20-Year Outcomes of Anterior Cruciate Ligament Reconstruction With Hamstring Tendon Autograft: The Catastrophic Effect of Age and Posterior Tibial Slope

Background: No well-controlled studies have compared the long-term outcome of anterior cruciate ligament (ACL) reconstruction with hamstring tendon autograft between adolescents and adults. Increased posterior tibial slopes (PTSs) have been reported in the ACL-injured versus controls, but the effect of PTS on the outcome after reconstruction is relatively unexplored. Purpose: To compare the prospective longitudinal outcome of “isolated” ACL ruptures treated with anatomic endoscopic ACL reconstruction using hamstring tendon autograft over 20 years in adolescent and adult cohorts and to examine factors for repeat ACL injury. Study Design: Case-control study; Level of evidence, 3. Methods: A single-surgeon series of 200 consecutive patients undergoing isolated primary ACL reconstruction with hamstring tendon autograft were prospectively studied. Subjects were assessed preoperatively and at 2, 7, 15, and 20 years postoperatively. Outcomes included International Knee Documentation Committee (IKDC) Knee Evaluation, IKDC subjective scores, KT-1000 instrumented laxity testing, and radiological evaluation of degenerative change and medial tibial slope. Twenty-year outcomes were compared between those who underwent surgery at the age of 18 years or younger (adolescent group, n = 39) and those who underwent surgery when older than 18 years (adult group, n = 161). Results: At 20 years, 179 of 200 subjects were reviewed (89.5%). ACL graft rupture occurred in 37 subjects and contralateral ACL injury in 22 subjects. Of those with intact ACL grafts at 20 years, outcomes were not statistically different between adolescents and adults for the variables of IKDC subjective score ( P = .29), return to preinjury activity level ( P = .84), current activity level ( P = .69), or degree of radiological degenerative change at 20 years ( P = .51). The adolescent group had a higher proportion of grade 1 ligamentous laxity testing compared with the adult group ( P = .003). Overall, ACL graft survival at 20 years was 86% for adults and 61% for adolescents (hazard ration, 3.3; P = .001). The hazard for ACL graft rupture was increased by 4.8 in adolescent males and 2.5 in adolescent females compared with adults. At 20 years, the ACL survival for adolescents with a PTS of ≥12° was 22%. The hazard for ACL graft rupture was increased by 11 in adolescents with a PTS of ≥12° ( P = .001) compared with adults with a PTS <12°. Conclusion: Repeat ACL injury after isolated ACL reconstruction is common, occurring in 1 in 3 over 20 years. In the absence of further injury, isolated ACL reconstruction using this technique was associated with good long-term outcomes with respect to patient-reported outcomes and return to sports, regardless of age. However, mild ligament laxity and ACL graft rupture after ACL reconstruction are significantly more common in adolescents, especially adolescent males, compared with adults. PTS of 12° or more is the strongest predictor of repeat ACL injury, and its negative effect is most pronounced in adolescents.

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20 Year Outcomes of ACL Reconstruction with Hamstring Tendon Autograft. Does Age Matter?

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967117s00175 ◽

2017 ◽

Vol 5 (5_suppl5) ◽

pp. 2325967117S0017

Author(s):

Justin Roe ◽

Feisal Shah ◽

Emma Fitzgibbon ◽

Lucy Salmon ◽

James Linklater ◽

...

Keyword(s):

Acl Reconstruction ◽

Degenerative Change ◽

Acl Injury ◽

Tibial Slope ◽

Hamstring Tendon ◽

Activity Level ◽

Long Term Outcomes ◽

Posterior Tibial ◽

Tendon Autograft

Introduction: The purpose of this study was to document the prospective longitudinal outcome of ‘isolated’ anterior cruciate ligament (ACL) ruptures treated with anatomical endoscopic reconstruction using hamstring tendon autograft over 20 years. Long term outcomes were compared between those undergoing ACL reconstruction age 18 or less and those >18 years the time of surgery. Methods: A total of 100 consecutive men and 100 consecutive women with ‘isolated’ ACL rupture underwent four-strand hamstring tendon reconstruction with anteromedial portal femoral tunnel drilling and interference screw fixation by a single surgeon. At the time of ACL reconstruction 39 participants were aged 18 or less, 81 were aged 19 to 25 and 80 were over 25. Reviews were performed pre-operatively and at 1, 2, 7, 15 and 20 years post-operatively. Outcomes included further ACL injury, clinical examination, subjective and objective scoring systems, and radiological assessment. Results: Further ACL injury occurred in 55 of the 200 patients (28%), 37 ruptured the ACL graft and 22 ruptured the contralateral ACL. ACL graft rupture was significantly increased in the young; 39% in those aged 18 or less, 21% of those aged 19-25 and 6% of those over 25 years (p=0.001). Participants with a posterior tibial slope of 12 degrees or more sustained a further ACL injury in 65% of cases. Moderate to severe radiological degenerative change was evident in 14% at 20 years. Outcomes were not statistically different between those aged 18 or less and those >18 years for the variables of IKDC subjective score (p=0.98), rate of return to preinjury activity level (p=0.32), current activity level, or degree of radiological degenerative change at 20 years (p=0.65). Conclusions: ACL reconstructive surgery in patients with an ‘isolated’ rupture using this technique was associated with good long term outcomes and does not appear to cause osteoarthritis, regardless of age. However further ACL injury after ACL reconstruction is significantly more common in the young and those with a high posterior tibial slope. **This study was performed with support from AOA Research Foundation

