Semitendinosus Gracilis Research Articles

Functional Outcomes of Bone-Patellar Tendon-Bone Versus Quadrupled Semitendinosus and Gracilis Autografts for Anterior Cruciate Ligament Reconstruction.

Introduction Anterior cruciate ligament reconstruction (ACLR) with autografts has been available for decades; however, the choice of graft is still debated. Here, we compared the functional outcomes of the two most widely used autografts, bone-patella tendon-bone (BPTB) and quadruple-stranded semitendinosus/gracilis (ST/G) autografts, at six months following ACLR. Materials and methods This prospective study was performed in the Department of Orthopedics of Yenepoya Medical College and Hospital located in Mangalore, Karnataka, India,a tertiary care institute over a period of 18 months (November 2018 to April 2020). The study included 38 adult patients whounderwent ACLR and were randomly divided into two groups: BPTB autograft (n=19) or ST/G autograft (N=19). The patients were followed up at one-, three-, and six months. Postoperatively, surgical morbidity, knee stability functional outcome on Lysholm score, and knee range of motion (ROM) were assessed. Results The groups were homogenous and comparable regarding age, sex, side of ACL affected, duration of tear to treatment, and muscle wasting (all p-values > 0.05). At six months, the majority of the patients had a tibial translation of 0-2 mm on the Lachman test and anterior drawer test, and the groups did not differ significantly (both p-values > 0.05). Additionally, at six months, both groups demonstrated a significant increase in mean Lysholm score and mean ROM (both p-values < 0.001). However, the groups did not differ in mean Lysholm score and mean ROM at baseline and any of the follow-up visits (all p-values > 0.05). Conclusion At six months, ACLR with BPTB and ST/G autografts produced significant and comparable knee stability, functional outcome, and ROM.

Comparison of the retear rate 2 years after ACL reconstruction with the Tape Locking Screw short graft system and the STG technique: A case control study with propensity score matching

PurposeTheoretically, short semitendinosus grafts result in less pain and morbidity while providing greater knee flexion strength and sparing the gracilis tendon. They often require the use of blind bone tunnels as well as fixation at both ends of the graft with suspensory cortical buttons. The “Tape Locking Screw” (TLS) system is another option. There are few studies comparing ACL reconstruction with a short graft using the 4-strand semitendinosus graft (ST4-TLS) technique with that of the semitendinosus-gracilis (STG) procedure. This study was designed: (1) to compare the retear rate following these two technics after 2years of follow-up, (2) to compare the clinical scores, complications and return to sport times between the two procedures Q1, Q2. HypothesisOur hypothesis was that there would be no differences in retear rates between the two techniques. MethodsThis single center case control study included 290 patients who underwent STG reconstruction that were paired by propensity score matching to 299 patients who underwent ST4-TLS reconstruction. The main evaluation criterion was the retear rate 2years after surgery. Secondary criteria were the two-year postoperative complication rate, the time to return to sport, to pivot sports and to running, as well as the complication rates and clinical scores 6months, 1year and 2years after surgery. ResultsAt the final follow-up, the overall retear rate in our series of ACL ligament reconstruction was 6.0% (36/596). There was no difference in retear rates between the groups 2years after ligament reconstruction [ST4-TLS: 6.7% (20/299) vs. STG: 5.4% (16/297); p=0.47]. The postoperative KOOS symptom score and the Tegner score were found to be better in the STG group at 1year (81 vs. 78, p=0.008) and 2years (5.64 vs. 5.10, p=0.016), respectively, representing the minimally clinically important difference (MCID) for the latter. No difference was found in the other clinical scores 6months, 1year or 2years after surgery. There was no significant difference in the return to sport [TLS: 93.0% (164/299) vs. STG: 93.0% (158/297) p=0.99] or the complication rate [TLS: 8.7% (26/299) vs. STG: 7.4% (22/297) p=0.89] between the groups. DiscussionThe ST4-TLS ACL ligament reconstruction technique was found to be as reliable as the standard STG procedure 2years after surgery for the retear rate and the return to sport, although the results of certain postoperative clinical scores seem to be lower. Level of evidenceIII; case control study.

