Quadrupled Hamstring Graft Research Articles

Correlation between body mass index and quadrupled hamstring tendon autograft size in ACL reconstruction.

the aim of this study was to assess the relationship of patient weight, height and body mass index (BMI) with the size of the quadrupled hamstring tendon used in anterior cruciate ligament (ACL) reconstruction. from patient records, we retrospectively assessed the weight, height, BMI and graft sizes of 126 patients who underwent ACL reconstruction using a quadrupled hamstring tendon autograft between January 2010 and January 2013 at our institution. The data obtained from perioperative measurements were studied using correlation analysis. statistically significant relationships were found between patient height and graft diameter (p = 0.033, r = 0.19) and between patient weight and graft diameter (p < 0.0001, r = 0.33). No statistically significant relationships were found between graft diameter and BMI or between graft length and patient height, weight and BMI (p > 0.05). patient height and weight were found to be related to quadrupled hamstring graft diameter in our patient population. BMI was not related to the quadrupled hamstring graft size. The exact size of the graft cannot be predicted preoperatively on the basis of these variables. Level IV, retrospective case series.

Prospective study of the anterior cruciate ligament reconstruction associated with high tibial opening wedge osteotomy in knee arthritis associated with instability.

Chronic ACL insufficiency with associated varus malalignment due to knee osteoarthritis (OA) is challenging to treat surgically. A combined ACL reconstruction (ACLR) with medial open wedge high tibial osteotomy (HTO) without using any metallic implant for HTO is an effective technique. All the patients attending the outpatient department ACL injury and with associated medial compartment OA (Kellegren's grade 2 and grade 3) were considered for inclusion in the study. Forty patients who met inclusion criteria were included in the study. Simultaneous ACLR (single bundle of quadrupled hamstring graft fixed with Endobutton on femoral side and biointerference screw on the tibial side) along with medial opening wedge osteotomy (with tricalcium phosphate wedge) was done. The patients were assessed with IKDC, KOOS scores and any change in anterior tibial translation was also checked. The combined procedure showed mean varus angle correction of 9° (10.5-1.5°), and the mechanical axis of the knee was restored from an average of 172-181.5°. There was a significant improvement in knee score (KOOS and IKDC) after the surgery (p<0.05). The average time for the radiological union of the osteotomy was 3.56 months. The anterior tibial translation was improved. No intraoperative complications and slippage of the synthetic graft were noted in any case. Combined ACLR with HTO (using TCP wedge, without any hardware) is a reliable method that prevents rapid progression of OA. It reliably corrects varus deformity and obviates the use of any hardware.

The Early Results of the Reconstruction of Chronic Anterior Cruciate Ligament Deficiency with Single Tunnel-Dual-Bundle Technique and Quadruple Hamstring Autograft

Purpose: Our study retrospectively evaluates the early results of the reconstruction of anterior cruciate ligament (ACL) defficiency by single tunnel–Dual bundle technique and quadruple autogenous hamstring tendon graft. Methods: Fourteen female and 46 male patients whom with chronic instability due to ACL deficiency were included in this study. The injury mechanism was sports related injury in 45 patients and in 15 patients the injury were other causes. All of the patients were treated with Single tunnel–Dual band technique and quadruple autogenous hamstring semitendinosus (ST) and gracilis (G) tendon graft. The patients were clinically evaluated with Lachman test, pivot-shift test, anterior drawer test, Mc Murray test, Lysholm activity scale and International Knee Documentation Comittee (IKDC) Questionaire preoperatively and postoperatively and the data were recorded. Results: The average follow-up was 34.08 months (45–26 months). Both of the menisci were intact in 22 of the patients (36.6%) and meniscal lesion were present in 38 (63.3%) patients. Two of the patients with medial meniscal lesion were sutured with meniscal repair system. Also micro-fracture was performed in 4 patients with grade 3 chondral lesion in medial femoral condyle. The preoperative mean IKDC scores of 38.3 points (range 28.7–63.9) raised to 78.1 points (range 54-98.9) postoperatively and the difference was statystically significant. Conclusion: In light of the findings of our study and related literature we can comment that the mid-term results of the reconstruction of anterior cruciate ligament (ACL) defficiency by single tunnel–Dual band technique and quadruple autogeneus hamstring tendon graft with AperFix fixation system are stisfactory.