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Arthroscopic anterior cruciate ligament reconstruction using single bundle hamstring tendon autograft

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20211619 ◽

2021 ◽

Vol 7 (3) ◽

pp. 615

Author(s):

Harpreet Singh ◽

Tilak Patel ◽

Kamal Kumar Agarwal ◽

Parth Patel ◽

Dhruv Patel ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

Cruciate Ligament ◽

Tibial Tunnel ◽

Donor Site ◽

Hamstring Tendon ◽

Single Bundle ◽

Hamstring Tendon Autograft ◽

Anterior Cruciate ◽

Tendon Autograft

Background: The present study was designed to analyze the postoperative outcome of arthroscopic anterior cruciate ligament (ACL) reconstruction with anatomical single bundle hamstring tendons autograft fixed in femoral tunnel using endobutton and in the tibial tunnel using interference screws and reinforced by anterior half of peroneus longus tendon (AHPLT), wherever required.Methods: 39 patients of complete ACL tear underwent arthroscopic anatomical single bundle ACL reconstruction using quadrupled hamstring tendon autograft. It was ensured that the quadrupled graft had a length of at least 7 cm and thickness of at least 8 mm. If either of these requirements were not met, then the graft was supplemented by AHPLT. For functional assessment, international knee documentation committee (IKDC) knee score was taken and clinical tests for antero-posterior stability were done. In addition, the foot and ankle disability index (FADI) scores were used to evaluate the ankle donor site of the AHPLT.Results: The average graft diameter was 8.74 mm and average graft length was 9.12 cm. There was significant improvement in post op IKDC score when compared with pre op score. There was no antero-posterior instability seen in any of the patients during follow up. 10 patients required an additional graft augmentation with AHPLT. There was no complaint about weakness of the ankle joint after surgery.Conclusions: Arthroscopic ACL reconstruction with anatomical single bundle hamstring tendon autograft is an excellent treatment option for ACL deficient knees. It gives excellent functional outcome with minimal complications. Graft if small in diameter can be reinforced by AHPLT without any detrimental effect on ankle function.

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Transphyseal Anterior Cruciate Ligament Reconstruction in the Skeletally Immature: Quadriceps Tendon Autograft Versus Hamstring Tendon Autograft

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119872450 ◽

2019 ◽

Vol 7 (9) ◽

pp. 232596711987245 ◽

Cited By ~ 3

Author(s):

Andrew T. Pennock ◽

Kristina P. Johnson ◽

Robby D. Turk ◽

Tracey P. Bastrom ◽

Henry G. Chambers ◽

...

Keyword(s):

