Quadrupled Hamstring Autograft Research Articles

Comparison of Cross-Pin Versus Cortical Button Femoral Fixation in Anterior Cruciate Ligament Reconstruction With Hamstrings Autograft: A Long-Term Clinical Study and Review of the Literature.

Background Anterior cruciate ligament reconstruction (ACLR) is a common operative procedure and many options regarding the type of the selected graft and fixation technique have been described to date. Although many studies have addressed the issue of the optimal femoral fixation device during ACLR with a hamstring tendon (HT) autograft, no clear evidence to indicate one technique over another has been found. Objective The purpose of this study was to compare the long-term postoperative outcomes and complication rates between transfemoral Cross-pin (CP) and Endobutton-Cortical Button (CB) fixation techniques in patients undergoing ACLR with an HT autograft. Methods One hundred and seven consecutive patients underwent ACLR by using a quadruple HT autograft that was stabilized with either a CP (CP Group: 52 patients) or a CB (CB Group: 55 patients) fixation technique. The Lachman test (LT), the Pivot-shift test (PST), the side-to-side difference in anterior translation of the tibia, the International Knee Documentation Committee (IKDC), and the Lysholm knee scoring systems were evaluated before surgery and during long-term follow up. Thefemoral and tibial tunnel diameter was measured in the anteroposterior (AP) and lateral radiographsafter surgery and at the final follow-up. Areview of the literature was also carried out to identify any differences between both techniques. Results Study groups were comparable in terms of patient demographics. The mean follow-up was 10.4 ± 1.3 and 10.6 ± 1.3 years in the CP and CB Groups, respectively (p = 0.47). In the CP Group, improvements after surgery in LT and PST from grade 2 (n=34) or 3 (n=18) to grade 0 (n = 41) or 1 (n = 11) and from grade 2 (n=36) or 3 (n = 16) to grade 0 (n = 44) or 1 (n = 8), respectively, were observed. In the CB Group, similar improvements in LT and PST scores from grade 2 (n = 40) or 3 (n = 15) to grade 0 (n = 46) or 1 (n = 9) and from grade 2 (n = 41) or 3 (n = 14) to grade 0 (n = 47) or 1 (n = 8), respectively, were observed. However, no differences between the groups (p = 0.53 for LT and p = 0.90 for PST) were noted. The mean Lysholm scores were 89.7 ± 6.8 and 90.2 ± 7.2 in the CP and CB groups, respectively (p = 0.59). Side-to-side difference improved from 9.1 ± 2.8 to 1.7 ± 1.5 mm and from 8.6 ± 2.5 to 1.6 ± 1.4 mm in the CP and CB groups, respectively (p = 0.89 between groups). According to IKDC grades, 92.1% and 91.4% of knees in the CP and CB groups, respectively were reported to be Grade A (Normal) or B (Nearly Normal) with a p = 0.7. Femoral and tibial tunnel widening was found in the last follow-up in both groups. However, there was no difference in the degree of tunnel widening among the two techniques.With respect to LT, PST, anterior drawer test, and IKDC score, none of the 15 published comparative studies demonstrated any significant differences between the two techniques and only one study detected a difference regarding the Lysholm score in favor of CP fixation. Conclusion In the long term, both CB and CP femoral stabilization techniques were shown to be associated with similar functional outcomes and low complication rates. Further large multicenter random clinical trials are still required to identify the most effective method of femoral fixation for HT autograft during ACLR surgery.

Clinical Outcomes in Patients Undergoing Anterior Cruciate Ligament Reconstruction With Controlled Accelerated Rehabilitation.

