Semitendinosus-gracilis Autograft Research Articles

Transphyseal Anterior Cruciate Ligament Reconstruction in Patients With Open Physes

Background: The treatment of anterior cruciate ligament (ACL) injuries in skeletally immature patients is controversial. Current evidence supports the view that surgical techniques restore knee stability and prevent progressive articular damage. However, most of the studies on this topic are small case series or they have short- or medium-term follow-up times. Purpose: To determine the long-term functional outcomes and secondary complications of transphyseal intra-articular ACL reconstruction with hamstring graft in skeletally immature patients. Study Design: Case series; Level of evidence, 4. Methods: Transphyseal ACL reconstruction with autograft hamstrings was performed in 27 skeletally immature patients. The average age at surgery was 13 years (range, 12-16 years), and the average follow-up time was 10.6 years (range, 10-13 years). Clinical outcomes were assessed with preoperative and final follow-up Tegner, International Knee Documentation Committee (IKDC) subjective, and Lysholm scores. Surgery details, return to sports, and ACL reconstruction failures were collected. The anteroposterior knee laxity was assessed by arthrometry, and the presence of deformities and lower limb length discrepancies were evaluated by radiographs. The presence of degenerative signs on anteroposterior and lateral knee radiographs at final follow-up was also evaluated. Results: Transphyseal ACL reconstruction was performed with vertically oriented tunnels, 7 to 10 mm in diameter, using semitendinosus-gracilis autograft. The average preoperative Tegner, IKDC, and Lysholm scores were 7, 55, and 40, respectively. Significant differences in these scores were observed at the time of the final assessment (Tegner, 6 [P = .026]; IKDC, 94 [P < .001]; Lysholm, 92 [P < .001]). Two patients reported instability during sports activity. Three patients had a rupture of the ACL graft. No leg length discrepancy, axis malalignment, or degenerative changes were observed. Conclusion: The transphyseal ACL reconstruction in skeletally immature patients is a safe option, with high functional and satisfaction results, without significant growth plate damage in this series of patients.

Reconstrucción anatómica del ligamento cruzado anterior: técnica quirúrgica y reporte de casos

IntroductionThe main goal in anterior cruciate ligament (ACL) reconstruction is to restore the biomechanics of the knee, provide adequate stability, and pain free function for the patient in order to return to pre-injury functionality. Materials and methodsA retrospective study was designed to clinically and subjectively assess a sample of patients who had an ACL reconstruction with the medial portal technique performed in the Saludcoop Medellin clinic. This sample included all patients who could be evaluated regularly by the treating orthopedist between February 2010 and August 2011. The functional measurement was made using the Lysholm scale. ResultsA total of 38 patients with 39 ACL reconstructions (one patient bilateral) were followed up. A semitendinosus-gracilis autograft, as well as two patellar bone-tendon-bone autografts, were used in 37 patients. Functional scale showed that the average preoperative score was 50.3 (16–90), and the postoperative score was 85.5 (20–95). Lower postoperative scores were associated with patients who had lateral pain when a TransFix® fixation technique was performed. DiscussionThe number of complications is low with this technique, and functional outcomes of patients are excellent. Further prospective studies should be performed to validate this technique.

The Effects of Early Aggressive Rehabilitation on Outcomes After Anterior Cruciate Ligament Reconstruction Using Autologous Hamstring Tendon: A Randomized Clinical Trial

Prospective randomized clinical trial. Thirty-six patients who had a primary anterior cruciate ligament reconstruction (ACL-R) with a semitendinosus-gracilis (STG) autograft from a single orthopedic surgeon were prospectively randomized into 2 groups. Nineteen patients were randomized to the aggressive group (53% male, mean age 30.1 + 10.5 y) and 17 to the nonaggressive group (88% male, mean age 33.1 + 10.9 y). Impairment measures of anteroposterior (A-P) knee laxity, range of motion (ROM), and peak isometric force (PIF) values were obtained 12 wk postoperatively. Subjective response to the International Knee Documentation Committee knee form (IKDC) was collected 1, 12, and 24 wk postoperatively. One-way ANOVA was used to analyze differences between groups at 12 wk for A-P knee laxity, ROM, and PIF. Differences between the groups for the IKDC scores were determined using 1-way ANOVA with repeated measures 1, 12, and 24 wk postoperatively. Bonferroni adjustment was used for multiple comparisons. There were no differences between the groups for the baseline characteristics (P > .05). There was no difference found between the groups in respect to A-P knee laxity, ROM, or PIF at 12 wk (P > .05). Further analysis also showed no significant differences in the IKDC scores between groups at 12 or 24 wk (P > .05). No differences were found between early aggressive and nonaggressive rehabilitation after an isolated ACL-R using STG autografts for the primary outcomes of A-P knee laxity and subjective IKDC score. In addition, no differences were observed for secondary outcomes between groups for differences in ROM and PIF values.

