Braided Hamstring Tendons for Reconstruction of the Anterior Cruciate Ligament: A Biomechanical Analysis

2002 ◽  
Vol 30 (5) ◽  
pp. 684-688 ◽  
Author(s):  
John E. Tis ◽  
William R. Klemme ◽  
Kevin L. Kirk ◽  
Kevin P. Murphy ◽  
Bryan Cunningham
Keyword(s):  
Anterior Cruciate Ligament ◽  
Patellar Tendon ◽  
Cruciate Ligament ◽  
Hamstring Tendon ◽  
Biomechanical Analysis ◽  
Hamstring Tendons ◽  
Tendon Grafts ◽  
Anterior Cruciate ◽  
Strength And Stiffness ◽  
Bone Patellar Tendon

Background: In an effort to improve the strength and stiffness of anterior cruciate ligament grafts, several authors have advocated alterations of graft structure and orientation, including braiding the tendons in hamstring tendon grafts. Hypothesis: Braiding hamstring tendons does not increase graft strength and stiffness. Study Design: Controlled laboratory study. Methods: Sixteen hamstring tendon and 21 bone-patellar tendon-bone grafts were harvested from 12 cadavers and divided into three groups: 1) braided four-strand hamstring tendon, 2) unbraided four-strand hamstring tendon, and 3) bone-patellar tendon-bone. All grafts were placed under a 50-N preload on a servohydraulic testing device and were tensioned to failure. Results: The strength and stiffness of the tested specimens averaged 427 ± 36 N and 76 ± 10 N/mm, respectively, for braided specimens, 532 ± 44 N and 139 ± 18 N/mm for unbraided specimens, and 574 ± 46 N and 158 ± 15 N/mm for patellar tendon specimens. There was a 20% decrement in hamstring tendon graft tensile strength and a 45% decrease in stiffness after braiding because of the suboptimal multidirectional orientation of individual tendons within the braided grafts. Conclusions: In vitro braided hamstring tendon grafts demonstrated mechanically inferior strength and stiffness characteristics compared with unbraided hamstring tendon grafts and patellar tendon grafts. Clinical Relevance: Braiding of hamstring tendon grafts provides no mechanical advantage in anterior cruciate ligament reconstruction.

Hamstring Tendon versus Patellar Tendon Anterior Cruciate Ligament Reconstruction Using Biodegradable Interference Fit Fixation

2005 ◽  
Vol 33 (9) ◽  
pp. 1327-1336 ◽  
Author(s):  
Michael Wagner ◽  
Max J. Kääb ◽  
Jessica Schallock ◽  
Norbert P. Haas ◽  
Andreas Weiler
Keyword(s):  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Patellar Tendon ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Hamstring Tendon ◽  
Cruciate Ligament Reconstruction ◽  
Tendon Grafts ◽  
Anterior Cruciate ◽  
Bone Patellar Tendon

Background There are still controversies about graft selection for primary anterior cruciate ligament reconstruction, especially with respect to knee stability and functional outcome. Hypothesis Biodegradable interference screw fixation of hamstring tendon grafts provides clinical results similar to those achieved with identical fixation of bone-patellar tendon-bone grafts. Study Design Cohort study; Level of evidence, 2. Methods In 1996 and 1997, primary isolated anterior cruciate ligament reconstruction using a bone-patellar tendon-bone autograft was performed in 72 patients. Since 1998, hamstring tendons were used as routine grafts. Matched patients with a hamstring tendon graft were selected from a database (n = 284). All patients were followed prospectively for a minimum of 2 years with KT-1000 arthrometer testing, International Knee Documentation Committee score, and Lysholm score. Results In the bone-patellar tendon-bone group, 9 patients were excluded because of bilateral rupture of the anterior cruciate ligament, 3 patients (4.2%) had a graft rupture, and 4 patients were lost to follow-up (follow-up rate, 92.1%), leaving 56 patients for a matched-group analysis. In the hamstring tendon database, the graft rupture rate was 5.6% (P = .698). The Lysholm score was 89.7 in the patellar tendon group and 94 in the hamstring tendon group (P = .003). The KT-1000 arthrometer side-to-side difference was 2.6 mm for the patellar tendon group and 2.1 mm for the hamstring tendon group (P = .041). There were significantly less positive pivot-shift test results in the hamstring tendon group (P = .005), and hamstring tendon patients showed lower thigh atrophy (P = .024) and patellofemoral crepitus (P = .003). Overall International Knee Documentation Committee scores were better (P = .001) in the hamstring tendon group (hamstring tendon: 34 × A, 21 × B, 0 × C, 0 × D; bone-patellar tendon-bone: 17 × A, 32 × B, 6 × C, 0 × D). Conclusions In this comparison of anterior cruciate ligament reconstruction with bone-patellar tendon-bone and anatomical hamstring tendon grafts, the hamstring tendon graft was superior in knee stability and function. These findings are partially contrary to previous studies and might be attributable to the use of an anatomical joint line fixation for hamstring tendon grafts. Thus, hamstring tendons are the authors’ primary graft choice for anterior cruciate ligament reconstruction, even in high-level athletes.