Background An anterior cruciate ligament (ACL) tear is one of the most common sports injuries in the knee region. Currently, anatomical ACL reconstruction with quadrupled hamstring tendon autograft and controlled accelerated rehabilitation is a frequently used treatment approach. This study aims to add to the literature the early and mid-term clinical results of the controlled accelerated rehabilitation program we implemented in our clinic to enable patients to return to their daily activities faster after ACL reconstruction. Methodology In this retrospective study, 51 patients (50 males, 1 female) diagnosed with ACL tear and undergoing ACL reconstruction with quadrupled hamstring tendon graft were included in our study.In the femoral fixation of the graft, the transfix method was used in 22 patients and the Endobutton-CL method was used in 29 patients. A controlled accelerated rehabilitation program developed by Shelbourne was employed with some modifications to the patients. Clinical evaluation of patients was performed using Lysholm, Cincinnati, Tegner, and International Knee Documentation Committee (IKDC) scoring systems. Results The mean postoperative follow-up period was 18.7 months (range = 6-36 months). During the physical examination, Lachman, anterior drawer, and pivot shift, 49 (96%) patients achieved excellent or good results, while only two (5%) patients experienced fair clinical outcomes. On clinical assessment using the Lysholm and IKDC scoring systems, 50 (98%) patients demonstrated excellent or good results, whereas only one (2%) patient showed fair results. Excellent and good outcomes were observed in all patients using the Cincinnati scoring system. We found a significant decrease in Tegner activity score pre-surgery, which significantly increased post-surgery. Conclusions The combination of Endobutton and cross-pin for femoral fixation and staples and interference screw for tibial fixation is thought to be safe in patients undergoing controlled accelerated rehabilitation after ACL reconstruction. The implementation of controlled accelerated rehabilitation enables patients to return to their social lives earlier without resulting in clinically poor outcomes in grafts and implants applied in the early and middle stages.

Is fixation with a U-shaped staple necessary in anterior cruciate ligament reconstruction?

Aims: This study aimed to compare the clinical and functional outcomes of patients who underwent anterior cruciate ligament reconstruction using a quadruple hamstring autograft with and without U-shaped staple fixation and tibial tunnel BioScrew fixation. Methods: Patients who underwent arthroscopic anterior cruciate ligament (ACL) reconstruction by a single surgeon between August 2020 and June 2022 were retrospectively analyzed. The time to return to sports after surgery and the evaluation of preoperative and postoperative Lysholm Knee scores, International Knee Documentation Committee (IKDC) scores, VAS scores, and thigh diameters, were conducted. Statistical analysis of the study data was performed using SPSS 29.0 (IBM InCorp, USA). Results: A total of 100 patients (77% male) who underwent arthroscopic ACL reconstruction were included in the analysis. There was no significant difference in Lysholm knee scores and IKDC scores between patients undergoing fixation with or without staples. However, VAS scores were significantly lower in the non staple group. Conclusion: The present study found that fixation with a staple in addition to tibial BioScrew fixation of the autograft in the tibial tunnel resulted in more pain in the patients, and there was no significant difference in clinical and functional outcomes between the staple and non staple groups.

Evaluation of Long-term Outcome of Arthroscopic Reconstruction of Anterior Cruciate Ligament Injury by Hamstring quadrupled Auto graft fixed by Bio Screws in a tertiary level hospital

Background: Hamstring tendon auto grafts in the form of quadrupled semitendinosus and gracilis (STG) has become an increasingly used alternative for anterior cruciate ligament (ACL) reconstruction. Bio screw avoids complications by decreasing possibility of graft damage. Current study was designed to evaluate arthroscopic ACL reconstruction with quadrupled semitendinosus auto graft and fixation of the graft by two biodegradable screws in both femur and tibia.
 Objectives: This study was conducted to evaluate the outcome of arthroscopic ACL reconstruction by semitendinosus tendon autograft using biodegradable screws for both tibia and femur. Methods: 300 patients with ACL injury admitted from January 2010 to December 2015 in the then Apollo Hospitals Dhaka (Evercare Hospital Dhaka now) were enrolled. All patients underwent ACL reconstruction surgery by quadrupled semitendinosus or gracilis auto graft fixed by Bio Screws. After discharge, these patients were followed up for 3 weeks, 3 months and final outcome was recorded after 6 years.
 Results: 270 patients (90%) had an uneventful post-operative period. 200 patients (66.67%) complained of postoperative pain after 3 weeks, 10 patients (3.33%) complained of knee swelling, 10 (3.33%) patients had infections & 20 patients (6.65%) had knee stiffness after 6 months. Postoperatively, Lachman test improved significantly, grade 0 in 93.33% cases (280 patients) and grade I was in 6.67% cases (20 patients). Anterior drawer test was also markedly improved. Grade 0 was in 93.33% cases (280 patients) and grade I was in 6.67% cases (20 patients). According to the Lysholm Knee Scoring, the final long-term outcome was excellent in 76.67% cases (230 patients), good in 20% cases (60 patients) and fair in 3.33% cases (10 patients).
 Conclusion: Arthroscopic reconstruction of ACL by quadrupled hamstring autograft fixed by biodegradable screws for both tibia and femur, leads good to excellent results in the majority of the cases.
 Pulse Vol.15, 2023 P: 9-15