Functional outcome and single hop test results of ACL reconstruction in athletes at a follow-up of 6 and 12 months: modified all-inside versus conventional hamstring autograft

reconstruction (ACLR) is a surgical treatment orthopedists perform. This study aims to compare the 6 and 12 months post-op results of single leg hop tests (SLHT) performed in multidirectional conventional semitendinosus/gracilis (ST/G) and modified all inside (MAI) ACLR techniques on both sides and the limb symmetry indexes (LSI) of both techniques. This study evaluated a retrospective cohort of 50 male athletes who applied MAI (n = 23) and traditional ACLR ST/G (n = 27) techniques. Functional knee strength of the participants on both sides was measured with different SLHTs at 6 and 12 months postoperatively. The SLHT included medial side (MSTH), triple hop (TH), medial rotation (90◦) (MRH), crossover triple (CH) ve the single hop (SH) hop for distance. Both ACLR techniques showed significant improvement in mean Tegner, International Knee Documentation Committee (IKDC) and Lysholm scores preoperatively and at 6 and 12 months postoperatively (p &lt; 0.05). For MAI and ST/G techniques, there was no significant difference in the results of SLHTs at 6 and 12 months for both the operated and non-operated sides (p &lt; 0.05). Significance was found only in the MRH test of the non-operated side (p &lt; 0.05). There was no significant difference in SLHT scores between the operated and non-operated sides at 6 and 12 months postoperatively (p &gt; 0.05). There was no difference in LSI scores between techniques (p &lt; 0.05). Our study revealed similar LSI rates in ST/G and MAI techniques at 6 and 12 months, suggesting that MAI technique can be used as a functional ACLR technique for athletes.

Acute effects of ipsilateral semitendinosus and gracilis autograft anterior cruciate ligament reconstruction on lower limb muscle activation

There is little information regarding the acute repercussions of anterior cruciate ligament (ACL) reconstruction on muscle activation, especially on the proximal hip muscles. Thus, this study analyzed the acute effects of ACL reconstruction with doubled semitendinosus/gracilis (ST/G) autografts on lower limb muscle activation. Fourteen male recreational athletes that presented a primary unilateral ACL rupture and underwent the ACL reconstruction with an ST/G graft. Surface electromyographic (sEMG) signal were recorded from each participant during the maximal voluntary isometric contraction (MVIC) of the gluteus maximus and gluteus medius, vastus lateralis and vastus medialis, semitendinosus, biceps femoris, and medial gastrocnemius muscles and also during bipodal mini-squatting with open and closed eyes, before surgery and 15 days postoperatively. (sEMG) signal were normalized to isometric peak electromyography.The postoperative assessment showed reduced muscle activation in the gluteus maximus (p = 0.013, d:0.48) in non-operated limb and also in the muscle gluteus medius (p = 0.013, d:0.79), vastus medialis (p = 0.035, d:0.63) semitendinosus (p = 0.001, d:2.46), biceps femoris (p<0.001, d:1.5), and medial gastrocnemius (p = 0.001, d:1.45) during MVIC in the operated limb. The postoperative assessment also revealed alterations in the sEMG activity of the hip and local thigh muscles in the operated and non-operated limbs during mini-squatting with opened eyes and closed eyes (p<0.05). ACL reconstruction surgery with a doubled ST/G autograft may promote immediate changes in lower limb muscle activation of the operated and non-operated limb.

Comparison of “ligamentization” process between preserved insertion hamstring tendon autograft and bone-patellar tendon-bone autograft

BackgroundLigamentization is a complex process and effect of preservation of hamstring tendon graft insertion on this process is not well studied. Present study was conducted to analyze and compare the ligamentization of semitendinosus gracilis graft with preserved tibial insertion (STGPI) and bone-patellar tendon-bone (BPTB) autografts. MethodsA total of 50 sportspeople who underwent ACL reconstruction using either BPTB (group A; n = 25) or STGPI (group B; n = 25) autografts were included in the study. Contrast enhanced MRI was done at 8 months and 14 months post-ACL reconstruction to evaluate the ligamentization using Signal noise quotient (SNQ), graft intensity and enhancement index. Clinical outcomes (Lysholm score) and knee laxity were also assessed at 8 months and 14 months. Results18/23 (78%) patients in group A and 14/23 (61%) patients in group B had hyperintense graft signal at 8 months (n.s.) and at 14 months, 1/23 patients in group A and none of the patients in group B had hyperintense graft. SNQ at 8 months was 3.6 ± 2 and 3.7 ± 2 in group A and B respectively (n.s.) and at 14 months, SNQ was 2.5 ± 1.5 in group A and 2.4 ± 1.3 in group B (n.s.). Enhancement index at 8 months was 1.5 ± 0.3 and 1.2 ± 0.3 in group A and B respectively (p = 0.0001). Enhancement index at 14 months was 1.21 ± 0.2 in group A and 1.07 ± 0.2 in group B (p = 0.003). Functional outcomes and knee laxity were comparable in both the groups at 8 and 14 months (n.s.). ConclusionBoth the grafts i.e. BPTB and STGPI are similar in terms of rate and extent of ligamentization. Clinical outcomes and knee laxity are also comparable between two grafts.