Outcome of anterior cruciate ligament reconstruction with emphasis on sex‐related differences

The aim of this retrospective study was to compare the results after arthroscopic anterior cruciate ligament (ACL) reconstruction using the four-strand semitendinosus-gracilis (ST/G) autograft in male (n=141) vs female (n=103) patients. The patients were operated on between 1996 and 2005, using interference screw fixation and drilling the femoral tunnel through the anteromedial portal. The pre-operative assessments and demographics, apart from age (males 29 years, females 26 years; P=0.02), were comparable at the time of surgery. At 25 (23-36) months post-operatively, no significant differences were found between the study groups in terms of anterior side-to-side knee laxity, manual Lachman test, Tegner activity level, Lysholm knee score, range of motion or donor-site morbidity. Both study groups improved significantly in most clinical assessments and functional scores compared with their pre-operative values. Two years after ACL reconstruction using ST/G autografts, there were no significant differences between male and female patients in terms of clinical outcome or functional scores.

Knee flexor strength after ACL reconstruction: comparison between hamstring autograft, tibialis anterior allograft, and non-injured controls

Hamstring muscle group dysfunction following anterior cruciate ligament reconstruction (ACL) using a semitendinosus-gracilis autograft is a growing concern. This study compared the mean peak isometric knee flexor torque of the following three groups: subjects 2 years following ACL reconstruction using semitendinosus-gracilis autografts (Group 1), subjects 2 years following ACL reconstruction using tibialis anterior allografts (Group 2), and a non-injured, activity-level-matched control group (Group 3). We hypothesized that Group 1 would have greater mean involved lower extremity peak isometric knee flexor torque deficits than the other groups. Handheld dynamometry with subjects in prone and the test knee at 90 degrees flexion was used to determine bilateral peak isometric knee flexor torque. Group 1 (86.4 +/- 11) and Group 2 (80.5 +/- 13) had similar 2000 IKDC Subjective Knee Evaluation Form scores (P = NS). Group 1 had a mean involved lower extremity peak isometric knee flexor torque deficit of -17.0 +/- 14 Nm. Group 2 had a mean involved lower extremity peak isometric knee flexor torque deficit of -0.8 +/- 9 Nm. Group 3 (control) had a mean left and right lower extremity peak isometric knee flexor torque difference of -0.7 +/- 14 Nm. Group 1 had decreased involved lower extremity peak isometric knee flexor torque compared to Groups 2 and 3 (two-way ANOVA; group x side interaction P < 0.05, Tukey HSD = 0.008). Long-term knee flexor strength deficits exist following hamstring autograft use for ACL reconstruction that does not occur when a tibialis anterior allograft is used. Early identification of impaired knee flexor strength among this group and modified rehabilitation may reduce these deficits. Adding quantitative biomechanical testing of sprinting and sudden directional change movements to the standard physical therapy evaluation will better elucidate the clinical and functional significance of the observed knee flexor strength impairments and aid in determining sport specific activity training readiness.

Long-term Results of Isolated Anterolateral Bundle Reconstructions of the Posterior Cruciate Ligament