Correlation of Anthropometric Measurements with Hamstring Graft Size in Anterior Cruciate Ligament Reconstruction in Nepalese Population: A Prospective Observational Study

Background: The use of autologous hamstring tendon for arthroscopic Anterior Cruciate ligament (ACL) reconstruction is very common. The size of hamstring tendons varies significantly between individuals, and graft diameter is unpredictable. Anthropometric measurements may be a simple way to estimate hamstring tendon length and diameter. This study aims to determine the correlation between anthropometric measurements of patients with length and diameter of harvested hamstring autograft during ACL reconstruction.Methods: A prospective observational study was carried out after ethical approval. All patients who underwent arthroscopic ACL reconstruction from 1 March 2022 to 30 April 2023 in Birat Medical College Teaching Hospital were included. Fourty seven patients’ age, sex, height, weight and thigh length were recorded preoperatively. Hamstring tendons were harvested and length of the semitendinosus tendon and diameter of the quadrupled graft (doubled semitendinosus and doubled gracilis) was measured intraoperatively. We used Pearson’s correlation coefficient to observe the relationship between anthropometric measurements and graft variables.Results: Mean length of harvested semitendinosus tendon was 27.4 ± 1.8 cm and mean quadrupled hamstring autograft diameter was 7.4 ± 0.8 mm. A significant positive correlation between graft variables (semitendinosus tendon length and quadrupled hamstring autograft diameter) and patients’ height and thigh length was found.Regression equations for predicting Semitendinosus tendon length and quadrupled hamstring autograft diameter from thigh length in males and females are also derived.Conclusion: Height and thigh length of patients are useful parameters for predicting semitendinosus tendon length and quadrupled hamstring graft diameter before ACL reconstruction.

Evaluation of Long-Term Outcome of Arthroscopic Reconstruction of Isolated Anterior Cruciate Ligament Injury by Hamstring Quadrupled Auto Graft Fixed by Bio Screws in a Tertiary Level Hospital

Background: Hamstring tendon auto grafts in the form of tripled or quadrupled semitendinosus and gracilis (STG) has become useful alternative for anterior cruciate ligament (ACL) reconstruction. Bio screw avoids complications by decreasing possibility of graft damage. Current study was designed to evaluate arthroscopic ACL reconstruction with quadrupled semitendinosus auto graft and fixation of the graft by two biodegradable screws in both femur and tibia. Objectives: This study was conducted to evaluate the long term outcome of arthroscopic reconstruction of injured ACL by quadrupled semitendinosus tendon auto graft using biodegradable screws for both tibia and femur. Methods: 300 patients with isolated ACL injury admitted from January 2010 to December 2015 in Apollo Hospitals Dhaka were enrolled. All patients underwent arthroscopic ACL reconstruction surgery by Hamstring quadrupled auto graft fixed by Bio Screws. After discharge, these patients were followed up for 3 weeks, 3 months and final outcome was recorded after 6 years. Results: 270 patients (90%) had uneventful post-operative period. 20 patients (6.67%) complained post-operative pain after 3 weeks, 10 patients (3.33%) complained of knee swelling ,7 (2.33%) patients had infections & 24 patients (8%) had knee stiffness after 6 months. Post operatively, Lachman test improved significantly, grade 0 in 94.33% cases (283 patients) and grade I was in 5.67% cases (17 patients). Anterior drawer test was also markedly improved. Grade 0 in 96.33% cases (290 patients) and grade I was in 3.67% cases (10 patient). According to the Lysholm Knee Scoring, the final long term outcome was excellent in 76.67% cases (230 patients), good in 20% cases (60 patients) and fair in 3.33% cases (10 patients). Conclusion: Arthroscopic reconstruction of ACL by quadrupled hamstring autograft fixed by biodegradable screws for both tibia and femur, leads good to excellent results in majority of the cases.