A fast, easy and reliable method for hamstrings graft size prediction in anterior cruciate ligament reconstruction

PurposeThe aim of this study is to describe and validate a simple and reliable method to pre-operatively predict the size of the ACL graft in the double strand technique with autologous semitendinosus–gracilis tendons on the same MRI used for ACL rupture diagnosis.MethodsThe study included 92 patients, with a median age of 31 years (IQR 26–41 years), 73/92 (79%) of whom were males. All patients that underwent an ACL reconstruction with doubled ST + GT between 2017 and 2022 were counted in the study.ResultsOverall, the median predicted graft diameter from MR imaging was similar to the actual graft diameter with no significant differences (n.s.). Regarding the comparison between predicted and actual graft size, concordance was 78/92 (85%, 95% CI 76–91%), with κ = 0.797 which corresponds to a level of agreement defined as “Strong”. Tendon sizes calculated on pre-operative MRI were evaluated both with intra-observer and inter-observer reliability demonstrating a statistically reproducible method. The predicted graft was then compared to the reported one with a statistically significant reliability found.ConclusionThis study can help the surgeons to perform a fast pre-operative planning of an ACL reconstruction for graft selection. If the planned graft with ST and GT is smaller than 8 mm, the clinician can decide to switch to a different type of graft or plan a different graft preparing technique and, therefore, reduce the risk of post-operative ligament re-rupture. The method proposed is reliable and reproducible. The major strength of the planning technique proposed is that it relies on data that are already available for the clinician before surgery, without the need of further analysis.Level of evidenceIV.

Patellofemoral Angle, Pelvis Diameter, Foot Posture Index, and Single Leg Hop in Post-Operative ACL Reconstruction.

Background and Objectives: Anterior cruciate ligament (ACL) injuries occur as a result of the deterioration of the static and dynamic stability of the knee. One of the structures involved in providing static stability is the patellofemoral angle (Q angle). The aim of this study was to investigate the relationships between Q angle, pelvis diameter, lower extremity length, and foot posture index (FPI) in patients who had undergone ACL reconstruction (ACLR) with the semitendinosus/gracilis (ST/G) technique on both the operated and non-operated sides. Materials and Methods: Twenty-five male recreational athletic patients between the ages of 18 and 35 who had undergone semitendinosus/gracilis (ST/G) anterior cruciate ligament reconstruction at least 6 months earlier were included in the study. Femur length, lower extremity length, pelvis diameter, and Q angle measurements, total foot posture index (FPI) scores, and single leg hop (SLH) and triple hop distance (THD) test results were determined on the operated and non-operated sides. Results: When the findings of the patients were evaluated statistically between the operated and non-operated sides, no significant differences were found in Q angle, femur length, and lower extremity length (p > 0.05). In terms of FPI scores, a significant difference was found only in the inversion/eversion of the calcaneus (CALC) parameter (p < 0.05). When the single hop test (SLHT) results were evaluated statistically on the operated and non-operated sides, the results were in favor of the non-operated side (p < 0.05). In the correlation analysis conducted for both the operated and non-operated sides, positive and significant correlations were found only between SLH and THD (p < 0.05). No significant difference was found in the other parameters. Conclusions: The fact that ST/G ACLR 6th month post-operative findings revealed similar results in Q angle, lower extremity length, and total FPI scores between the operated and non-operated sides showed that the 6-month process did not cause a difference in these parameters. However, it was found that the operated sides showed lower findings compared to non-operated sides for SLHTs, although these findings were within normal ranges in terms of the limb symmetry index.

Post-Operative Results of ACL Reconstruction Techniques on Single-Leg Hop Tests in Athletes: Hamstring Autograft vs. Hamstring Grafts Fixed Using Adjustable Cortical Suspension in Both the Femur and Tibia.