Background Little is known about the parameters that influence the long-term results of isolated arthroscopically assisted reconstructions of the anterolateral bundle of the posterior cruciate ligament (PCL). Hypothesis Chondrosis, time interval from injury to surgery, and graft choice significantly influence the long-term results of single-bundle PCL reconstructions. Study Design Case series; Level of evidence, 4. Methods Between 1995 and 2001, 22 male and 3 female patients with a mean age of 30.8 years (range, 17-52) underwent an anterolateral bundle reconstruction of the PCL for functional instability and pain. Nine were treated with a bone–patellar tendon– bone autograft (BPTB), 15 with a semitendinosus gracilis (STG) autograft, and 1 with an Achilles tendon allograft. Twenty-two patients were clinically and radiographically reviewed at a mean follow-up of 9.1 years (range, 6.5-12.6). Three patients were interviewed by telephone. Thirteen patients had chondrosis at time of surgery. The mean time from injury to surgery was 1.5 years. Results The mean final International Knee Documentation Committee (IKDC), Lysholm, and functional visual analog scale (VAS) scores (65, 75, and 8, respectively) were fair to good and were significantly better than preoperatively (38, 50, and 4, respectively) (P <. 001). The final Tegner (5.7) score was significantly lower than the preinjury score (7.2) (P <. 001). The mean anteroposterior laxity measured by KT-1000 arthrometer and Telos stress radiographs was significantly increased on the operated side (mean side-to-side difference of 2.1 mm and 4.7 mm, respectively). The functional scores were not significantly different between the BPTB and STG reconstructions. Patients without chondrosis at time of surgery and patients operated within the first year from injury had significantly better functional results at final follow-up (P <. 05). Conclusion Arthroscopically assisted reconstructions of the anterolateral bundle of the PCL in patients with symptomatic isolated grade II to IV PCL-deficient knees lead to significantly improved functional results at long term if there is no cartilage damage at time of surgery. Nonoperative treatment should not be extended more than 1 year from injury. Graft choice did not significantly influence the functional outcome at long term.

Comparison Of Landing Mechanics During A Drop Jump In Semitendinosus-gracilis Acl-reconstructed Females And Noninjured Females

Women with different types of anterior cruciate ligament (ACL) reconstruction have shown similar landing mechanics as non-injured women. ACL reconstruction using the Semitendinosus-gracilis (SG) graft is one of the preferred options for ACL reconstruction in women. PURPOSE: To compare knee valgus between non-injured women and women with SG ACL reconstruction during a 60-cm double-legged drop jump. METHODS: Twenty-nine females 21-35 years of age (non-injured =15, weight: 60.25 ± 10.63 Kg, height: 161.24 ± 6.70 cm; SG = 15, weight: 67.20 ± 11.46 Kg, height: 166.92 ± 8.44 cm) participated in this investigation. Participants performed 5 trials of a double-legged drop jump from a 60-cm height box. The double-legged landing task involved landing from the 60-cm drop box and immediately jumping vertically as high as possible (countermovement jump). Reflective markers were attached over bony prominences of both legs according to the model embedded in the software. A static trial was used to estimate each subject's joint centers. Five infrared cameras (120 Hz) were used to capture the trajectory of reflective markers during the drop jump. Knee valgus was defined as the minimum distance between markers placed at the lateral femoral epicondyles during the ground contact phase. The ground contact phase was defined as the moment of initial contact until the participant cleared both feet from the floor during the maximal vertical jump push-off. The average valgus from five trials was used for analysis using an Analysis of Variance (ANOVA) to compare knee valgus among groups. RESULTS: The ANOVA revealed no statistically significant differences (p= 0.842) between groups for knee valgus during the ground contact phase of the drop jump. CONCLUSION: Young women with SG ACL reconstruction presented similar knee valgus as young women without knee surgery on a 60-cm double-legged drop jump. It appears that young women who undergo ACL reconstruction with SG autograft do not experience long term landing mechanics deficits that could predispose them to re-injury. NIH Grants G12RR03051 and 1P20 RR11126, and NSCA Foundation supported this project.

Tibial Fixation in Anterior Cruciate Ligament Reconstruction with Bone–Patellar Tendon–Bone and Semitendinosus-Gracilis Autografts

Background Knee instability after anterior cruciate ligament reconstruction rarely manifests with activities of daily living, but it may occur in high-level sports performance, resulting in secondary injuries. Faced with these circumstances, sports orthopaedists have continued to improve on the results obtained with surgical techniques for treating knee joint injuries. Hypothesis Transverse tibial fixation with bioabsorbable cross pins is a valid technique for anterior cruciate ligament reconstruction with both the patellar tendon (bone—patellar tendon—bone) and semitendinosus and gracilis tendon. Study Design Cohort study; Level of evidence, 3. Methods The study population was 120 patients operated on by the same surgeon and subdivided into 4 subgroups of 30 subjects each. Patients were chosen and assigned to each group consecutively. Patients in group 1 (bone—patellar tendon—bone) were implanted with bioabsorbable interference screws, group 2 (bone—patellar tendon—bone) received 2 bioabsorbable cross pins, group 3 (semitendinosus and gracilis tendon) received a bioabsorbable interference screw, and group 4 (semitendinosus and gracilis tendon) received 2 bioabsorbable cross pins. Patients were assessed at 5-year follow-up for International Knee Documentation Committee Knee Ligament Standard Evaluation Form, Lysholm Knee Scoring Scale, Lysholm-Tegner Activity Scale, and KT-1000 arthrometer testing. Results The results at 5 years after anterior cruciate ligament reconstruction were similar across all 4 groups. No significant differences have been observed between groups. Conclusion The results suggest that transverse tibial fixation with bioabsorbable cross pins is a safe and reliable procedure, yielding clinical results that are comparable with those of the more widely used bioabsorbable interference screws.