Outcome of Anatomical Arthroscopic Trans-Portal Anterior Cruciate Ligament Reconstruction Among Sudanese Patients

Introduction: Worldwide incidence of ACL tear increased with increasing of contact-sport activity and increasing of RTA injuries and its management depend on arthroscopic with variety of methods, in this study our aim to determine the clinical and functional outcome of anatomical trans-portal arthroscopic ACL reconstruction with quadruple hamstring tendon auto-graft. Material &Methods: Cross sectional observational study hospitally based, it took Two years since 2019.Data taken from the patients directly. A total 51 male and female patients their age ranges from 18 years to 46years the mean age 27 years having ACL injury confirmed by clinical examination and MRI scan were included in this study. Patients' check list detailed demography including age, sex, causes of injury and duration of symptoms pre-operative were recorded after written consent from every patient. Lachman, anterior drawer and Pivot-shift tests were performed before surgery. All patients filled subjective Lysholm Knee form before surgery and at final follow up post-operative. In all patient arthroscopic trans-portal technique was used for ACL reconstruction with Hamstring auto-graft. Results: There were 48 (94.1%) males and 3 (5.9%) females. Right knee was injured in 34(66.6%) cases and left knee 17(33.4%) cases. At final follow-up, 68.6% patients achieved full ROM flexion, all of them have no giving way symptoms after 2 to 3monthes post-operative. There was significant improvement in Lysholm score. Out of 51 patients, 8 (16%) patients developed post-operative infection complication. Conclusion: Arthroscopic ACL reconstruction with quadrupled Hamstrings graft will give very good result if used as management procedure for knee instability after ACL injury. Because it uses anatomical placing the graft and tensioning it, so it has less morbidity, highly stability in coronal & sagittal plan and excellent range of motion and functional outcome.

Outcome of anatomical arthroscopic trans portal anterior cruciate ligament reconstruction among sudanese patients

Worldwide incidence of ACL tear increased with increasing of contact-sport activity and increasing of RTA injuries and its management depend on arthroscopic with variety of methods, in this study our aim to determine the clinical and functional outcome of anatomical trans-portal arthroscopic ACL reconstruction with quadruple hamstring tendon auto-graft.

Meniscus Work and Implant Selection Are Major Cost Drivers of Anterior Cruciate Ligament Reconstruction.

Background The current study examines the financial charges associated with primary anteriorcruciate ligament reconstruction (ACLR), specifically the contribution of graft choice, graft type, and concomitant meniscus surgery, in the outpatient hospital setting. Methods A retrospective financial billing review was performed on patients who underwent ACLR at a singleacademic medical center from January to December 2019. Age, BMI, insurance, length of operation, regional block, implants, meniscus surgery, graft type, and graft choice were extracted from hospital electronic patient records. Charges attributed with graft, anesthesia services, supplies, implants, surgeon fees, radiology charges, and total charges were collected. Total amount that insurance and patient paid were also obtained. Descriptive and quantitative statistics were performed. Results A total of 28 patients were studied (18 males, 10 females). The average age was 23.8 years. There were 20 concomitant meniscus surgeries. Six allografts and 22 autografts were used [eight bone-patellar tendon-bone (BPTB), eight hamstrings, six quadriceps]. The average and median total charge was $61,004 and $60,390, respectively (range: $31,403 to $97,914). The average insurance paid was $26,045 while out-of-pocket costs were $402. The average paid by privateinsurance was higher compared to government insurance($31,111 vs. $11,066, p<0.001). Graft choicesuch as allograft vs. autograft (p=0.035) and meniscus surgery (p=0.048) were significant factors to the overall cost. Conclusions Graft choice, specifically the quadrupled hamstring autograft, and concomitant meniscal surgery are major contributors to variations in ACLR charges. Decreasing implant and graft costs and limiting surgical time can decrease charges associated with ACLR.We hope these findings can help guide surgeon financial decisions, by demonstrating the need to take into account the increased total charges and amount paid associated with specific grafts, meniscus surgery, and prolonged OR time.

Earlier Return to Sports, Reduced Donor-Site Morbidity with Doubled Peroneus Longus Versus Quadrupled Hamstring Tendon Autograft in ACL Reconstruction.