A Prospective Randomized Study of Patellar versus Hamstring Tendon Autografts for Anterior Cruciate Ligament Reconstruction

2003 ◽  
Vol 31 (1) ◽  
pp. 12-18 ◽  
Author(s):  
Kim A. Jansson ◽  
Eric Linko ◽  
Jerker Sandelin ◽  
Arsi Harilainen
Keyword(s):  
Anterior Cruciate Ligament ◽  
Patellar Tendon ◽  
Plate Fixation ◽  
Cruciate Ligament ◽  
Randomized Study ◽  
Hamstring Tendon ◽  
Graft Material ◽  
Hamstring Tendons ◽  
Anterior Cruciate ◽  
Bone Patellar Tendon

Background Bone-patellar tendon-bone graft has been the most commonly used graft material in anterior cruciate reconstructions, but there has been increasing use of hamstring tendon grafts. However, no existing clinical studies show adequate support for the choice of one graft over the other. Hypothesis Hamstring tendons are equally as good as patellar tendon in anterior cruciate ligament reconstructions. Study Design Prospective randomized clinical trial. Methods Ninety-nine patients with laxity caused by a torn anterior cruciate ligament underwent arthroscopically assisted reconstruction with graft randomization according to their birth year. Grafts were either bone-patellar tendon-bone with metal interference screw fixation or double-looped hamstring tendons with metal plate fixation. There were no significant differences between the two groups preoperatively or at operation. Standard rehabilitation included immediate postoperative mobilization without a knee brace, protected weightbearing for 2 weeks, and return to full activity at 6 to 12 months. Results Forty-three patients in the patellar tendon group and 46 patients in the hamstring tendon group were available for clinical evaluation at a minimum of 21 months after surgery. No statistically significant differences were seen with respect to clinical and instrumented laxity testing, International Knee Documentation Committee Score ratings, isokinetic muscle torque measurements, and Kujala patellofemoral, Lysholm, and Tegner scores. Conclusion Equal results were seen for patellar and hamstring tendon autograft anterior cruciate ligament reconstructions at 2 years after surgery. Both techniques seem to improve patients' performance.

scholarly journals Failure rates of common grafts used in ACL reconstructions: a systematic review of studies published in the last decade

2021 ◽  
Author(s):  
Gerwin Haybäck ◽  
Christoph Raas ◽  
Ralf Rosenberger
Keyword(s):  
Anterior Cruciate Ligament ◽  
Patellar Tendon ◽  
Graft Failure ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Quadriceps Tendon ◽  
Hamstring Tendon ◽  
Failure Rates ◽  
Anterior Cruciate ◽  
Bone Patellar Tendon

Abstract Introduction In this review paper, graft failure rates of different graft types (hamstring tendon autografts, bone–patellar tendon–bone autografts, quadriceps tendon autografts and diverse allografts) that are used for surgical reconstruction of the anterior cruciate ligament are compared and statistically analysed. Methods Literature search was conducted in PubMed according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) criteria. A total of 194 studies, which reported graft failure rates of at least one of the anterior cruciate ligament reconstruction methods mentioned above, were included in this systematic review. To be able to compare studies with different follow-up periods, a yearly graft failure rate for each reconstruction group was calculated and then investigated for significant differences by using the Kruskal–Wallis test. Results Overall, a total of 152,548 patients treated with an anterior cruciate ligament reconstruction were included in the calculations. Comparison of graft types showed that hamstring tendon autografts had a yearly graft failure rate of 1.70%, whereas the bone–patellar tendon–bone autograft group had 1.16%, the quadriceps tendon autograft group 0.72%, and the allografts 1.76%. Conclusion The findings of this meta-data study indicate that reconstructing the anterior cruciate ligament using quadriceps tendon autografts, hamstring tendon autografts, patellar tendon autografts or allografts does not show significant differences in terms of graft failure rates.

A 7-Year Follow-up of Patellar Tendon and Hamstring Tendon Grafts for Arthroscopic Anterior Cruciate Ligament Reconstruction

2005 ◽  
Vol 33 (9) ◽  
pp. 1337-1345 ◽  
Author(s):  
Justin Roe ◽  
Leo A. Pinczewski ◽  
Vivianne J. Russell ◽  
Lucy J. Salmon ◽  
Tomomaro Kawamata ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Patellar Tendon ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Hamstring Tendon ◽  
Extension Deficit ◽  
Graft Rupture ◽  
Significant Difference ◽  
Tendon Grafts ◽  
Anterior Cruciate

Background For arthroscopic anterior cruciate ligament reconstruction, the most commonly used graft constructs are either the hamstring tendon or patellar tendon. Well-controlled, long-term studies are needed to determine the differences between the 2 materials. Hypothesis There is a difference between hamstring and patellar tendon grafts in the clinical results of anterior cruciate ligament reconstructions at 7 years. Study Design Cohort study; Level of evidence, 2. Methods Two groups of 90 patients each, consecutively treated with hamstring or patellar tendon grafts, were followed and assessed at 1, 2, 5, and 7 years after surgery. Results At the 7-year review, abnormal radiographic findings were seen in 45% (24/53) of the patellar tendon group and in 14% (7/51) of the hamstring tendon group (P = .002). Although there was no significant difference between the groups in extension deficit (P= .22), the percentage of patients with an extension deficit increased significantly in the patellar tendon group from 8% at 1 year to 25% at 7 years (P= .02). No significant change was seen in the hamstring tendon group over time (P= .20). There was no significant difference in laxity between the groups on Lachman (P= .44), pivot-shift (P= .39), or instrumented (P= .44) testing. Graft rupture occurred in 4 patients from the patellar tendon group and in 9 patients from the hamstring tendon group (P= .15). Both autografts gave excellent subjective results, as evidenced by the International Knee Documentation Committee evaluation and Lysholm knee scores at 7 years. Conclusions Both hamstring and patellar tendon grafts provided good subjective outcomes and objective stability at 7 years. No significant differences in the rate of graft rupture or contralateral anterior cruciate ligament rupture were identified. Patients with patellar tendon grafts had a greater prevalence of osteoarthritis at 7 years after surgery; therefore, the authors preferred hamstring tendons as the primary graft choice in anterior cruciate ligament reconstructions.

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