Tension patterns of the anteromedial and posterolateral grafts in a double‐bundle anterior cruciate ligament reconstruction

The two functional bundles of the anterior cruciate ligament (ACL), namely, the anteromedial (AM) and posterolateral (PL) bundles, must work in concert to control displacement of the tibia relative to the femur for complex motions. Thus, the replacement graft(s) for a torn ACL should possess similar tension patterns. The objective of the study was to examine whether a double-bundle ACL reconstruction with the semitendinosus-gracilis autografts could replicate the tension patterns of those for the intact ACL under controlled in vitro loading conditions. By means of a robotic/universal force moment sensor (UFS) testing system, the in situ force vectors (both magnitude and direction) for the AM and PL bundles of the ACL, as well as their respective replacement grafts, were determined and compared on nine human cadaveric knees. It was found that double-bundle ACL reconstruction could closely replicate the in situ force vectors. Under a 134-N anterior tibial load, the resultant force vectors for the intact ACL and the reconstructed ACL had a difference of 5 to 11 N (p > 0.05) in magnitude and 1 to 13 degrees (p > 0.05) in direction. Whereas, under combined rotatory loads of 10-N-m valgus and 5-N-m internal tibial torques, the corresponding differences were 10 to 16 N and 4 degrees to 11 degrees, respectively. Again, there were no statistically significant differences except at 30 degrees of flexion where the force vector for the AM graft had a 15 degrees (p < 0.05) lower elevation angle than did the AM bundle.

Graft Tensioning in Anterior Cruciate Ligament Reconstruction: A Systematic Review of Randomized Controlled Trials

The purposes of this study were to (1) perform a systematic review of randomized controlled trials evaluating graft tensioning in anterior cruciate ligament (ACL) reconstruction, and (2) determine the scientific quality of published randomized controlled trials evaluating graft tensioning in ACL reconstruction. The search strategy included a computerized literature search, a citation search, and a manual search of key journals and conference proceedings. Eligible studies were randomized controlled trials evaluating the effect of graft tensioning on the outcomes of ACL reconstruction. Two reviewers independently performed the literature searches. The validity of the trials was scored using the Detsky quality scale. Consensus was achieved by a study committee of 3 investigators. Five randomized controlled trials met the inclusion criteria. The mean standardized Detsky score was 61.3 +/- 15.2%. Only 2 of the studies scored >or=75%. All trials consisted of autogenous graft sources, with 3 involving a bone-patellar tendon-bone graft, 1 involving a 5-strand semitendinosus-polyester (5STP) graft, and 1 involving a semitendinosus-gracilis-polyester (STGP) graft. Based on the evidence in this systematic review, there is a trend that suggests that 80 N of tension is the most effective amount of tension to apply during ACL reconstruction using hamstring-polyester graft sources. For ACL reconstruction using semitendinosus-gracilis or patellar tendon graft sources, there is no clear trend in terms of statistically significant or clinically relevant differences in terms of the amount of applied tension to apply to the graft during graft fixation. We are unable to provide recommendations as to the amount of tension to apply to 4-strand semitendinosus-gracilis autografts without polyester augmentation because there has been no randomized clinical trial conducted to determine the most effective amount of tension to apply when using this graft source.