Graft choice for anterior cruciate ligament reconstruction (ACLR) has been evolving. The peroneus longus tendon (PLT) has been seen as a suitable choice for ACLR, providing comparable results to those of hamstring tendon (HT) autograft, but its clinical relevance in terms of return to sports, to our knowledge, has not been studied. Two hundred and thirty-two patients who sustained an isolated ACL injury were enrolled and underwent ACLR using doubled PLT autograft or quadrupled HT autograft; 158 were followed for 24 months. Functional scores (International Knee Documentation Committee [IKDC] and Tegner-Lysholm scores) were assessed preoperatively and at 3,6, 12, and 24 months postoperatively. Graft diameter and graft harvesting time were measured intraoperatively. Donor-site morbidity was evaluated using subjective evaluation. Time to return to sports in both groups was compared. The mean diameter of PLT autograft was significantly larger than that of HT autograft, and the mean graft-harvesting time was less (p < 0.001). Patients in the PLT group returned to sports a mean of 34 days earlier than those in the HT group (p < 0.001) and had a lower rate of donor-site morbidity and, at 6 months, better patient-reported outcomes at the knee (p < 0.001). There were no significant differences between the groups in the rate of graft rupture or in IKDC and Tegner-Lysholm scores at the 24-month follow-up. PLT is a suitable autograft for ACLR in terms of graft diameter and graft-harvesting time and may offer athletes an earlier return to sports related to better outcomes at 6 months of follow-up. HT autograft was associated with increased thigh weakness. Both grafts, however, performed similarly at 24 months postoperatively. Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Outcome analysis of arthroscopic reconstruction of anterior cruciate ligament in adults

Background: Anterior cruciate ligament injury is the common knee injury consequent to contact sports. There are different techniques recommended for the ACL reconstruction, with different graft materials. The aim of this study is to evaluate the functional outcome of arthroscopic single bundle ACL reconstruction using hamstring tendon graft in ACL deficient knees in adults. AIM: To evaluate the functional outcome of arthroscopic single bundle anterior cruciate ligament reconstruction using quadrupled hamstring tendon (Gracilis and semitendinosus) autograft with endobutton as femoral fixation device and interference screw as tibial fixation device in ACL deficient knees in adults. Methodology: Between December 2020 to December 2022, a prospective study was conducted in Government Medical College, Kota on 21 ACL deficient patients (M =19, F = 2] but 1 male patient was lost to follow-up. All patients were evaluated pre-operatively using the Lysholm & Gillquist score and IKDC – 2000 score. All patients underwent arthroscopic single bundle ACL reconstruction with hamstring tendon graft, which was fixed with an endobutton fixation system on the femoral side and an interference screw on tibial side. They were advised a regular rehabilitation protocol. All patients were evaluated post-operatively at 6 weeks, 3 months, 6 months and a year by same assessment scores. Results: 20 patients were available for follow up for a period of 6 months to 2 years. The mean follow-up period was 10.5 months. When compared with their respective pre-operative knee assessment scores, it was found that a definite improvement was there in their knee function. The results were good to excellent in 80% patients and fair in 20%. Conclusion: For young active adults, single bundle reconstruction by arthroscopic methods gives acceptable results. The problems which are faced post-operatively can be again settled arthroscopically. A long term follow-up of these cases is a must to analyze if there is degeneration that happened in the time between injury and ligament reconstruction.

Comparison of Functional outcome of Arthroscopic ACL reconstruction between Quadruple Hamstring, Peroneus Longus and BPTB Autograft in Indian Population

The Anterior Cruciate ligament (ACL) is the primary stabilizer of the knee and its deficiency af- fects Knee stability, resulting in giving way symptoms in daily and sports activities with in- creased the risk of intra-articular damage. To prevent the deterioration of the existing lesions ACL reconstruction is necessary. Arthroscopic reconstruction of the injured ACL has become the “gold standard” method for treatment of ACL tear. However there is a controversy in literature regarding the best graft option is to replace the injured graft. The present study was aimed to study and compare the functional outcome of single bundle arthroscopic ACL reconstruction by Hamstring , Peroneus Longus and BPTB autografts using Lysholm Knee Activity Score

Evaluation of the short-term outcomes of anatomic ACL reconstruction with hamstring autograft in patients with generalized joint laxity: A retrospective case-control study.