Acl Reconstruction ◽

Cruciate Ligament ◽

Quadriceps Tendon ◽

Hamstring Tendon ◽

Skeletally Immature ◽

Hamstring Tendon Autograft ◽

Tendon Grafts ◽

Anterior Cruciate ◽

Tendon Autograft

Background: It is unclear what the optimal graft choice is for performing anterior cruciate ligament (ACL) reconstruction in a skeletally immature patient. Purpose: To evaluate outcomes and complications of skeletally immature patients undergoing transphyseal ACL reconstruction with a hamstring tendon autograft versus a quadriceps tendon autograft. Study Design: Cohort study; Level of evidence, 3. Methods: Between 2012 and 2016, 90 skeletally immature patients from a single institution underwent primary transphyseal ACL reconstruction with either a quadriceps tendon autograft or a hamstring tendon autograft based on surgeon preference (n = 3). Patient demographic, injury, radiographic, and surgical variables were documented. Outcome measures included the Lysholm score, Single Assessment Numeric Evaluation (SANE), Tegner activity score, pain, satisfaction, and complications such as graft tears and physeal abnormalities. Results: A total of 83 patients (56 hamstring tendon, 27 quadriceps tendon) were available for a minimum follow-up of 2 years or sustained graft failure. The mean age of the patients was 14.8 ± 1.4 years at the time of ACL reconstruction. No differences in chronological age, bone age, sex, patient size, or mechanism of injury were noted between groups. There were no differences in surgical variables, except that the quadriceps tendon grafts were larger than the hamstring tendon grafts (9.6 ± 0.6 mm vs 7.8 ± 0.7 mm, respectively; P < .001). Patient outcomes at a mean follow-up of 2.8 ± 0.9 years revealed no differences based on graft type, with mean Lysholm, SANE, pain, satisfaction, and Tegner scores of 96, 93, 0.6, 9.6, and 6.6, respectively, for the quadriceps tendon group and 94, 89, 0.9, 9.2, and 7.1, respectively, for the hamstring tendon group. While there were no physeal complications in either group, patients undergoing ACL reconstruction with a hamstring tendon autograft were more likely to tear their graft (21% vs 4%, respectively; P = .037). Conclusion: Skeletally immature patients undergoing ACL reconstruction can be successfully managed with either a quadriceps tendon autograft or a hamstring tendon autograft with good short-term outcomes, high rates of return to sport, and low rates of physeal abnormalities. The primary differences between grafts were that the quadriceps tendon grafts were larger and were associated with a lower retear rate. ACL reconstruction performed with a quadriceps tendon autograft may reduce early graft failure in skeletally immature patients.

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Double-bundle anterior cruciate ligament recontruction by Hamstring tendon autograft: the ALL - INSIDE technique

Vietnam Journal of Endolaparoscopic Surgery ◽

10.51199/vjsel.2019.2.4 ◽

2019 ◽

Vol 9 (2) ◽

Author(s):

Ngọc Trưởng Phạm ◽

Hải Nam Vũ

Keyword(s):

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

Cruciate Ligament ◽

Hamstring Tendon ◽

Double Bundle ◽

Rotational Stability ◽

Hamstring Tendon Autograft ◽

Anterior Cruciate ◽

Double Bundle Acl Reconstruction ◽

Tendon Autograft

Tóm tắt Đặt vấn đề: Đánh giá kết quả đạt được trong việc tái tạo 2 bó dây chằng chéo trước All-inside, gân cơ Hamstring. (DCCT) với kỹ thuật “all-inside” bó sau ngoài sử dụng mảnh ghép gân cơ thon, gân cơ bán gân tự thân. Từ kết quả đạt được đưa ra một số nhận xét về kỹ thuật. Phương pháp nghiên cứu: Tiến cứu, mô tả cắt ngang 43 bệnh nhân tổn thương DCCT được lựa chọn chỉ định phẫu thuật nội soi tái tạo DCCT 2 bó bằng gân cơ bán gân và gân cơ thon tự thân với kỹ thuật “all-inside” bó sau ngoài tại Bệnh viện 198 Bộ Công an. Kết quả: 43 bệnh nhân trong lứa tuổi 19-35, thời gian theo dõi trung bình là 13,5 tháng. Kết quả bước đầu, bệnh nhân cải thiện rất tốt sự ổn định và chức năng của khớp gối nhất là ổn định xoay. Điểm Lysholm ở mức độ tốt và rất tốt đạt 95,4%. Tỷ lệ quay lại tập luyện thi đấu thể thao là 93,0% và chưa phát hiện bệnh nhân đứt lại DCCT sau tái tạo. Kết luận: Phẫu thuật tái tạo 2 bó DCCT với kỹ thuật “all-inside” bó sau ngoài có ưu điểm cố định được mảnh ghép ngắn, sử dụng được nguồn gân ghép tự thân, cho kết quả phục hồi chức năng tốt. Phẫu thuật góp phần nâng cao hiệu quả điều trị tái tạo DCCT, làm giảm nguy cơ phải sử dụng mảnh ghép đồng loại. Abstract Introduction: To evaluate the results obtained in the Double-Bundle Anterior Cruciate Ligament (ACL) Reconstruction of the hamstring tendon autograft with the "all-inside" technique Material and Methods: A prospective, cross-sectional study of 43 patients with indication for Double-Bundle Anterior Cruciate Ligament Reconstruction with hamstring tendon autograft Results: 43 patients between the ages of 19-35 years, with a mean follow-up of 13.5 months, 95,4% good and excellent Lysholm score and were shown to significantly improve rotational stability. The return to sport rate following ACL reconstruction was 93,0% and the graft failure rate was 0%. Conclusion: The hamstring tendon autograft can be used for the Double-Bundle ACL reconstruction with the "all-inside" technique. This technique can use short graft, resulting in good rehabilitation Keywords: ACL double-bundle reconstruction, “all-inside” technique, minimally invasive, hamstring tendon.

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