In Vivo Estimation of Compressive Loads in the ACL-Reconstructed Knee

It is not possible to measure joint compressive loads non-invasively in vivo. This is unfortunate because high compressive loads lead to articular cartilage failure and osteoarthritis. While gait analysis can be used to estimate net joint moments, it cannot be used to estimate compressive forces because high compressive forces can be found where net joint moments are minimal (and vice versa). Biomechanical models using optimization have been used to estimate joint compressive loads, but they do not account for the way different individuals use their muscles, which is a key determinant of joint compressive load. PURPOSE: To estimate joint compressive loads in vivo in unimpaired subjects and those with ACL reconstructions using biologically-driven data and to compare results associated with different autograft types. METHODS: The hybrid approach taken here uses both inverse dynamics and forward dynamics. Joint moments were determined from inverse dynamics and muscle forces were determined from EMGs recorded from ten muscles that cross the knee (Buchanan et al., MSSE 37:1911-1916, 2005). Joint compressive loads were calculated by resolving the joint and muscle forces into their compressive components and summing. Three subject groups were tested: unimpaired subjects, subjects who have had ACL reconstructed knees using bone-patellar tendon-bone (BPTB) autografts and those with quadruple-bundled semitendinosus-gracilis (QSTG) autografts. To date, two subjects in each group have been examined. RESULTS: Average peak joint compressive loads were found to be lower in ACL reconstructed subjects than unimpaired subjects: 10.8% lower for the QSTG autografts and 28.7% lower for the BPTB autografts. CONCLUSIONS: Joint compressive loads may be an important indicator of future degenerative joint disease. Although compressive forces in the different autograft groups were found to be smaller when compared to the unimpaired group, more subjects are needed for a statistically definitive analysis. Supported by NIH Grant R01-AR046386.

Predictors for Hamstring Graft Diameter in Anterior Cruciate Ligament Reconstruction

Background The ability to accurately predict the diameter of autograft hamstring tendons has implications for graft choice and fixation devices used in anterior cruciate ligament (ACL) reconstruction. Purpose To determine whether simple anthropometric measurements such as height, mass, body mass index (BMI), age, and gender can be used to accurately predict the diameter of hamstring tendons for ACL reconstruction surgery. Study Design Cohort study (prevalence); Level of evidence, 2. Methods The authors conducted medical record reviews and telephone interviews of 106 consecutive patients with ACL reconstruction using quadrupled semitendinosus-gracilis autograft from 2004 to 2006. Data included anthropometric measurements (height, mass, gender, and age at the time of surgery). Hamstring diameter was obtained using cylindrical sizers in 0.5-mm increments and recorded in the patient's surgical record. Correlation coefficients (Pearson r) and stepwise, multiple linear regression were used to determine the relationship between the outcome variable (hamstring graft diameter) and the predictor variables (age, gender, height, mass, and BMI). Independent sample t tests were used to compare hamstring graft diameter between genders. Results Hamstring graft diameter was related to height (r = .36, P < .001), mass (r = .25, P = .005), age (r = —.16, P = .05), and gender (r = —.24, P = .006) but was not related to BMI (P > .05). Height was a statistically significant prediction variable (R2 = .13, P < .001). From the current data, a regression equation was calculated that suggested that a patient <147 cm (58 in) tall is likely to have a quadrupled hamstring graft diameter <7 mm in diameter (graft size = 2.4 + 0.03 × height in cm). Women had significantly smaller hamstring graft diameters (7.5 ± 0.7 mm) than did men (7.9 ± 0.9 mm, P = .01). Conclusions Of the parameters studied, height was the best predictor of hamstring tendon diameter, particularly in women.

Early Application of Negative Work via Eccentric Ergometry Following Anterior Cruciate Ligament Reconstruction: A Case Report

Case report. To present a progressively increasing negative-work exercise program via eccentric ergometry early after anterior cruciate ligament reconstruction (ACL-R) and to suggest the potential of negative work to amplify the return of quadriceps size and strength. The patient was a 26-year-old highly active recreational athlete who sustained an ACL tear while skiing in January 2004 and then again while skiing in February 2005. This individual underwent an arthroscopically assisted ACL-R with a double-loop semitendinosusgracilis autograft initially, then a patellar tendon autograft following his ACL graft rupture. Beginning within 3 weeks after surgery, a progressive negative-work exercise program was initiated using an eccentric ergometer. The patient completed 31 training sessions of 5 to 30 minutes in duration over a 12-week period following the ACL-R and 33 training sessions of the same frequency and duration following the ACL revision. Following ACL-R, quadriceps volume increased 28% (involved lower extremity) and 14% (uninvolved lower extremity) during the 12-week training program. Following revision, quadriceps volume returned to similar levels at the same postoperative period as those achieved after the initial surgery (2% less on the involved side and 2% greater on the uninvolved side). Quadriceps strength, 15 weeks after ACL-R, exceeded preoperative measures by an average of 20% (involved) and 14% (uninvolved). Quadriceps strength after ACL revision exceeded all previous measures. This case report suggests that if gradually and progressively applied, negative work via eccentric ergometry can be both safe and efficacious early after ACL-R. Eccentric exercise may mitigate the prevalent muscle size and strength deficits commonly observed after ACL-R. The results of this case suggest a need for continued research with early negative work interventions following ACL-R.