The outcomes of anterior cruciate ligament reconstruction (ACLR) in patients with generalized joint laxity (GJL) are not clearly understood. In this study, we compared the outcomes of ACLR with quadruple hamstring autograft between GJL and non-GJL patients. In a retrospective case-control study, 36 patients with GJL, according to the Beighton and Horan Joint Mobility Index, who underwent ACLR surgery, were included. Forty-four group-matched non-GJL patients were included in the control group. The mean follow-up of the patients was 20.65 ± 6.93‏ months. The outcomes of ACLR were evaluated by the Lachman test, pivot shift test, anterior tibial translation and KT-1000 side-to-side difference, and International Knee Documentation Committee (IKDC) scale. The results of the Lachman and pivot shift test were not significantly different between the GJL and non-GJL patients (P = 0.67 and P = 0.27, respectively). The mean anterior tibial translation was 7.06 ± 1.41mm in the GJL group and 6.11 ± 1.53mm in the non-GJL group (P = 0.006). The mean KT-1000 side-to-side difference was 2.25 ± 1.31mm in the case and 2.5 ± 1.44mm in the control group (P = 0.42). The mean IKDC score of the patients was not significantly different between the GJL and non-GJL groups (66.1 ± 20.6 vs. 69.9 ± 16.1, P = 0.35). ACLR failure occurred in 2 (5.5%) patients of the GJL group and no patients of the control group (P = 0.21). The present findings suggest ACLR with quadruple hamstring autograft as an adequate treatment for GJL patients, at least in short-term follow-up.

Peroneus Longus Tendon Autograft versus Hamstring Tendon Autograft in Anterior Cruciate Ligament Reconstruction: A Comparative Study with a Mean Follow-up of Two Years.

Peroneus longus tendon can be a suitable alternative autograft for anterior cruciate ligament reconstruction (ACLR). The present study aimed to compare the clinical outcome and donor site morbidity in ACLR using peroneus longus tendon autograft versus hamstring tendon autograft. In a comparative cross-sectional study, ACLR was performed with quadrupled hamstring tendon autograft in 65 patients between 2017 and 2018, and in another group, peroneus longus tendon autograft was used for ACLR in 65 patients between 2018 and 2019. The same surgical technique, fixation method, and postoperative protocol were used in both groups. The knee functional outcomes were assessed according to the Lysholm score and the International Knee Documentation Committee scale at preoperative and at the end of at least 2 years after the procedure. Moreover, graft diameter was measured intraoperatively. Thigh circumference, the American Orthopedic Foot and Ankle Score (AOFAS), The Foot & Ankle Disability Index (FADI), and ankle range of motion (ROM) were used to evaluate ankle donor site morbidities. A total of 130 patients (65 patients in each group) were evaluated with a minimum follow-up of 2 years (range 24-31 months). Both groups showed no significant differences in clinical outcomes and knee stability. The peroneus longus graft diameter was significantly larger than the hamstring diameter (P<0.001). Assessment of AOFAS, FADI, and ankle ROM showed no apparent ankle joint dysfunction in the peroneus longus tendon group. Faster knee extensions, less anteromedial knee pain, and thigh hypotrophy were observed in peroneus longus tendon patients. Peroneus longus tendon autograft can be an appropriate autograft for ACLR due to its strength, larger graft diameter, and avoiding potential complications of hamstring autograft obtained from the knee region.

No Difference Could Be Detected in Clinical Outcomes of 5-Strand and Quadruple Hamstring Autografts of Similar Diameter in Anterior Cruciate Ligament Reconstruction: A Retrospective Cohort Study.

Background: There are few studies examining the clinical outcomes of 5-strand autografts in anterior cruciate ligament reconstruction (ACL-R). Purpose: We aimed to compare the clinical outcomes of ACL-R using 5-strand (5HS) and 4-strand (4HS) hamstring autografts of similar graft diameter to study the potential effects of autograft strand number on clinical outcomes. Methods: Patients who underwent ACL-R from 2013 to 2018 at a single academic institution and received a 4HS or 5HS autograft were included. Exclusion criteria were less than 2-year follow-up and any additional ligamentous reconstruction. Revision ACL-R and cyclops lesions were assessed at a minimum 2 years of postoperative follow-up. Objective measures of ability to return to sport were assessed at 6 months. Results: The mean graft diameters for 4HS (n = 51) and 5HS (n = 23) autografts were 8.3 ± 0.7 mm and 8.4 ± 0.7 mm, respectively. The mean follow-up for the 4HS and 5HS cohorts was 3.0 ± 1.5 years and 3.3 ± 1.3 years, respectively. The 4HS and 5HS cohorts had revision ACL-R rates of 15.7% (8/51) and 8.7% (2/23), respectively. Cyclops lesions occurred in 5.9% of 4HS patients and 13.0% of 5HS patients. We found no statistically significant differences between groups on objective measures of ability to return to sport. Conclusion: This retrospective cohort study detected no difference in revision ACL-R rates, frequency of cyclops lesions, or objective measures of ability to return to sport in patients who received 4HS or 5HS autografts of similar diameter for ACL-R. Further comparative study with larger sample sizes is warranted.