Background and Objectives: Anterior cruciate ligament (ACL) tears are common injuries in the athletic population, and accordingly, ACL reconstruction (ACLR) is among the most common orthopedic surgical procedures performed in sports medicine. This study aims to compare the semitendinosus/gracilis (ST/G) and ACL hamstring grafts fixed using adjustable cortical suspension in both the femur and tibia (MAI) ACLR techniques. We aimed to compare the results of single-leg hop tests (SLHT) applied in different directions and limb symmetry indices (LSI) in athletes with a 6-month post-operative ACLR history. Materials and Methods: A retrospective cohort of 39 athletes from various sports branches who underwent MAI (n = 16) and ST/G (n = 23) ACLR techniques by the same surgeon were evaluated. The knee strength of the participants on the operated and non-operated sides was evaluated with five different SLHTs. The SLHT included the single hop for distance (SH), triple hop for distance (TH), crossover triple hop for distance (CH), medial side triple hop for distance (MSTH), and medial rotation (90°) hop for distance (MRH). Results: There was a significant improvement in the mean Lysholm, Tegner, and IKDC scores in the post-operative leg for both techniques (p < 0.05) compared to the pre-operative levels. When there was a difference between the SH of the operative and the non-operative legs in the ST/G technique (p < 0.05), there was no significant difference in the other hop distance for both ST/G and MAI (p > 0.05). There was no difference between the techniques regarding the LSI scores. Conclusions: The fact that our research revealed similar LSI rates of the SLHTs applied in different directions in the ST/G and MAI techniques assumes that the MAI technique can be an ACLR technique which can be functionally used in athletes.

Revision anterior cruciate ligament reconstruction and outcomes with different autografts in a population with kneeling customs.

This study was designed to evaluate, compare the mid-term functional outcome of revision anterior cruciate ligament reconstruction (ACLR) using different autografts and assess the cause of failure of primary ACLR in an Omani population with kneeling customs. Patients with failed primary ACLR who underwent revision ACLR using autografts were included in this retrospective study. The cause of primary ACLR failure and the functional outcome was assessed using the Tegner-Lyholm knee score and compared among bone patella tendon-bone (BPTB), quadriceps tendon (QT), semitendinosus gracilis (STG) autografts used. One hundred two patients (102 male) were included in the study with a minimum follow-up of 2 years. Thirty-one patients underwent revision with BPTB, 34 with STG and 19 with QT autografts. Majority of the patients (70.23%) achieved good-to-excellent functional outcome based on their Tegner-Lysholm scores. The functional outcome of different autografts was comparable to each other based on Kruskal-Wallis test. The causes of primary ACLR failure were failure due to trauma in 58.33% of patients, technical failure in 22.61% of patients, and nontraumatic failure in 19.04% of patients. The functional outcome of revision ACLR in this Middle Eastern Asian Omani population was good-to-excellent, with the patients experiencing no difficulty in performing activities of daily living, including kneeling activities. The outcome of different autografts, BTPB, QT, STSG is similar in high knee flexion patients with no autograft found to be superior. The findings of this study add to the literature on functional outcomes after primary and revision ACLR in a customary kneeling population.

Acute anterolateral knee instability in adults: combined proximal ACL and ALL injury repair is not inferior to standard ACL reconstruction with LET in 2 years.

Objectives:The objective was to compare the clinical results of ACL and ALL repair with those of standard ACL reconstruction + LET. The hypothesis was that combined repair is non-inferior to standard reconstruction + LET in adults with acute anterolateral knee instability.Methods:Patients with severe acute anterolateral instability (ACL + ALL injuries) who underwent early ACL surgery (injury-to-surgery interval < 14 days), a total of 58 patients, were prospectively enrolled in the study. ACL injuries were classified according to the Sherman classification. Patients with a proximal injury (types 1 and 2) were assigned to receive ACL repair (ACLrep) (n = 37), patients with types 3 and 4 and moderate tissue quality (n = 21) were assigned to receive ACL reconstruction (ACLrec) + lateral extra-articular tenodesis (LET). Repair consisted of transosseous suture of the stump to the anatomic origin of the ACL and direct repair of the ALL. Reconstruction consisted of standard ACL reconstruction by semitendinosus-gracilis (STG) autograft + LET. PROMs included IKDC, Lysholm, KOOS, and assessment of anteroposterior (AP) knee laxity in 2 years.Results:A sample size calculation showed that 21 patients in each group were needed for a 95% power (with a 95% CI) to show non-inferiority of the repair group considering an arthrometric side-to-side difference of at least +1.5. Patients in the ACLrep group showed better results on all scales: mean IKDC was 95.51 ± 52.4 versus 86.92 ± 13.92 (p = 0.02); mean KOOS was 97.49 ± 2.71 versus 93.50 ± 7.05 (p = 0.009); and mean Lysholm was 96.98 ± 5.14 versus 91.69 ± 10.08 (p = 0.02). There was no difference in the KT1000 measurement (ACLrep: 1.70 ± 1.02; ACLrec: 2.21 ± 0.80; p = 0.11). The one-sided 95% CI was 1.7 (to 2.02) (< at the 3.01 limit for non-inferiority) for ACLrep and 2.21 (to 2.46) for ACLrec, p = 0.147. Therefore, non-inferiority was provenConclusion:In acute knee instability resulting from a combined ACL and ALL injury, direct repair is non-inferior in terms of PROM and knee laxity compared to standard ACL + LET reconstruction in 2 years.

