSI score and more often achieved a score of ≥65 at the 6-month and RTS time points compared with the HA and BTB groups. QA may afford an advantage over other grafts in terms of improved psychological readiness to RTS.

Anterior Cruciate Ligament Reconstruction Graft Options.

Anterior cruciate ligament reconstruction is one of the most common orthopaedic sports medicine surgeries. Its prevalence in the sports medicine sphere is matched by the numerous options of different techniques. Chief among these is graft selection, which most commonly falls into 1 of 4 options: bone-patellar tendon-bone (BPTB) autograft, hamstring tendon autograft (HT), quadriceps tendon autograft, and allografts. The most frequently used allografts include BPTB, HT, tibialis anterior or posterior tendon, and Achilles tendon. Each graft option possesses unique advantages and disadvantages. BPTB autograft demonstrates the fastest incorporation via bone-to-bone healing. It also yields a lower revision rate and greater return-to-sport rate compared with HT. However, because of donor-site morbidity, anterior knee pain and kneeling pain can occur. There is also a small risk of patellar fracture as well as patellar tendon rupture. HT autograft requires a smaller incision than BPTB and preserves the extensor mechanism. Patients are at risk for knee flexion weakness, saphenous nerve injury, and potential graft loosening over time secondary to bone tunnel widening. Quadriceps tendon autograft may be harvested with minimally invasive techniques. As with HT, the all soft-tissue composition allows use in skeletally immature patients. Although early studies show promise, knee extension weakness has been documented, and long-term outcomes are less clear. Allograft possesses no donor-site morbidity and reduced surgical time; however, allografts are associated with the greatest failure rate in young athletes and a lower return-to-sport rate compared with autografts. They also incur a greater financial cost than autografts. To be proficient at performing anterior cruciate ligament reconstruction, it is important that the sports medicine surgeon be well versed in the various graft options and the ideal patient populations for whom they are best used.

Late-stage rehabilitation effects do not differ between quadriceps and hamstring tendon autograft after anterior cruciate ligament reconstruction: a multicentre propensity score-matched case-control intervention trial

Late-stage rehabilitation effects do not differ between quadriceps and hamstring tendon autograft after anterior cruciate ligament reconstruction: a multicentre propensity score-matched case-control intervention trial

Association of Preoperative Cartilage T1ρ Values With Progression of Knee Osteoarthritis 10 Years After Anatomical Double-Bundle ACL Reconstruction: Follow-up of a Previous Prospective Study.

The factors contributing to osteoarthritis progression after anterior cruciate ligament (ACL) injury and reconstruction (ACLR) are not fully understood. Quantitative magnetic resonance imaging (MRI) offers a noninvasive way to evaluate cartilage biochemical composition using T1ρ mapping, thereby detecting early cartilage degeneration. The specific impact of preoperative quantitative MRI on long-term outcomes after ACLR remains underreported. The purpose of this study was to investigate the effects of various factors, including preoperative cartilage T1ρ values, on the 10-year outcomes after ACLR. It was hypothesized that individual differences in baseline cartilage degeneration would influence osteoarthritis progression at 10 years postoperatively. Case series; Level of evidence, 4. This case series involved 13 patients with primary ACL injury who underwent anatomical double-bundle ACLR using hamstring tendon autograft between April 2012 and August 2013. All patients underwent preoperative quantitative MRI using a 3.0-T scanner with an 8-channel knee coil. Cartilage was divided into 18 compartments for compositional analysis, and average T1ρ values were calculated for each compartment. At the 10-year follow-up, 9 of the patients were available for patient-reported outcome (PRO) measures and radiographs. The 9 patients (6 female, 3 male) had a mean age of 26.4 years and a mean body mass index of 23.3 at surgery. All patients exhibited favorable PRO scores at the 10-year follow-up, but 5 patients showed osteoarthritis progression according to Kellgren-Lawrence (KL) grade. Although preoperative T1ρ values did not significantly correlate with PRO scores, patients with KL grade progression had significantly higher preoperative T1ρ values in the posterolateral tibial cartilage than those without progression (P = .04). Ten years after anatomical double-bundle ACLR, most patients reported favorable outcomes. Preoperative T1ρ values were not directly correlated with PROs, although the presence of a patient subset with progressive KL grades suggests that preoperative posterolateral tibial cartilage condition may influence long-term osteoarthritis progression.

Primary Anterior Cruciate Ligament reconstruction performed with hamstring tendon autograft leads to an over four times greater rate of second ACL rupture after return to sport in patients with generalized joint hypermobility compared to bone-patellar tendon-bone autograft.

The purpose of this study was to examine the 12-month (12M), the 24-month (24M) and longest available time (LAT) rate of 1) second anterior cruciate ligament (ACL) rupture (graft rupture or contralateral ACL rupture), and 2) graft rupture alone, respectively, in patients with generalized joint hypermobility (GJH) following return to sport (RTS) after ACL reconstruction depending on graft choice, i.e., hamstring tendon (HT) autograft or bone-patellar tendon-bone (BPTB) autograft. Data were extracted from a rehabilitation registry that comprised patients who had undergone ACL reconstruction between 2014-2022. Patients with GJH between 16-50 years of age who had ≥24 months follow-up time following RTS after ACL reconstruction with HT autograft (GJH-HT) or BPTB autograft (GJH-BPTB) were included. Cox proportional hazard regression model was used to examine the rate of 1) a second ACL rupture (graft rupture or contralateral ACL rupture), and 2) graft rupture alone, at 12M, 24M and at the LAT after RTS. Eighty-two patients (GJH-HT n=54 and GJH-BPTB n=28) of which 72.0% were females, with an average age of 22.7±7.4 years were included. The proportion of second ACL ruptures was greater in GJH-HT compared to GJH-BPTB at 12M (11/54, 20.4% versus 0/28, 0%, p=0.013), at 24M (13/54, 24.1% versus 1/28, 3.6%, p=0.028) and at LAT after RTS (16/54, 29.6% versus 2/28, 7.1%, p=0.024). The rate of second ACL rupture was greater in GJH-HT compared to GJH-BPTB (hazard ratio=4.98, p=0.032) at LAT after RTS. The proportion of patients with graft rupture was greater in GJH-HT compared to the GJH-BPTB at 12M (8/54, 14.8% versus 0/28, 0%, p=0.046), at 24M (10/54, 18.5% versus 0/28, 0%, p=0.013)and at LAT after RTS (12/54, 22.2% versus 0/28, 0%, p=0.006). Over 4 times greater rate of second ACL rupture after RTS was reported for patients with GJH and who had ACL reconstruction performed with HT compared with BPTB autograft. Patients with GJH who were treated with BPTB autograft for ACL reconstruction did not experience graft rupture after RTS. Level III, Retrospective study.

Simultaneous quadricipital tendon and contralateral patellar tendon rupture in a patient undergoing hemodialysis treated using hamstring autograft: A case report

Simultaneous quadricipital tendon and contralateral patellar tendon rupture in a patient undergoing hemodialysis treated using hamstring autograft: A case report