Comparative evaluation of knee stability following reconstruction of the anterior cruciate ligament with the bone–patellar tendon–bone and the double semitendinosus–gracilis methods: 1- and 2-year prospective study

An account of a prospective study of anterior cruciate ligament reconstructions with the bone-patellar tendon-bone autograft (BPTB) and the doubled semitendinosus-gracilis autograft (ST-GR) is given in 39 patients and 22 patients, respectively. The BPTB patients were younger, and there were more women in the ST-GR group. There were no statistical differences in the clinical and instrumental evaluations of stability after 1 and 2 years (Lachman and Jerk test, KT1000) between the two groups. Slightly better results were obtained in the BPTB group: mean 0.80 and 0.96 (first and second years) versus 1.18 and 1.20. Both methods, in fact, resulted in very satisfactory anterior knee stability, even when applied in two dissimilar groups of patients.

Return to Official Italian First Division Soccer Games Within 90 Days After Anterior Cruciate Ligament Reconstruction: A Case Report

Case report. To present the rehabilitative course, decision-making, and clinical milestones that allowed a top-level professional soccer player to return to full competitive activity 90 days after surgery. The patient was a 35-year-old forward player who sustained an isolated complete tear of the left anterior cruciate ligament (ACL) in the midst of the competitive 2001-2002 season. He was in contention for a position on the Italian World Cup Team that was to be played 135 days after his injury, only if he demonstrated that he could return to play at the highest level before the team was selected. The patient underwent an arthroscopically assisted ACL reconstruction with a double-loop semitendinosus-gracilis autograft 4 days after the injury. Eight days after surgery he began rehabilitation at a rate of 2 sessions a day, 5 days a week, plus 1 session every Saturday morning. These sessions were performed in a pool for aquatic exercises, in a gymnasium for flexibility, coordination, and strength exercises, and on a soccer field for recovery of technical and tactical skills, with continuous monitoring of training intensity. The surgical technique and the progressive rehabilitation program allowed the patient to play for 20 minutes in an official First Division soccer game 77 days after surgery and to play a full game 90 days after surgery. Eighteen months postsurgery, the player had participated in 62 First Division matches, scoring 26 times, and had received no further treatment for his knee. This case report suggests that early return to high-level competition after ACL reconstruction is possible in some instances. Some factors that may have favored the early return include optimal physical fitness before surgery, a strong psychological determination, an isolated ACL lesion, a properly placed and tensioned graft, a personalized progression of volume and intensity of exercise loads, and an appropriate density of rehabilitative training consisting of a mix of gymnasium, pool, and field exercises.

女性の膝前十字靭帯再建術施行例における術後筋力評価―再建材料による比較―

The purpose of this study was to evaluate knee muscle strength following anterior cruciate ligament (ACL) reconstruction in female. We treated 12 female patients with a bone-patellar tendon-bone autograft (BTB) and 29 female patients with a semitendinosus-gracilis autograft (STG) in ACL reconstruction. Knee extensor and flexor strength were measured by KIN-COM before operation, and 3 months, 6 months and 9-12 months after operation. The angular velocity was set at 60 and 180 degrees/second. The results showed that the STG group was better than BTB group on extensor and flexor muscle strength after 3 and 6 months, but there were no significant differences after 9 to 12 months. BTB group patients over 30 years of age showed the worst recovery of extensor muscle strength after 9 to 12 months. The results suggest a delay or deficit in the recovery of knee muscle strength in middle-aged female with BTB in ACL reconstruction.