ACL reconstruction with femoral and tibial adjustable versus fixed-loop suspensory fixation: a retrospective cohort study

BackgroundCortical suspensory fixation (CSF) devices gain more and more popularity as a reliable alternative to interference screws for graft fixation in anterior cruciate ligament (ACL) reconstruction. Adjustable-loop fixation may be associated with increased anterior laxity and inferior clinical outcome. The purpose of the study was to compare anterior laxity and clinical outcome after minimally invasive all-inside ACL reconstruction using an adjustable-loop (AL) to a standard technique with a fixed-loop (FL) CSF device.MethodsPatients who underwent primary single-bundle ACL reconstruction with a quadrupled hamstring autograft at a single institution between 2012 and 2016 were reviewed. In the AL group minimally invasive popliteal tendon harvesting was performed with an all-inside approach (femoral and tibial sockets). In the FL group a traditional anteromedial approach was used for tendon harvesting and a femoral socket and full tibial tunnel were drilled. An objective clinical assessment was performed with Telos x-rays and the International Knee Documentation Committee (IKDC) Objective Score. Patient-reported outcomes (PRO) included the IKDC Subjective Score, the Lysholm Knee Score, the Knee Injury and Osteoarthritis Score (KOOS) and the Tegner Activity Scale.ResultsA total of 67 patients were enrolled in this retrospective study with a mean follow-up of 4 (± 1.5) years. The groups were homogenous at baseline regarding age, gender, and the time to surgery. At follow-up, no statistically significant differences were found regarding anterior laxity (AL: 2.3 ± 3 mm vs. FL: 2.3 ± 2.6 mm, p = 0.981). PRO scores were comparable between the AL and FL groups (IKDC score, 84.8 vs. 88.8, p = 0.185; Lysholm 87.3 vs. 89.9, p = 0.380; KOOS 90.7 vs. 91.4, p = 0.720; Tegner 5.5 vs. 6.2, p = 0.085). The rate of saphenous nerve lesions was significantly lower in the AL group with popliteal harvesting of the tendon (8.3% vs. 35.5%, p = 0.014).ConclusionThe use of an adjustable-loop device on the femoral and tibial side led to similar stability and clinical results compared to a fixed-loop device.

Assessment of functional outcome of arthroscopic assisted anterior cruciate ligament reconstruction using quadrupled hamstring auto-graft: Case series

Background: We assessed the functional outcome of the patient following ACL reconstruction using quadrupled hamstring autograft.Methods: In this case series of 21 patients who had ACL insufficiency underwent arthroscopic assisted ACL reconstruction using quadrupled hamstring autograft from November 2019 to March 2021. The functional outcome of patients was assessed with Lyscholm Knee Scoring System and IKDC score.Results: The injury was predominant in males. A larger percentage of cases was operated less than 6 months from the date of injury. The mean graft diameter was 7.90 mm, with a positive correlation to the function of the knee. The preoperative mean Lysholm score of 59.19 improved to 94.95 after surgery. The mean preoperative IKDC score improved from 46.81 to 81.95. Excellent outcome was seen in a majority of patients. Two patients had an infection and one patient had reduced range of motion. The timing of surgery and rehabilitation influence the outcome largelyConclusion: ACL reconstruction surgery with quadrupled hamstring graft provides an excellent outcome in ACL injuries when the surgery is timed well, with sufficient graft thickness and good rehabilitation.

