A quadrupled semitendinosus only anterior cruciate ligament reconstruction with tibial suspensory fixation
Keywords:
ACL reconstruction, suspensory fixation, suture disc, quadrupled semitendinosus graft, gracilis tendon sparing
Abstract
Purpose: Study is designed to analyze the postoperative outcome of arthroscopic ACL reconstruction with quadrupled semitendinosus tendon autograft fixed in femoral tunnel using tight rope and in the tibial tunnel using suture disc.
Methods: A prospective study on a continuous series of 102 patients, operated for ACL rupture, using the same technique, from September 2010 to March 2013.
Results:The longest follow-up was at 24 months. At 2 year follow-up the mean International Knee Documentation Committee (IKDC 1999) evaluation score revealed that 63.7% had a normal overall grade A. The mean Lysholm score improved from 59.4 to 92.4 at follow-up. The improvement in the limb symmetry index by single hop test was statistically significant. Laxity assessment at 12 months showed 87.2% had a grade 0 or 1 Lachman laxity with a hard end point. Patients had no motion deficit and the knee was stable in deep flexion and retained their strength during internal rotation of the knee.
Conclusion: a quadrupled semitendinosus graft was adequate in order to be used alone as a four-strand graft and to get a minimum length and thickness for our graft construct. This enhanced our post-operative rehabilitation by contribution to stability in deep flexion and retaining the strength during internal rotation of the knee. It is cost effective to use atightropeat the femoral end and suture disc at the tibial end as compared to an aperture fixation by a bioscrew.
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References
1. Tiago LazzarettiFernandes, Douglas Badillo Ribeiro, Diogo Cristo da Rocha, Cyro Albuquerque, César Augusto, André Pedrinelli et al. Description of an evaluation system for knee kinematics in ligament lesions, by means of optical tracking and 3D tomography. RevistaBrasileira de Ortopedia 2014; 49(5):513-519.
2. Prodromos CC, Han YS, Keller BL, Bolyard RJ.Stability results of hamstring anterior cruciate ligament reconstruction at 2- to 8-year follow-up.Arthroscopy. 2005 Feb;21(2):138-46.
3. Hospodar SJ, Miller MD. Controversies in ACL reconstruction: bone-patellar tendon-bone anterior cruciate ligament reconstruction remains the gold standard.Sports Med Arthrosc. 2009 Dec;17(4):242-6. doi: 10.1097/JSA.0b013e3181c14841.
4. IS Corry, JM Webb, AJ Clingeleffer, LA Pinczewski. Arthroscopic reconstruction of the anterior cruciate ligament A comparison of patellar tendon autograft and four-strand hamstring tendon autograft. The American Journal of Sports Medicine 1999; 27(4): 444-454.
5. Roe J, Pinczewski LA, Russell VJ, Salmon LJ, Kawamata T, Chew M.A 7-year follow-up of patellar tendon and hamstring tendon grafts for arthroscopic anterior cruciate ligament reconstruction: differences and similarities.Am J Sports Med. 2005 Sep;33(9):1337-45. Epub 2005 Jul 7.
6. Reinhardt, Keith R, IftachHetsroni, and Robert G. Marx. Graft selection for anterior cruciate ligament reconstruction: a level I systematic review comparing failure rates and functional outcomes. Orthopedic Clinics of North America 2010; 41(2): 249-262.
7. Chae-Gwan Kong, Yong In, Geon-Hyeong Kim, and Chi-Young Ahn, Cross pins versus endobutton femoral fixation in hamstring anterior cruciate ligament reconstruction: minimum 4-year follow-Up. Knee surgery & related research2012; 24(1):34-39.
8. Frank Adam, Dietrich Pape, Karin Schiel, Oliver Steimer, Dieter Kohn, and Stefan Rupp. Biomechanical properties of patellar and hamstring graft tibial fixation techniques in anterior cruciate ligament reconstruction Experimental study with roentgen stereometric analysis. The American journal of sports medicine 2004;32(1):71-78.
9. James J. Irrgang, Allen F. Anderson, Arthur L, Boland, Christopher D. Harner, Masahiro Kurosaka, PhillipeNeyret, et al. Development and validation of International Knee Documentation Committee Subjective Knee Form. The American Journal of Sports Medicine, 2001;29(5):600-613.
10. Lysholm J, Gillquist J.Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale.Am J Sports Med. 1982 May-Jun;10(3):150-4. [PubMed]
11. Frank R. Noyes, Sue D. Barber and Robert E. Mangine, Abnormal lower limb symmetry determined by function hop tests after anterior cruciate ligament rupture. The American Journal of Sports Medicine, 1991; 19(5):513-518.