Intraarticular hamstring graft diameter decreases with continuing knee growth after ACL reconstruction with open physes.

To evaluate the graft diameter size after one-year follow-up or more of patients Tanner II, III, and IV who were submitted to anterior cruciate ligament reconstruction. Ten patients [five males (mean age: 14.4 years) and five females (mean age: 13.6 years)] with open physis and anterior cruciate ligament tear were submitted to transphyseal anterior cruciate ligament reconstruction with quadruple hamstrings graft. During the procedure, graft and tunnel size were recorded. After last clinical follow-up (range 1-11 years), an MRI study was requested and their measurements near the tibial tunnel were compared with the graft diameter measured and used during primary procedure. Four patients had Tanner stage II, four patients Tanner stage III, and two Tanner IV. There were statistically significant decreases in the quadruple hamstrings graft diameter size (average of 25.3%). Mean size at time of surgery was 7.9 mm (±0.87), and mean size measured at different points of follow-up evaluation was 5.9 mm (±0.65). Diameter size of hamstring graft in skeletally immature patients is smaller in most cases. If there is a decrease in the diameter of the graft along postoperative time, the risk of a re-rupture is theoretically further increased. Quadruple hamstring graft decreases a mean 25.3% in diameter from time of anterior cruciate ligament reconstruction surgery until reassessment period in skeletally immature patients. IV.

Prediction of quadruple hamstring graft diameter for anterior cruciate ligament reconstruction by anthropometric measurements.

Background:The literature is scanty regarding the anthropometric predictors on the diameter of quadruple hamstring graft obtained in anterior cruciate ligament (ACL) reconstruction in Indian population. Minimum diameter of the graft for ACL reconstruction should be >7 mm to preclude failure. The objective of this study was to assess the prediction of the hamstring graft diameter by several anthropometric parameters including age, thigh circumference, weight, height and body mass index (BMI).Materials and Methods:46 consecutive patients who had undergone ACL reconstruction by the same surgeon using quadruple hamstring grafts were evaluated. The age, thigh circumference of the normal side, height, weight and BMI were recorded preoperatively and Pearson correlation was done using these parameters with graft diameter measured intraoperatively. Regression analysis in a stepwise manner was undertaken to assess the influence of individual anthropometric parameters on the graft diameter.Results:There were 44 males and 2 females. Mean age was 29.4 years, mean height was 172.6 cm, mean weight was 70.9 kg, mean BMI was 23.8 kg/m2, mean thigh circumference was 47.1 cm and mean graft diameter was 7.9 mm. There was a positive correlation individually between the thigh circumference and graft diameter obtained (r = 0.8, P < 0.01, n = 46), and between the height and graft diameter (r = 0.8, P < 0.01, n = 46). On the regression analysis thigh circumference and height were found to be significant predictors of graft diameter giving the following equation: Graft diameter (mm) = 0. 079 height (cm) +0.068 thigh circumference (cm) −9.031.Conclusion:Preoperatively using the above equation if graft diameter came out to be <7 mm then alternate options of graft material must be kept in mind in order to prevent failure.

Effect of drainage tube on knee function after arthroscopically assisted anterior cruciate ligament reconstruction

Background: There is a paucity of literature evaluating the use of intra-articular drains after arthroscopically assisted anterior cruciate ligament (ACL) reconstruction and their effects on knee function. Objective: The aim of this study is to determine the effect of postoperative drain use on knee function after ACL reconstruction with quadrupled hamstring graft. Materials and Methods: In this study, 44 arthroscopic ACL reconstruction patients were randomized for either intra-articular suction drain group or nondrain group. Outcome assessment was done on postoperative day 4, day 10, 1 month, 3, 6, and 12 months after the surgery in which patients were asked to complete a visual analog pain scale. They were assessed for a range of motion (ROM) in flexion and extension with a universal goniometer, knee effusion, and knee stability by Lachman's test. Results: Both treatment and control groups showed no statistical significant difference in flexion of the knee through the ROM (P = 0.116). The percentage reduction in knee effusion was found to be statistically significant at 4 th (P < 0.001), 10 th (P < 0.001) 16, and 1 month (P = 0.012) in between treatment and control group. The overall pain difference between the two groups was not found to be statistically significant (P = 0.198). Conclusion: Clinically, the drain group showed faster pain relief, lesser effusion, and early return to motion compared to the no-drain group but was not statistically significant.