Correlation of interference screw insertion torque with depth of placement in the tibial tunnel using a quadrupled semitendinosus-gracilis graft in anterior cruciate ligament reconstruction

To evaluate the insertion torque of a soft-tissue interference screw in relation to depth of insertion into the tibial tunnel when used for fixation of a quadrupled semitendinosus-gracilis autograft in anterior cruciate ligament reconstruction. Biomechanical cadaver study. Ten quadrupled semitendinosus-gracilis grafts were harvested from fresh-frozen cadaver knees and fixed in donor proximal tibias using 10-mm bioabsorbable interference screws (Arthrex, Naples, FL). A cannulated torque screwdriver was used to measure screw insertion torque at 3 depths in the tibial tunnel: the outer cortex (distal third), the articular surface (proximal third), and between these 2 points (middle third). The mean insertion torques for the distal third, middle third, and proximal third were 8.7, 4.7, and 4.3 in/lb, respectively. The insertion torque was significantly higher at the outer cortex (distal third) than the middle third and proximal third (joint line of the tibial tunnel) ( P < .05). Our results indicate a correlation between insertion torque and depth of placement of bioabsorbable interference screws used for fixation of a semitendinosus-gracilis graft. Lower insertion torque at the articular surface, resulting in lower peak load or pullout strength, may outweigh the proposed benefits of joint-line fixation of a semitendinosus-gracilis graft used for anterior cruciate ligament reconstruction. Studies have suggested that anatomic proximal fixation of ACL grafts in the tibial tunnel produces stability similar to intact knees. The results of our study indicate that lower insertion torque at the articular surface results in lower peak load and pullout strength of the graft, which may outweigh the proposed benefits of joint-line fixation.

Tendon-to-bone healing of a quadrupled hamstring tendon graft fixed with biodegradable screws in an immature athlete: A radiologic, arthroscopic, histologic, and electromicroscopic investigation

Abstract Quadrupled hamstring tendon is one of the most commonly used ligamentous substitutes in anterior cruciate ligament reconstruction. We describe a case of a young athlete who sustained a rerupture of a semitendinosus-gracilis autograft fixed with biodegradable screws 2 years after primary surgery. Radiologic, arthroscopic, histologic, and electromicroscopic investigation showed tendon-to-bone healing of the soft tissue graft and partial degradation of the interference screws.

Tendon-to-bone healing of a quadrupled hamstring tendon graft fixed with biodegradable screws in an immature athlete: A radiologic, arthroscopic, histologic, and electromicroscopic investigation

Quadrupled hamstring tendon is one of the most commonly used ligamentous substitutes in anterior cruciate ligament reconstruction. We describe a case of a young athlete who sustained a rerupture of a semitendinosus-gracilis autograft fixed with biodegradable screws 2 years after primary surgery. Radiologic, arthroscopic, histologic, and electromicroscopic investigation showed tendon-to-bone healing of the soft tissue graft and partial degradation of the interference screws.

Neuromuscular function after anterior cruciate ligament reconstruction with autologous semitendinosus-gracilis graft

Background: The quadrupled autologous semitendinosus-gracilis graft is the first choice of many orthopaedic surgeons when reconstructing the anterior cruciate ligament. The effect that this procedure has on voluntary muscle control remains unclear. The purpose of this study was to evaluate the effect that anterior cruciate ligament reconstruction with autologous semitendinosus-gracilis graft has on voluntary muscle control by assessing subjects’ specificity of muscle action. Methods: The voluntary muscle control of 10 people (seven males, three females) with acute, isolated ACL ruptures was assessed in the days prior to when they underwent anterior cruciate ligament reconstruction with quadrupled autologous semitendinosus-gracilis grafts and after they had returned to play in sports requiring quick changes of direction and jumping (approximately 6 months later). The experimental protocol included the use of an established target-matching protocol that requires subjects to produce and modulate force with fine control, electromyographic recordings from 11 muscles about the knee, and the use of circular statistics to calculate specificity indices that describe the degree of focus (specificity) associated with the activity pattern of each muscle. Data were analyzed by performing pre-surgery and post-return to sports side-to-side comparisons, as well as, pre-surgery to post-surgery ipsilateral comparisons. Results: Diminished specificity of muscle action was observed in the activity patterns of most of the muscles of the subjects’ anterior cruciate ligament deficient knees prior to surgery. The quadriceps muscles were particularly affected. Post-return to sports results indicated that voluntary muscle control had improved in most muscles. There was no significant difference in pre-surgery and post-return to sports semitendinosus and gracilis muscle control. The semimembranosus muscle displayed less specific muscle activity patterns following surgery, which may represent a compensation strategy for minor changes in neuromuscular function. Conclusions: Voluntary muscle control improved in most muscles following ACL reconstruction with semitendinosus-gracilis autografts. Semitendinosus and gracilis muscle control did not appear to be altered significantly by the procedure.