12. Majewski M, Susanne H, Klaus S.Epidemiology of athletic knee injuries: A 10-year study.Knee. 2006 Jun;13(3):184-8. Epub 2006 Apr 17. [PubMed]
13. Cooley, Vernon J., Kathleen T. Deffner, and Thomas D. Rosenberg. Quadrupled semitendinosus anterior cruciate ligament reconstruction: 5-year results in patients without meniscus loss. Arthroscopy: The Journal of Arthroscopic & Related Surgery2001; 17(8):795-800. [PubMed]
14. Chen L, Cooley V, Rosenberg T. ACL reconstruction with hamstring tendon.Orthop Clin North Am. 2003 Jan;34(1):9-18. [PubMed]
15. Randy Schwartzberg, Bradd Burkhart, and Christopher Lariviere, Prediction of Hamstring Tendon Autograft Diameter and Length for Anterior Cruciate Ligament Reconstruction, Am J Orthop. 2008;37(3):157-159. [PubMed]
16. Papastergiou G. Stergios, Konstantinidis A. Georgios, Natsis Konstantinos, PapathanasiouEfthymia, Koukoulias Nikolaos, and Papadopoulos G. Alexandros. Adequacy of Semitendinosus Tendon Alone for Anterior Cruciate Ligament Reconstruction Graft and Prediction of Hamstring Graft Size by Evaluating Simple Anthropometric Parameters. Anatomy Research International Volume 2012, Article ID 424158, 8 pages doi:10.1155/2012/424158.
17. Maurilio Marcacci, Stefano Zaffagnini, Francesco Iacono, Alberto Vascellari, Ivano Loreti, Elisavetaet al, Intra- and extra-articular anterior cruciate ligament reconstruction utilizing autogeneous semitendinosus and gracilis tendons: 5-Year clinical results, Knee Surgery, Sports Traumatology, Arthroscopy 2003;11(1):2–8.
18. Howell SM, Deutsch ML.Comparison of endoscopic and two-incision techniques for reconstructing a torn anterior cruciate ligament using hamstring tendons.Arthroscopy. 1999 Sep;15(6):594-606.
19. S. M. Howell. Gold standard-DLSTG graft, Presented at AAOSM Specialty Day New Orleans, Louisiana, USA, 2003.
20. A. Gobbi. Double bundle ACL reconstruction Using Only the Semitendinosus. ISAKOS Current concepts, winter 2007.
21. V. Cooley and K. Deffner. Quadrupled semi-T anterior cruciate ligament reconstruction: tips, techniques, and results. Techniques in Orthopaedics, 2005; 20(3):207–210.
22. J. A. Feller, R. Siebold, and K. E. Webster, ACL reconstruction in females: patellar tendon versus hamstring tendon autograft,” in Journal of Bone and Joint Surgery B 2005; 87(3):305.
23. Grood ES, Walz-Hasselfeld KA, Holden JP, Noyes FR, Levy MS, Butler DL, Jackson DW, Drez DJ.The correlation between anterior-posterior translation and cross-sectional area of anterior cruciate ligamentreconstructions.J Orthop Res. 1992 Nov;10(6):878-85.
24. M. Hamada, K. Shino, S. Horibe, T. Mitsuoka, Y. Toritsuka, and N. Nakamura, “Changes in cross-sectional area of hamstring anterior cruciate ligament grafts as a function of time following transplantation,” Arthroscopy, 2005;21(8):917-922.
25. L'Insalata JC, Klatt B, Fu FH, Harner CD. Tunnel expansion following anterior cruciate ligament reconstruction: a comparison of hamstring and patellar tendon autografts. Knee Surg Sports TraumatolArthrosc 1997; 5:234-238.
26. Webster KE, Feller JA, Hameister KA. Bone tunnel enlargement following anterior cruciate ligament reconstruction: a randomised comparison of hamstring and patellar tendon grafts with 2- year follow-up. Knee Surg Sports Traumatol Arthrosc 2001; 9:86-91.
27. Baumfeld JA, Diduch DR, Rubino LJ, Hart JA, Miller MD, Barr MS, Hart JM. Tunnel widening following anterior cruciate ligament reconstruction using hamstring autograft: a comparison between double cross-pin and suspensory graft fixation. Knee Surg Sports Traumatol Arthrosc 2008; 16:1108-1113.
28. Hersekli MA, Akpinar S, Ozalay M. Tunnel enlargement after arthroscopic anterior cruciate ligament reconstruction: comparison of bone-patellar tendon-bone and hamstring autografts. AdvTher 2004; 21:123-131.
29. Harvey AR, Thomas NP, Amis AA.The effect of screw length and position on fixation of four-stranded hamstring grafts for anterior cruciate ligament reconstruction.Knee. 2003 Mar;10(1):97-102.