Hallux limitus fonctionnel (HLF) et rupture du LCA : liens de causalité, prévention et solutions thérapeutiques. Functional hallux limitus (FHL)

Introduction FHL is the clinical manifestation of a tenodesis effect of the flexor hallucis longus tendon (FHL) occurring at the level of its retrotalar tunnel, resulting in the limitation of the dorsiflexion of the first metatarsophalangeal ray (MP1). The timely passage from pronation to supination and vice versa during the gait cycle is deregulated. ACL injuries occur mainly during sudden direction changes and are linked to a rapid pivot movement concluding in valgus-internal rotation: the knee medial collapse. This abrupt transition from supination to an exaggerated pronation is related to FHL. Due to the FHL-caused time mismatch of muscle contraction, the knee is deprived of this injury preventive compensation mechanism and is trapped into a spiral movement, leading to the injury of the ACL. The aim of our study was to establish a causative relation between the FHL and the ACL rupture and to present a new treatment strategy. Methods Our population consisted of a prospective cohort of patients with ACL rupture and positive stretch test for the diagnosis of FHL. The patients underwent endoscopic retrotalar release of the flexor hallucis longus (FHL) tendon and arthroscopic single-bundle ACL reconstruction, by use of an autologous quadrupled hamstring graft (semitendinosus). Additional interventions for accompanying injuries were performed when needed. Gait analysis was implemented pre- and postoperatively by Wintrack analyzing static, postural and dynamic parameters. Clinical questionnaires were used prospectively. Statistical analysis was performed with SPPS for Mac with the statistical significance set at P Results One hundred and thirty-five patients were included in our study (m/f–47/53%) divided in 6 groups based on the time of the LCA rupture and the concomitant injuries. The mean age was 36.8 years old (range 14–72). The mean time of follow-up was 16 weeks. (15.2–16.4). The side of operation was bilateral in the 77.7% of the patients. There were no complications encountered. The average pressure under the Hallux was statistically significantly lower in all patients after the FHL tenolysis. The area of pressure under the Hallux and the first metatarsal heads were statistically significantly increased after the operation (P Conclusions In the presence of FHL, the mechanical support and stability mechanisms of the foot are disrupted with consequences in the knee, which is deprived of his protective mechanisms and adopts an increased flexion posture and valgus deformity. Arthroscopic release of the FHL can be considered a safe additional treatment in the presence of an ACL rupture. Additional research studies with longer follow-up period are warranted.

Clinical outcome after implant-free ACL reconstruction with hamstring tendon graft

To assess the outcome of arthroscopic anterior cruciate ligament (ACL) reconstruction with quadruple hamstring tendon graft using all press-fit technique with bone plugs near the native insertion of the ACL. This prospective study included 50 consecutive active patients. There were 47 males and 3 females. The mean age was 30 years (range 17–44). The mean follow-up was 24 months (range 12–48). Patients were evaluated using subjective as well as objective International Knee Documentation Committee (IKDC) assessment forms, Tegner Lysholm knee score. Instrumental testing included digital rolimeter as well as the KT-1000 testing. Assessment using IKDC scoring revealed that 95 % of the patients had normal or nearly normal knee (IKDC score of A/B). Postoperative level of activity was excellent in 82 % of patients. The mean side-to-side difference using the digital rolimeter measurements was 1.3 mm (range 0.1–5.5 mm). The mean side-to-side difference using the KT 1000 measurements was 1.4 mm (range 0–5 mm). On pivot shift test, we have 97 % of our patients with either equal pivot shift tests on both sides or just a glide. The mean preoperative Tegner Lysholm score was 52 (41–90) while the mean postoperative score was 92 (range 67–100). We found no graft displacement on follow-up radiographs. This study showed that arthroscopic ACL reconstruction with quadruple hamstring tendon graft using all press-fit technique with bone plugs is a reliable, cost-effective technique with fast bone-to-bone healing, and ease for revision surgery.

Are pre-operative anthropometric parameters helpful in predicting length and thickness of quadrupled hamstring graft for ACL reconstruction in adults? A prospective study and literature review.