Assessment of functional outcome of anterior cruciate ligament reconstruction in early and delayed presentation

Introduction: Surgical techniques of anterior cruciate ligament reconstruction have evolved over the past 3 decades along with debate regarding the timing of surgery. There is no consensus in the literature regarding the optimal time of surgical intervention. Methods: A prospective comparative study was conducted on 30 patients who were diagnosed with an anterior cruciate ligament tear. Patients were equally categorised into 2 groups (15 patients) based on a presentation from time of injury as - early presentation group (3 weeks from injury). All these patients underwent reconstruction with Semitendinosus Gracilis or Peroneus longus autografts by the same surgeon where standard surgery and rehabilitation protocols were followed. Functional outcome after ligament reconstruction was assessed using the IKDC and Lysholm scores preoperatively and postoperatively at 6weeks, 3 months and 6 months. Results: The functional outcome of the knee showed better improvement in the delayed presentation group than the early presentation group in both IKDC and Tegner Lysholm scores in the initial follow-up. Both the groups also recovered with a good range of movement but the delayed group scored better than the early presentation group. But the difference was insignificant at the end of 1 year. Conclusion: The functional outcome and range of motion after reconstruction of the anterior cruciate ligament is better after the healing of the soft tissue and bony contusion.

Long-term outcome following anterior cruciate ligament reconstruction: preliminary results of a 25-year prospective study

Background: In 1993, Gillquist stated that the only effect of anterior cruciate ligament (ACL) reconstruction is to give the patient enough security to reach the goal of going back to strenuous sports and then ruining the knee. Very few long-term studies able to address this issue, exist. This prospective long-term study aims to investigate objective and subjective outcomes 25 years post-ACL reconstruction using either bone-patellar tendon-bone (B-PT-B) or semitendinosus/gracilis (STG) grafting. Methods: The first ten patients (7 males, 3 females, mean age 51 years, B-PT-B graft n=4, STG graft n=6) from a cohort of 62 patients operated on between 1996 and 1998 were assessed using the same measures as three previous time-frames. This cohort had followed comprehensive quadriceps-emphasised rehabilitation delivered by the same physiotherapist. Outcome measures included quadriceps and hamstring strength (Cybex 11), clinical and instrumented stability (KT1000), three agility tests (shuttle run, side-step, carioca), two hop tests (hop, triple hop), return to sport history, current sport involvement, and bilateral knee x-rays. Results: One patient ruptured their graft and contralateral patellar tendon; one patient tore their hamstring; one patient had two arthroscopies; and two patients ruptured their contralateral ACL, one of whom underwent bilateral total knee replacements (TKR). Mean quadriceps strength index (60°/sec) was 92%, and mean hamstring index was 90%. Mean KT1000 side-to-side difference (20 lbs) was 1mm. One patient had a positive pivot shift test and one a pivot glide. Excluding the patient with TKRs, nine patients performed the agility tests well. Mean hop indices were 94% for the hop and 96% for the triple hop (n=8). Nine patients had returned to competitive pivoting sport, three for nearly 20 years. Three patients continued to play competitive volleyball, cricket and soccer at Masters level. Six patients remained active in less vigorous activities (running, football coaching, golf, aerobics, gym). On x-ray, four patients had mild tibiofemoral osteoarthritis (TFOA), four had moderate TFOA and one had severe TFOA (Kellgren-Lawrence grading). Findings were similar for patellofemoral OA. No patient regretted having surgery. Discussion: The most important finding was the high level of strength, stability, function and sports participation found in this group, despite moderate-severe radiographic OA observed in half of the patients. Ongoing study of the full cohort will provide key information as to how clinicians can improve long-term results following ACL reconstruction. My co-authors and I acknowledge that we have no conflict of interest of relevance to submission of this abstract.