30. Giurea M, Zorilla P, Amis AA, Aichroth P.Comparative pull-out and cyclic-loading strength tests of anchorage of hamstring tendon grafts in anterior cruciate ligament reconstruction.Am J Sports Med. 1999 Sep-Oct;27(5):621-5.
31. Plaweski, S., J. Rossi, and P. Merloz. Anterior cruciate ligament reconstruction: Assessment of the hamstring autograft femoral fixation using the EndoButton CL®. Orthopaedics& Traumatology: Surgery & Research, 2009;95(8):606-613.
32. Spicer DD, Blagg SE, Unwin AJ, Allum RL.Anterior knee symptoms after four-strand hamstring tendon anterior cruciate ligament reconstruction.Knee Surg Sports TraumatolArthrosc. 2000;8(5):286-9.
2. Prodromos CC, Han YS, Keller BL, Bolyard RJ.Stability results of hamstring anterior cruciate ligament reconstruction at 2- to 8-year follow-up.Arthroscopy. 2005 Feb;21(2):138-46.
3. Hospodar SJ, Miller MD. Controversies in ACL reconstruction: bone-patellar tendon-bone anterior cruciate ligament reconstruction remains the gold standard.Sports Med Arthrosc. 2009 Dec;17(4):242-6. doi: 10.1097/JSA.0b013e3181c14841.
4. IS Corry, JM Webb, AJ Clingeleffer, LA Pinczewski. Arthroscopic reconstruction of the anterior cruciate ligament A comparison of patellar tendon autograft and four-strand hamstring tendon autograft. The American Journal of Sports Medicine 1999; 27(4): 444-454.
5. Roe J, Pinczewski LA, Russell VJ, Salmon LJ, Kawamata T, Chew M.A 7-year follow-up of patellar tendon and hamstring tendon grafts for arthroscopic anterior cruciate ligament reconstruction: differences and similarities.Am J Sports Med. 2005 Sep;33(9):1337-45. Epub 2005 Jul 7.
6. Reinhardt, Keith R, IftachHetsroni, and Robert G. Marx. Graft selection for anterior cruciate ligament reconstruction: a level I systematic review comparing failure rates and functional outcomes. Orthopedic Clinics of North America 2010; 41(2): 249-262.
7. Chae-Gwan Kong, Yong In, Geon-Hyeong Kim, and Chi-Young Ahn, Cross pins versus endobutton femoral fixation in hamstring anterior cruciate ligament reconstruction: minimum 4-year follow-Up. Knee surgery & related research2012; 24(1):34-39.
8. Frank Adam, Dietrich Pape, Karin Schiel, Oliver Steimer, Dieter Kohn, and Stefan Rupp. Biomechanical properties of patellar and hamstring graft tibial fixation techniques in anterior cruciate ligament reconstruction Experimental study with roentgen stereometric analysis. The American journal of sports medicine 2004;32(1):71-78.
9. James J. Irrgang, Allen F. Anderson, Arthur L, Boland, Christopher D. Harner, Masahiro Kurosaka, PhillipeNeyret, et al. Development and validation of International Knee Documentation Committee Subjective Knee Form. The American Journal of Sports Medicine, 2001;29(5):600-613.
10. Lysholm J, Gillquist J.Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale.Am J Sports Med. 1982 May-Jun;10(3):150-4. [PubMed]
11. Frank R. Noyes, Sue D. Barber and Robert E. Mangine, Abnormal lower limb symmetry determined by function hop tests after anterior cruciate ligament rupture. The American Journal of Sports Medicine, 1991; 19(5):513-518.
12. Majewski M, Susanne H, Klaus S.Epidemiology of athletic knee injuries: A 10-year study.Knee. 2006 Jun;13(3):184-8. Epub 2006 Apr 17. [PubMed]
13. Cooley, Vernon J., Kathleen T. Deffner, and Thomas D. Rosenberg. Quadrupled semitendinosus anterior cruciate ligament reconstruction: 5-year results in patients without meniscus loss. Arthroscopy: The Journal of Arthroscopic & Related Surgery2001; 17(8):795-800. [PubMed]
14. Chen L, Cooley V, Rosenberg T. ACL reconstruction with hamstring tendon.Orthop Clin North Am. 2003 Jan;34(1):9-18. [PubMed]
15. Randy Schwartzberg, Bradd Burkhart, and Christopher Lariviere, Prediction of Hamstring Tendon Autograft Diameter and Length for Anterior Cruciate Ligament Reconstruction, Am J Orthop. 2008;37(3):157-159. [PubMed]
16. Papastergiou G. Stergios, Konstantinidis A. Georgios, Natsis Konstantinos, PapathanasiouEfthymia, Koukoulias Nikolaos, and Papadopoulos G. Alexandros. Adequacy of Semitendinosus Tendon Alone for Anterior Cruciate Ligament Reconstruction Graft and Prediction of Hamstring Graft Size by Evaluating Simple Anthropometric Parameters. Anatomy Research International Volume 2012, Article ID 424158, 8 pages doi:10.1155/2012/424158.