Cross-sectional diameter of 7 mm or more of graft in anterior cruciate ligament reconstruction is arguably the single most important factor determining the success of the operation. Pre-operative anthropometric parameters have been reported to correlate with diameter of quadrupled hamstring graft, which is the most popular graft choice today. We conducted this prospective study to determine the value of some anthropometric measurements to predict the length of harvested semitendinosus and gracilis tendons and quadrupled hamstring graft diameter. We also assessed the reliability of the mathematical equation in accurately predicting the graft diameter. Height, weight, BMI and thigh length of 160 patients who underwent primary ACL reconstruction was measured before surgery. Using multivariate logistic regression analysis length of harvested semitendinous and gracilis tendons along with quadrupled graft diameter were correlated to height, weight, BMI and thigh length. Ninety-six percent had graft diameter of 7 mm or more. Height and thigh length were found to be most strongly correlating to both the length of harvested tendons and the quadrupled graft diameter (p ≤ 0.001, r = 0.25-0.39). Patients with height less than 147 cm were found to be at highest risk for inadequate graft diameter (less than 7 mm). Although the anthropometric parameters were found to be significantly related to height and thigh length, the strength of association is moderate. The mathematical equation for prediction of graft diameter using height was found to inaccurately over-predict the graft diameter in 33.1 % of cases, assessed using Bland-Altman plot. Anthropometric parameters, especially height and thigh length, can serve as a guide to plan hamstring graft diameter and length before ACL reconstruction. But, it is not advisable to rely on mathematical equations for absolute values of graft parameters as there is risk of over-estimating hamstring length or graft thickness.

Trans-tibial guide wire placement for femoral tunnel in single bundle anterior cruciate ligament reconstruction.

Background:Femoral tunnel location is of critical importance for successful outcome of ACL reconstruction. The aim was to study the femoral tunnel created by placing free hand guide wire through tibial tunnel, using the toggle of the guide wire in the tibial tunnel to improve femoral tunnel location.Materials and Methods:30 cases of a single bundle quadrupled hamstring graft anterior cruciate ligament reconstruction by trans-tibial free hand femoral tunnel creation is studied in this prospective study. The side to side play of the guide wire in the tibial tunnel was used to improve the tunnel location on femoral wall. The coronal angle of the femoral tunnel was measured on the anteroposterior radiograph. The femoral tunnel location on the lateral radiograph of the knee was recorded according to Amis method. Lysholm scoring was done preoperative and at each follow up. Assessment of laxity was done by Rolimeter (Aircast™) and pivot shift test.Results:The mean coronal angle of the femoral tunnel in postoperative radiograph was 47°. In lateral radiograph, the femoral tunnel was found to be >60% posterior on Blumensaat line in 67% cases (n = 20) and in the 33% cases (n = 10) it was anterior. The mean Lysholm score improved from 74.6 preoperative to 93.17 postoperative with no objective evidence of laxity.Conclusion:The free hand trans-tibial creation of the femoral tunnel leads to satisfactory coronal obliquity, but it is difficult to recreate anatomic femoral tunnel by this method as the tunnel is consistently anterior in the sagittal plane.

Greater fear of re-injury and increased tibial translation in patients who later sustain an ACL graft rupture or a contralateral ACL rupture: a pilot study

The aim was to compare fear of re-injury, patient reported function, static and dynamic tibial translation and muscle strength assessed before and 5 weeks after an anterior cruciate ligament (ACL) reconstruction between individuals who sustained a subsequent ACL graft rupture or a contralateral ACL injury within 5 years after the reconstruction, and individuals with no subsequent injury. Nineteen patients were investigated before, and 5 weeks after an ACL reconstruction with a quadruple hamstring tendon graft. At 5 years follow up, 3 patients had sustained an ACL graft rupture and 2 patients had sustained a contralateral ACL rupture. Fear of re-injury, confidence with the knee, patient reported function, activity level, static and dynamic tibial translation and muscle strength were assessed. The re-injured group reported greater fear of re-injury and had greater static tibial translation in both knees before the ACL reconstruction compared to those who did not sustain another ACL injury. There were no other differences between groups. In conclusion, fear of re-injury and static tibial translation before the index ACL reconstruction were greater in patients who later on suffered an ACL graft rupture or a contralateral ACL rupture. These factors may predict a subsequent ACL injury.