Clinical outcome of anterior cruciate ligament reconstruction with modified transtibial and anteromedial portal

Arthroscopic ACL reconstruction is the current standard care of treatment for anterior cruciate ligament (ACL) injuries. Modified transtibial (mTT) and anteromedial portal (AMP) techniques aim at the anatomical placement of femoral tunnel. Controversy existed in the literature with regard to the outcome of these techniques. Hence, we designed a retrospective comparative study to analyse the clinical and functional outcomes of mTT and AMP techniques. We hypothesized that there would be no difference between the clinical and functional outcomes in mTT and AMP techniques. This retrospective observational study was conducted in consecutive patients who underwent arthroscopic ACL reconstruction using semitendinosus-gracilis (STG) quadrupled graft in our tertiary care centre with a minimum follow-up of two years. Out of 69 patients, 37 had undergone ACL reconstruction by mTT technique and remaining by AMP technique. All the patients were assessed clinically by anterior drawer, Lachman’s, pivot shift and single-legged hop test. Lysholm Knee Scoring Scale and International Knee Documentation Committee (IKDC) subjective knee evaluation score were used for the functional status. Knee instability was assessed objectively by KT-1000 arthrometer. There was no statistically significant difference in baseline demographic characteristics between mTT and AMP groups. At the end of 2 years, no statistically significant difference was noted in the anterior drawer and Lachman’s test. Though not significant, IKDC scores and Lysholm’s scores showed a better outcome in the AMP group when compared to the mTT group. AMP group showed significantly better outcome with KT-1000 arthrometer. Based on the results obtained, we presume that overall both mTT and AMP have similar functional outcome. However, as AMP technique offers significantly improved subjective rotational stability on pivot shift test, better hop limb symmetry index and KT 1000 readings compared to mTT, we suggest AMP over mTT.

Comparison of Bone-Patellar Tendon-Bone Graft, Semitendinosus-Gracilis Graft and Semitendinosus-Gracilis with Preserved Tibial Insertion Graft in Anterior Cruciate Ligament Reconstruction in Sports Persons.

Introduction:Bone-patellar tendon-bone (BPTB) and semitendinosus–gracilis (STG) are the commonest grafts used for ACL reconstruction. However even after having been debated for years, there is no consensus about the ideal graft. Moreover, the literature is deficient about STG graft with preserved tibial insertion (STGPI) which preserves the proprioception. Our aim is to compare the outcome of BPTB, free STG and STGPI grafts after ACL reconstruction in professional sports persons. We compared the outcome in terms of mechanical stability, functional outcome, return to sports activity and degenerative changes.Material and Methods:Professional sports persons aged between 16-50 years operated for ACL tear using BPTB, free STG and STGPI grafts with minimum follow-up of two years were identified from hospital records. Patients with associated knee injuries were excluded. Patients, divided in three groups according to graft used, were compared in terms of mechanical stability (arthrometric examination KT-1000 score), functional outcome (Lysholm Score), return to sports activity (Tegner score and difference in thigh circumference) and degenerative changes (KL grading).Results:BPTB graft group was found to be better than free STG and STGPI graft groups in terms of KT-1000 score. There was no statistically significant difference among the groups in terms of Lysholm score, Tegner score, difference in thigh circumference and KL grading.Conclusion:BPTB graft is better than free STG and STGPI grafts in terms of knee stability. When compared for patient reported outcome, return to sports activity, osteoarthritic changes and graft failure there is no significant difference among the three types of grafts.

Outcomes after arthroscopic revision surgery for anterior cruciate ligament injuries

Background and purpose — The frequency of primary anterior cruciate ligament (ACL) reconstruction is increasing resulting in more ACL revision surgeries. Therefore, we assessed survival rates of 2 different grafts for ACL revision surgery at 1- and 5-year follow-ups, as well as physical activity levels of patients after revision surgery. Patients and methods — This is a retrospective cohort study involving 218 patients (176 males) who had revision surgery for anterior cruciate ligament injuries between 2008 and 2017 at the Clinic of Traumatology, Orthopedics and Joint Pathology Clinic (I.M. Sechenov First Moscow State Medical University). A comparison group involved 189 patients with only primary surgery. Surgical interventions were performed according to the standard procedure using bone–patellar tendon–bone (BTB) and semitendinosus/gracilis (ST/G) autografts. The results of revision surgery were assessed at 1- and 5-year follow-ups by using the Lysholm and International Knee Documentation Committee scores. Results — Malpositioned bone tunnels were found in 87/218 patients (40%). At 1 and 5 years postoperatively, the revision BTB group had significantly better results in terms of IKDC and Lysholm scores than the revision ST/G group (p = 0.03, Mann–Whitney U-test), and these results were comparable to those in the comparison group. Graft survival after revision was lower than after the primary operation. However, the survival rate of 80% is quite high and is consistent with previous findings. There were no statistically reliable differences in survival between ST/G and BTB autografts. Interpretation — The graft choice for revision ACL surgery should be decided upon before surgery based on, among other things, the state of bone tunnels, in particular their position and degree of bone resorption. Tunnel widening that exceeds 14 mm (osteolysis) would require 2-stage surgery using a BTB autograft with bone plugs because it is larger than the ST/G autograft.