17. Maurilio Marcacci, Stefano Zaffagnini, Francesco Iacono, Alberto Vascellari, Ivano Loreti, Elisavetaet al, Intra- and extra-articular anterior cruciate ligament reconstruction utilizing autogeneous semitendinosus and gracilis tendons: 5-Year clinical results, Knee Surgery, Sports Traumatology, Arthroscopy 2003;11(1):2–8.
18. Howell SM, Deutsch ML.Comparison of endoscopic and two-incision techniques for reconstructing a torn anterior cruciate ligament using hamstring tendons.Arthroscopy. 1999 Sep;15(6):594-606.
19. S. M. Howell. Gold standard-DLSTG graft, Presented at AAOSM Specialty Day New Orleans, Louisiana, USA, 2003.
20. A. Gobbi. Double bundle ACL reconstruction Using Only the Semitendinosus. ISAKOS Current concepts, winter 2007.
21. V. Cooley and K. Deffner. Quadrupled semi-T anterior cruciate ligament reconstruction: tips, techniques, and results. Techniques in Orthopaedics, 2005; 20(3):207–210.
22. J. A. Feller, R. Siebold, and K. E. Webster, ACL reconstruction in females: patellar tendon versus hamstring tendon autograft,” in Journal of Bone and Joint Surgery B 2005; 87(3):305.
23. Grood ES, Walz-Hasselfeld KA, Holden JP, Noyes FR, Levy MS, Butler DL, Jackson DW, Drez DJ.The correlation between anterior-posterior translation and cross-sectional area of anterior cruciate ligamentreconstructions.J Orthop Res. 1992 Nov;10(6):878-85.
24. M. Hamada, K. Shino, S. Horibe, T. Mitsuoka, Y. Toritsuka, and N. Nakamura, “Changes in cross-sectional area of hamstring anterior cruciate ligament grafts as a function of time following transplantation,” Arthroscopy, 2005;21(8):917-922.
25. L'Insalata JC, Klatt B, Fu FH, Harner CD. Tunnel expansion following anterior cruciate ligament reconstruction: a comparison of hamstring and patellar tendon autografts. Knee Surg Sports TraumatolArthrosc 1997; 5:234-238.
26. Webster KE, Feller JA, Hameister KA. Bone tunnel enlargement following anterior cruciate ligament reconstruction: a randomised comparison of hamstring and patellar tendon grafts with 2- year follow-up. Knee Surg Sports Traumatol Arthrosc 2001; 9:86-91.
27. Baumfeld JA, Diduch DR, Rubino LJ, Hart JA, Miller MD, Barr MS, Hart JM. Tunnel widening following anterior cruciate ligament reconstruction using hamstring autograft: a comparison between double cross-pin and suspensory graft fixation. Knee Surg Sports Traumatol Arthrosc 2008; 16:1108-1113.
28. Hersekli MA, Akpinar S, Ozalay M. Tunnel enlargement after arthroscopic anterior cruciate ligament reconstruction: comparison of bone-patellar tendon-bone and hamstring autografts. AdvTher 2004; 21:123-131.
29. Harvey AR, Thomas NP, Amis AA.The effect of screw length and position on fixation of four-stranded hamstring grafts for anterior cruciate ligament reconstruction.Knee. 2003 Mar;10(1):97-102.
30. Giurea M, Zorilla P, Amis AA, Aichroth P.Comparative pull-out and cyclic-loading strength tests of anchorage of hamstring tendon grafts in anterior cruciate ligament reconstruction.Am J Sports Med. 1999 Sep-Oct;27(5):621-5.
31. Plaweski, S., J. Rossi, and P. Merloz. Anterior cruciate ligament reconstruction: Assessment of the hamstring autograft femoral fixation using the EndoButton CL®. Orthopaedics& Traumatology: Surgery & Research, 2009;95(8):606-613.
32. Spicer DD, Blagg SE, Unwin AJ, Allum RL.Anterior knee symptoms after four-strand hamstring tendon anterior cruciate ligament reconstruction.Knee Surg Sports TraumatolArthrosc. 2000;8(5):286-9.
CITATION
DOI: 10.17511/ijmrr.2016.i01.006
Published: 2016-01-31
How to Cite
1.
Ballal MM, Chebbi P. A quadrupled semitendinosus only anterior cruciate ligament reconstruction with tibial suspensory fixation. Int J Med Res Rev [Internet]. 2016Jan.31 [cited 2024Nov.8];4(1):38-6. Available from: https://ijmrr.medresearch.in/index.php/ijmrr/article/view/430
Section
Original Article
OAI - Open Archives Initiative