Quadrupled Hamstring Graft Strength as a Function of Clinical Sizing

This study sought to compare the strength of quadrupled hamstring tendon (QHT) grafts of 6 to 9.5mm in clinical diameter with that of 10-mm bone-patellar tendon-bone (BPTB) grafts. Twenty cadaveric semitendinosus and gracilis tendons were combined into QHT grafts. These were sized using a standard graft-sizing device and an area micrometer, yielding grafts ranging from 6 to 9.5mm in diameter. The grafts were tested to failure. Five 10-mm BPTB grafts were also sized and tested. Clinical sizing did predict the strength of the graft but not profoundly. As a material alone, without consideration of fixation in bone tunnels, QHT grafts were stronger than BPTB grafts. Graft strength decreased with size, but a linear relation between strength and diameter (r(2)= 0.715, P < .001) was found to be as good as the expected quadratic fit (r(2)= 0.709). Compared with BPTB grafts, even the smallest QHT grafts (diameter <6.5mm) were still significantly stronger than 10-mm BPTB grafts (P= .004). The elastic moduli of the QHT and BPTB grafts were 761 ± 187MPa and 615 ± 403MPa, respectively; elongations at failure were 12.0% ± 2.0% and 7.5% ±1.6%, respectively; and failure stresses were 105 ± 18MPa and 50 ± 14MPa, respectively. This work shows that a clinical size of QHT grafts of 6mm in diameter is not a concern regarding the strength itself. For a possible lower-end prediction of acceptable size, assuming that a gracilis-semitendinosus graft would have only the stress of the weakest measured QHT graft of 88MPa, a graft of 5.5mm in diameter would suffice, having more strength in newtons than the average patellar tendon. Clinically sized QHT grafts have a higher failure strength than 10-mm patellar tendon grafts. Therefore the strength of the graft cannot account for the higher clinical failure rates of smaller hamstring grafts in active patients in clinical studies.

Effect of drainage tube on muscle strength &amp; knee function after arthroscopically assisted anterior cruciate ligament reconstruction

Background: There is a paucity of literature evaluating the use of intra-articular drains after arthroscopic procedures. The aim of this study is to determine the effect of postoperative drain use on muscle strength and knee function after arthroscopically assisted anterior cruciate ligament (ACL) reconstruction with quadrupled hamstring graft. Method: 44 arthroscopic ACL reconstruction patients were randomized for either intra-articular suction drain group or non-drain group. All arthroscopic ACL reconstructions using a four strands hamstrings graft as auto graft were included in the trial. Assessment was done on postoperative day 4, day10, 1 month, 3, 6 and 12 months after the surgery in which patients were asked to complete a visual analogue pain scale, were assessed for range of motion, knee effusion, measurement of quadriceps and hamstrings using dynamometer. Result: Comparison of quadriceps strength between the two groups showed no statistical significant difference at 30 degrees. (p <0.167) and 90 degrees (0.115) of knee flexion. Statistically significant difference was seen at 60 degrees knee flexion. (p = 0.036). Both groups showed no statistical significant difference in knee flexion. (p = 0.116) The reduction in knee effusion was found to be statistically significant at 4th (p <0.001), 10th (p <0.001)16 and one month (p = 0.012) ) in between treatment and control group. The overall pain difference between the two groups was not found to be statistically significant. (p = 0.198) Conclusion: This study showed that following surgery, clinically the increment in the muscle strength was more in the drain group compared to the no drain group but was statistically significant only for quadriceps at 60 degree flexion in drain group. Clinically the drain group showed faster pain relief, lesser effusion and early return to motion compared to the no drain group.

Static and dynamic tibial translation before, 5 weeks after, and 5 years after anterior cruciate ligament reconstruction.