Computed tomographic evaluation of bone tunnel enlargement following single bundle anterior cruciate ligament reconstruction with hamstring autograft

&lt;p class="abstract"&gt;The purpose of this study is to evaluate tibial and femoral tunnel diameter following single bundle anterior cruciate ligament (ACL) reconstruction and correlation between tunnel enlargement and clinical outcome. Twelve patients who underwent primary arthroscopic single bundle ACL reconstruction with hamstring graft were included in prospective case series. Preoperative clinical evaluation was performed using international knee documentation committee (IKDC) subjective score and grade, Tegner knee score and Lysholm knee score. Computed tomography (CT) evaluation of the femoral and tibial tunnels were done on post-operative day (POD) 1 and at a mean follow up of 9 months (range 7-12 months) and were compared with functional scores. Our study shows significant tibial and femoral tunnel enlargement on CT scan at 9 months (range 7-12 months) postoperatively. All the clinical evaluation scales showed improvement postoperatively. The mean average femoral tunnel diameter increased significantly (p&amp;lt;0.001) from 8.17±0.57 to 9.08±0.660 (10%) and tibial tunnel diameter increased significantly (p&amp;lt;0.001) from 8.08±0.669 to 9.07±0.601 (11%) postoperatively at a mean follow up of 9 months (range 7-12 months). No statistically significant difference between tunnel enlargement and clinical values were found. In our current prospective CT based study, we conclude use of extracortical fixation of femoral tunnel with stronger fixation of the tibial tunnel, tunnel orientation and anatomic fixation close to the joint line along with less aggressive rehabilitation protocol with use of extension knee brace may result in minimization of tunnel widening with quadrupled hamstring autograft.&lt;/p&gt;

Outcome of Arthroscopic Anterior Cruciate Ligament Reconstruction Knee Joint Using Hamstring Autograft

One of the most common injuries during sports is anterior cruciate ligament (ACL) injury. A number of surgical and rehabilitation techniques have been developed. ACL reconstruction is mainstay of treatment. Objective: In this study we are evaluating the outcome of ACL surgery. Design &amp; Setting: Retrospective study Methodology: Data collection of all cases that underwent primary arthroscopic anterior cruciate ligament reconstruction performed. All patients were operated with same surgical technique using quadrupled hamstring autograft. Results: There was an overall male predominance (95.3%). Medical meniscal injury was found in 05 (24%) patients. Lateral Meniscus injury was found in 04(19%) patients. Adjustable length CSF device was used in 12 (57%) patients and fixed-loop CSF device in 9 (43%) patients. Conclusion: At two years, outcome of ACL reconstruction performed by one surgeon using same surgical technique with adjustable CSF device and absorbable tibial screw granted satisfactory clinical results in all patients. Rehabilitation played an important role in return to activities of daily living in all patients at final follow up. Keywords: Anterior Cruciate Ligament, Arthroscopy, Rehabilitation

Functional outcome following arthroscopic ACL reconstruction using 4 stranded hamstring autograft and preservation of hamstring graft at tibial insertion

Background: The technique of arthroscopic anterior cruciate ligament reconstruction (ACLR) has undergone many modifications in the recent times with improved understanding of anatomy, kinematics, and biology of the graft. In this study, we evaluated the functional outcome following arthroscopic single bundle ACLR with tibial attachment preserving quadrupled hamstring autograft without implant on the tibial side.Results: There is a statistically significant increase in both IKDC and Lysholm score from preoperative/pre injury to post-operative assessment at minimal 9 month follow up.The mean pre injury Tegner score was 5.7 ± 1.194 and mean post injury Tegner score was 5.2 ± 1.055. The mean pre injury lysholm score was 97.9 ± 2.308 which at minimum 9 month follow-up was 88.3 ± 8.036. Out of 52 patients 37 of the patients (71.2%) were able to return to their pre injury activity including to recreational and to competitive sports. 5 patients (9.6%) had a drop of 1 level in Tegner activity level from there pre injury level of activity. 7 patients (13.5%) had a drop of 2 level in Tegner activity level from there pre injury level of activity. 2 patients (3.8%) had a drop of 3 level in Tegner activity level from there pre injury level of activity. 1 case reported a 4 level drop from pre injury levelsConclusion: Arthroscopic single-bundle ACL reconstruction using 4 stranded hamstring autograft, anatomic femoral tunnel placement and preservation of hamstring graft tibial insertion gives excellent to good functional outcome. Tibial attachment preserving hamstring graft without a tibial implant is a simple, time saving and cost effective technique that provides a consistently satisfactory outcome.