A STUDY OF THE OUTCOME OF “LIGAMENT CROISE ANTERIEUR" (ACL) RECONSTRUCTION USING AUTOLOGOUS HAMSTRING GRAFT

ACL injury is a widely recognized injury affecting the Genu-Joint Male to female ratio of “L ” injuries are, igament Croise Anterieur (ACL) as high as 9 :1 igament Croise Anterieur (ACL) . “L ” reconstruction with Hamstring grafts, is currently one of the most commonly used method nowadays. This Prospective study of 30 subjects treated by surgicalarthroscopic technique, wherein, Quadrupled Graft of Hamstring was used,for the femoral xation, an endo-button was used, and for the tibial xation, screw of the interference variety was used. Patients were on routine follow up,for at least a period of one year. All the subjects were subjected to post-operative AP and LAT X-rays, to ear mark the placement of the tunnel and positioning of the endo-button in the femoral sector and the interference screw in the tibial sector. Subjects were,upon a follow-up program, at 1,2,3months and there again at the end of 6 months and later on twice in a year. All subjects were evaluated with Tegner and Lysholm Knee Scoring Scale. The major Goal of “L ” recon, is towards re-establishing the stability of the knee. Succe igament Croise Anterieur (ACL) ssful functional outcomes following “L ” reconstruction,with a Semi-tendinosus Gracilis Graft, ha igament Croise Anterieur (ACL) s been reported in the literature. The optimal xation methodology for “L ” reconstruction is still evolving and the e igament Croise Anterieur (ACL) xisting xation devices which has been extensively used are the Endo-button and the “Biological Interference Screws, which has led to a better rehabilitation program postoperatively. In our study, all subjects were ordained to a proper rehabilitation protocol. 10% (n=3) subjects in the present study, had excellent results, 80% (n=24) of the subjects had good results and 10% (n=3) of the subjects had fair results. No subjects were reported to be, in the poor outcome category. Treatment of “L ” njuries necessitates, cautious pre-operati igament Croise Anterieur (ACL) i ve planning, selection of patients, radiological evaluation, selection of graft thickness, planning of timing of surgery, careful intra-operative care, good technique and post-operative rehabilitation, including thorough counselling for a good functional outcome.

Five-Strand Versus Four-Strand Hamstring Autografts in Anterior Cruciate Ligament Reconstruction—A Prospective Randomized Controlled Study

To compare the clinical outcomes of the routine use of 5-strand hamstring grafts (where possible) with those of 4-strand grafts in primary anterior cruciate ligament (ACL) reconstruction. A total of 64 patients were enrolled in a prospective randomized controlled study comparing the use of 5-strand and 4-strand semitendinosus-gracilis autografts in single bundle ACL reconstruction (n= 32 in each group). Four participants in each group were lost to follow-up and were excluded from the outcome analysis. The outcomes of 28 patients in the 5-strand group and 28 patients in the 4-strand group were analyzed. The diameters of all grafts were measured intraoperatively. Patients were assessed postoperatively at 2 years with objective assessments (anterior knee laxity using the KT-2000 arthrometer, Lachman test, pivot-shift test, hop test) and patient-reported outcome scores (Lysholm knee score, Knee Injury and Osteoarthritis Outcome Score, International Knee Documentation Committee subjective knee score, SF-36 physical and mental components, Tegner activity scale). Postoperative graft ruptures were also noted. There were improvements in all outcome measures postoperatively regardless of the number of graft strands. When we compared the study and control groups, there were no significant differences in all subjective and objective outcome measures except the Knee Injury and Osteoarthritis Outcome Score symptoms score (5-strand group 93.3 ± 9.2 vs 4-strand group 86.2 ± 14.7, P= .04). The KT-2000 side-to-side difference was 2.79 ± 2.11 mm in the 5-strand group and 2.54 ± 1.75 mm in the 4-strand group (P=.63). The 5-strand study group had 2 graft ruptures at 1 year, whereas the 4-strand control group had one partial graft rupture at 6 months. At 2-year follow-up, the routine use of the 5-strand hamstring tendon autograft was not superior to that of the quadrupled or 4-strand graft in primary ACL reconstruction. Level I, prospective randomized controlled trial.