To evaluate static and dynamic tibial translation before, 5 weeks after, and 5 years after anterior cruciate ligament (ACL) reconstruction. To explore whether static and dynamic tibial translation are correlated. Ten patients undergoing quadruple hamstring tendon graft ACL reconstruction were evaluated before, 5 weeks after, and 5 years after ACL reconstruction. Sagittal tibial translation was measured during the Lachman test (static translation) and during gait (dynamic translation) using a CA-4000 electrogoniometer. Five years after ACL reconstruction, static tibial translation did not differ between knees (Lachman test 90 N and 134 N n.s.). In contrast, there was greater maximal anterior tibial translation during gait in ACL-reconstructed knees than in uninjured knees (5.5 ± 1.4 vs. 4.5 ± 1.6 mm, P = 0.028). There were no differences in static or dynamic tibial translation between the 5-year follow-up and before ACL reconstruction or between the 5-year follow-up and the 5-week follow-up. There were no correlations between static and dynamic tibial translation. Although static tibial translation did not differ between knees 5 years after ACL reconstruction, dynamic tibial translation during gait was greater in ACL-reconstructed knees than in uninjured knees. Neither static nor dynamic tibial translation changed 5 years after ACL reconstruction as compared to before surgery and 5 weeks after surgery. Static tibial translation did not correlate with dynamic tibial translation. This study indicates that although the knee is stable during static measurements, kinematics during gait is impaired 5 years after ACL reconstruction. This may affect the return to sport and risk of osteoarthritis. Case series, Level IV.

Arthroscopic posterior cruciate ligament reconstruction by using hamstring tendon autograft and transosseous screw fixation: minimal 3 years follow-up.

The aim of this trial is to prospectively evaluate the outcomes of PCL reconstruction by means of quadruple hamstring tendon autograft with a double-fixation method at minimal 3-year follow-up. Only patients who underwent PCL reconstruction without any other concomitant injury were included in this study. A hamstring tendon graft is composed of a quadruple-stranded gracilis tendon and semitendinosus tendon about 10 cm in length. An arthroscopic technique via a two incision and a double-fixation method was applied. Clinical evaluations were performed for 52 patients. Clinical assessment of patients included the Lysholm knee scores, International Knee Documentation Committee (IKDC) scores, thigh muscle evaluation, and radiographic investigation. On the Lysholm knee score, 90 % of the patients displayed good or excellent rating in the final assessment. In the IKDC rating analyses, 60 % of the patients demonstrated 3-5-mm ligament laxity. For the IKDC final rating, 81 % were normal or nearly normal. Seventy-nine percent of the cases revealed less than a 10-mm difference in thigh girth between their reconstructed and contra lateral limbs. Arthroscopic PCL reconstruction using quadruple hamstring tendon autograft provides acceptable outcomes at a minimum 3-year follow-up. The four-stranded hamstring tendon graft is suitable in graft size and results in minimal harvesting morbidity. We recommend that quadruple hamstring tendon graft be chosen for PCL reconstruction to achieve good ligament reconstruction. A double-fixation method which has been applied in this trial can be used to provide rigid fixation.

Five-Strand Hamstring Autograft for Anterior Cruciate Ligament Reconstruction

Four-strand hamstring autograft is a common choice for anterior cruciate ligament reconstruction. A potential disadvantage of hamstring autograft for anterior cruciate ligament reconstruction is the inherent variability in graft diameter. Multiple studies have shown increased revision rates when using an undersized hamstring graft. Using an EndoButton (Smith & Nephew, Andover, MA) for femoral tunnel fixation, we convert a standard quadrupled hamstring graft into a 5-strand graft by creating 3 equal strands of the typically larger semitendinosus combined with a double-stranded gracilis. This technique may help alleviate some surgeon reluctance to use a hamstring graft by providing an intraoperative “bailout” option for an unexpectedly small tendon. On the basis of current data, increasing the diameter of the graft in these situations may decrease revision rates.

Functional Outcome of Arthroscopically Assisted Anterior Cruciate Ligament Reconstruction

Anterior cruciate ligament (ACL) tear is the most common ligamentous tear of knee joint. The goal of reconstruction of ACL is to restore the stability of knee joint. This study is to evaluate the functional outcome of Arthroscopically assisted ACL reconstruction using Bone patellar tendon bone graft and quadrupled hamstring graft. Our study of 30 cases of arthroscopic ACL reconstruction(21 Bone patellar tendon bone graft, 9 Quadrupled Hamstrig Graft). We have evaluated th knee function pre and post operatively using international knee documentation committee(IKDC) and Lysholm score. Our study showed that Arthroscopically assisted ACL reconstruction could effectively improve stability and function of knee joint. Our results were almost similar to the results obtained in the standard published literature.

Surgical treatment of partial anterior cruciate ligament lesions: medium-term results

this study was conducted to evaluate subjective and objective clinical outcomes of partial reconstruction of the anterior cruciate ligament (ACL) in comparison with complete ACL reconstruction. three groups, each comprising 20 patients, were evaluated at a minimum follow-up of 12 months. The group 1 patients underwent partial ACL reconstruction, while those in group 2 and group 3 underwent complete ACL reconstruction, performed using either bone-patellar tendon-bone (BPTB) or quadrupled hamstring tendon (HT) grafts, respectively. The subjective outcome was evaluated using the Lysholm knee scale and the subjective International Knee Documentation Committee (IKDC) scoring system. A visual analog scale (VAS) was used for pain assessment and sporting activity was rated using the Tegner activity scale. Objective evaluation was performed using the IKDC objective form, KT-1000 arthrometer and KiRA triaxial accelerometer. at the follow-up evaluation, the mean subjective IKDC score was 86.1±10.3 in group 1, 85.2±11.1 in group 2, and 82.7±7.8 in group 3. The Lysholm score was 91.3±7.3 in group 1, 91.7±9.6 in group 2, and 89.4±6.1 in group 3. KT-1000 tests showed a mean side-to-side difference of 1.1 mm ± 1.5 mm (range, 0-5 mm) in group 1; 0.79 mm ± 0.8 mm (range, 0-2mm) in group 2; and 1.45 mm ± 1 mm (range, 0-3 mm) in group 3. The differences between groups were not statistically significant. both subjective and objective outcomes of partial ACL reconstruction were comparable to those of complete reconstruction, but partial reconstruction in the presence of a partial lesion of the ACL is considered by the authors to be more respectful of the native vascularization, innervation and anatomy of the ACL, conferring an advantage in terms of recovery of the complete function of the knee. Level III, retrospective comparative study.

Quadruple hamstring tendon graft versus Bone-PatellarTendon-Graft for arthroscopic Anterior Cruciate Ligament reconstruction- comparison study with follow up of 2 years

Quadruple hamstring tendon graft versus Bone-PatellarTendon-Graft for arthroscopic Anterior Cruciate Ligament reconstruction- comparison study with follow up of 2 years

Impact of tendon suturing on the interference fixation strength of quadrupled hamstring tendon grafts

Interference screw fixation of soft tissue grafts has been a widely used fixation technique for cruciate ligament reconstruction. Suturing of the graft construct prior to graft fixation has been proposed to increase fixation strength; however, the effect on mechanical properties has not been well characterized. The goal of this study was to determine whether uniform suturing of the tendon graft affects (1) ultimate fixation strength of the hamstring tendon graft and (2) motion of the tendon in the bone tunnel during cyclic loading when comparing sutured grafts vs. unsutured grafts. Eight pairs of matched mature porcine tibias (age <2years) and eight paired fresh-frozen human quadrupled hamstring tendon grafts were used. One quadrupled graft from each pair was placed into one of two groups. In the group A a single cerclage suture 3cm from the doubled end of the graft was placed to join the four tendon strands. In group B a heavy suture was used to tightly unite the four strands of tendon graft to provide a better grip for the interference screw during fixation. The grafts were placed in tibial bone tunnels that matched the graft's diameter and fixed with an interference screw. The looped end of the graft and the attached tibia were rigidly fixed in a material testing machine. The graft constructs were subjected to 100 cycles of 20-250N load, followed by a load-to-failure test. In addition, a motion analysis system was used during cyclic testing to better determine the amount of elongation at the graft-tunnel interface. Statistical analysis of the failure load and stiffness and the overall elongation following cyclical loading was performed using the Wilcoxon rank sum test. Level of significance was set at p<0.05. Elongation at the tendon-bone interface during sub-maximal cyclic loading was 2.4±1.4mm (unsutured) vs. 2.0±0.7mm (sutured) (p>0.05). Failure load of the grafts without sutures (634±86N) was significantly lower than with the sutures (837±183N). Ultimate stiffness of group A (283±34N/mm) was lower than that of group B (331±51N/mm); however, this was not statistically significant (p=0.051). This study confirms that suturing of the graft construct before interference screw fixation may increase ultimate failure load. However, an improvement of structural properties in response to cyclic loading with sub-maximal loads could not be confirmed. Clinicians using interference screw fixation may suture the graft to improve fixation strength; however, suturing does not appear to allow a more aggressive rehabilitation after surgery.