Smaller cross-sectional areas of the hamstring tendon measured from preoperative ultrasonography are likely to need additional gracilis harvesting for double-bundle anterior cruciate ligament reconstructions

Background/PurposeHamstring tendon autografts are commonly used for double-bundle anterior cruciate ligament reconstruction (DB-ACLR). If the volume of the semitendinosus (ST) tendon is insufficient, the gracilis (G) tendon is also harvested. Additional harvesting of the G autograft can affect patients’ short-term postoperative outcome, such as muscle recovery; thus, preoperative information about whether an additional G autograft is needed would be useful. The purpose of this study was to investigate whether preoperative measurement of the ST tendon using ultrasonography could inform the intraoperative decision to harvest the G tendon.MethodsWe enrolled 20 patients (13 men and seven women) who underwent DB-ACLR between October 2017 and March 2019. The mean patient age was 28.5 years. The ipsilateral ST tendon was measured using ultrasonography before surgery. Measurements included the diameter and breadth of the short-axis image. The cross-sectional area (CSA) was calculated from these measurements. During surgery, when two grafts with diameters of ≥ 5.0 mm could not be made, the G tendon was also harvested. Patients were categorized into two groups: the ST group where only the ST tendon was harvested, and the semitendinosus gracilis tendon (STG) group where the ST and G tendons were both harvested. The CSA value was compared between the two groups, and the cutoff value was calculated.ResultsIn the ST group (n = 8), the mean diameter and breadth of the semitendinosus tendon were 4.21 and 2.34 mm, respectively. In the STG group (n = 12), the mean diameter and breadth of the ST tendon were 3.39 and 1.78 mm, respectively. The CSAs calculated for the ST group and the STG group were 7.74 mm2 and 4.79 mm2, respectively. A cutoff value of 7.0 mm2 was found to correspond to a specificity and sensitivity to harvest the G tendon of 87.5% and 75.0%, respectively.ConclusionsThe preoperative CSA of the ST tendon determined using ultrasonography can, therefore, be informative for deciding whether to harvest the G tendon for DB-ACLR. The results of this study provide valuable information for graft selection in anterior cruciate ligament reconstruction.Level of EvidenceIV (Retrospective case series design).

Pre-operative Joint Inflammation has no Bearing on Outcome of Arthroscopic Anterior Cruciate Ligament Reconstruction at 1-Year Follow-Up; a Prospective Study.

To study the effect of pre-operative joint inflammation on clinical outcome at 1year follow-up following ACL reconstruction surgery. Male patients, aged 18-40years, suffering from isolated ACL injury were included. All patients were randomly divided into two groups based on the type of graft used: Group A: semitendinosus gracilis graft with preserved insertions (STG-PI), Group B: bone-patellar tendon-bone graft (BPTB). Patients were categorised based on the time of presentation after injury: (a) within 6weeks of injury, (b) between 6 and 12weeks of injury, (c) after 12weeks of injury. Synovial fluid levels of Interlukin-1, Interlukin-6 and TNF-α were measured in all the ACL deficient knees by taking a joint fluid sample intra-operatively. The total number of patients in the study was 59; 23 in group A (STG-PI) and 36 in group B (BPTB). Mean age of patients was 26 ± 5.146years. 14 out of 59 (23.7%) patients presented within 6weeks of injury, 16 (27.11%) patients presented between 6 and 12weeks after injury and 29 (49.1%) patients presented after 12weeks of injury. IL-6 levels were significantly high in group with < 6weeks of injury than in group with > 12weeks since injury. IL-6 had significant correlation with VAS scores, KT 1000, Lysholm knee scores and Tegner level of activity. There was no difference in outcome (pain scores, mechanical stability, Lysholm knee score and Tegner level of activity) at 1year follow-up when patients with different time intervals since injury were compared. The clinical outcome in terms of pain score, mechanical stability, functional scores and return to sporting activity is comparable, irrespective of the time since injury, at short term follow-up.

Reconstruction of massive knee defects with extensor mechanism deficiency through concurrent anterolateral thigh flap and autogenous hamstring tendon: A report of two cases

Reconstruction of an infected knee joint with a large defect and extensor mechanism deficiency is challenging. In this study, we aim to describe a one-stage reconstruction surgery and provide its surgical outcome. Two patients had patellar open fracture and subsequent septic arthritis; in addition, a large soft tissue defect, loss of patella, and shortening of the patellar tendon were observed. The semitendinosus-gracilis tendon formed a loop to stabilize the patella. A free or supercharged reverse pedicle myocutaneous anterolateral thigh flap with fascial extension is designed to fill the defect and eradicate the infection. Mean clinical follow-up was 18 months. Although some limitation in the knee range of motion was observed, the dynamometer showed only partial loss in peak concentric power and eccentric power. We developed an innovative surgical procedure to alleviate infection and reconstruct a complex knee defect with extensor mechanism deficiency; this procedure resulted in favorable clinical outcomes.