A Randomized Clinical Trial to Evaluate Attached Hamstring Anterior Cruciate Ligament Graft Maturity With Magnetic Resonance Imaging

2018 ◽  
Vol 46 (5) ◽  
pp. 1143-1149 ◽  
Author(s):  
Shaohua Liu ◽  
Hong Li ◽  
Hongyue Tao ◽  
Yaying Sun ◽  
Shiyi Chen ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Signal Intensity ◽  
Cruciate Ligament ◽  
Hamstring Tendon ◽  
Control Group ◽  
Study Group ◽  
Tibial Insertion ◽  
Significant Difference ◽  
The Difference ◽  
Anterior Cruciate

Background: The hamstring tendons are commonly harvested for anterior cruciate ligament (ACL) reconstruction with detachment of the tibial insertion. Retaining the insertion may help to preserve vascularity and viability of the graft and bypass the stages of avascular necrosis and revascularization, which might be beneficial to graft maturity. Purpose: To investigate and compare graft maturity by magnetic resonance imaging (MRI) after ACL reconstruction with preservation or detachment of hamstring tendon tibial insertion at up to 2 years. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: Forty-five patients (age range, 18-45 years) undergoing isolated ACL reconstruction with hamstring tendon were enrolled and randomized to 2 groups. The tibial insertion of the hamstring tendon was preserved in the study group (n = 21) and detached in the control group (n = 24). Patients had follow-up at 3, 6, 12, and 24 months, which consisted of the following: (1) clinical examination and (2) MRI evaluation of graft signal intensity based on signal/noise quotient (SNQ) values. Finally, 18 patients in the study group and 19 in the control group received full follow-up evaluation (ie, at all 4 time points). Results: All knees acquired full range of motion at 24 months without significant laxity. At each time point, the KT-1000 arthrometer revealed no significant difference between groups; the clinical scores significantly improved in both groups, although the difference between groups was not significant. In the control group, the SNQ value increased from 3 months, peaked at 6 months, and then decreased (3 months, 21.4 ± 12.7; 6 months, 25.6 ± 12; 12 months, 18.3 ± 7.7; 24 months, 15.3 ± 6.3). However, the insertion-preserved graft in the study group maintained relatively lower and unchanged signal intensity throughout all time points (3 months, 15.0 ± 11.2; 6 months, 14.9 ± 6.3; 12 months, 12.6 ± 7.0; 24 months, 14.6 ± 7.0). Between groups, there was no significant difference at 3 or 24 months ( P = .11 and .75, respectively), while the SNQ values were significantly lower in the study group versus the control group at 6 and 12 months ( P = .002 and .02, respectively). Conclusion: The insertion-detached hamstring tendon grafts underwent a significantly increasing change in signal intensity during the first 2 years after ACL reconstruction, while the insertion-preserved grafts kept a relatively lower and unchanged signal intensity. The difference was most significant at 6 and 12 months postoperatively.

scholarly journals Insall–Salvati index is associated with anterior cruciate ligament tears in men: A Case-controlled study

2022 ◽  
Vol 30 (1) ◽  
pp. 230949902110696
Author(s):  
Necip GÜVEN ◽  
Sezai ÖZKAN ◽  
Tulin TURKOZU ◽  
Adem YOKUS ◽  
Cihan ADANAS ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Controlled Study ◽  
Control Group ◽  
Anterior Tibial Translation ◽  
Study Group ◽  
Significant Difference ◽  
Anterior Cruciate ◽  
And Control ◽  
Tibial Translation

Purpose Many factors in the etiology of anterior cruciate ligament (ACL) tears, predisposing factors related to knee morphology have also been reported. This study aimed to determine whether the Insall–Salvati (IS) index, which measures patella height, is a predisposing risk factor for ACL tears. Methods The IS index, patellar length (PL), and patellar tendon length (PTL) values of patients (study group) that underwent arthroscopic reconstruction for ACL tears obtained by preoperative magnetic resonance imaging (MRI) were compared with the index values in the preoperative MRIs of patients that underwent knee arthroscopy for reasons besides ACL tears. In addition, the anterior tibial translation (ATT) of both groups was also measured and compared on MRI images. The MRI findings of the subjects included in both study groups were arthroscopically confirmed. Results The mean ages of the study group (n = 120) and control group (n = 90) were 29.1 ± 8.2 years and 31.8 ± 9.8 years, respectively. There was a statistically significant difference between the study and control groups in terms of the PL and PTL values ( p = 0.016 and p = 0.001, respectively). The IS index was statistically significantly higher in the study group with ACL tears ( p = 0.009). The ATT was 8.61 ± 4.68 mm in the study group and 3.80 ± 1.92 mm in the control group. The ATT results of both groups were evaluated, and it was found that the study group was significantly higher than the control group ( p = 0.001) Conclusions As a result of our current study, we observed higher IS index values in patients with ACL tears than in patients without ACL tears. It should be kept in mind that patella alta, which is associated with a high IS index as one of the factors of knee morphology associated with ACL tears, may play a role in the etiology of ACL tears.

Advantages of an Attached Semitendinosus Tendon Graft in Anterior Cruciate Ligament Reconstruction in a Rabbit Model

2018 ◽  
Vol 46 (13) ◽  
pp. 3227-3236 ◽  
Author(s):  
Shaohua Liu ◽  
Yaying Sun ◽  
Fang Wan ◽  
Zheci Ding ◽  
Shiyi Chen ◽  
...  
Keyword(s):  
Bone Healing ◽  
Cruciate Ligament ◽  
Tendon Graft ◽  
Semitendinosus Tendon ◽  
Control Group ◽  
Study Group ◽  
Micro Ct ◽  
Tibial Insertion ◽  
Anterior Cruciate ◽  
Biomechanical Strength

Background: The semitendinosus tendon graft with an intact tibial insertion has a sustainable blood supply and might be beneficial for graft maturation after anterior cruciate ligament reconstruction (ACLR); however, its potential advantages for graft tendon-bone healing is still unclear. Hypothesis: Intact tibial insertion of the hamstring tendon can preserve enough blood supply to keep the harvested tendon alive, which can improve tendon-bone healing and the biomechanical strength of the graft. Study Design: Controlled laboratory study. Methods: Sixty-four healthy New Zealand White rabbits underwent unilateral ACLR with a semitendinosus tendon autograft after random enrollment into 2 groups (study group, n = 32 rabbits with semitendinosus tendon–preserved tibial insertions; control group, n = 32 rabbits with free semitendinosus tendons). At weeks 3, 6, 12, and 24, 8 rabbits in each group were sacrificed to evaluate tendon-bone healing by histologic staining, micro–computed tomography (micro-CT) examination, and biomechanical test. Results: The grafts in the study group maintained a similar cell count with no signs of necrosis or hypocellularity across all time points, but the grafts in the control group underwent a characteristic stage of necrosis at weeks 3 and 6. Sharpey-like fibers were observed from postoperative 3 weeks at the tendon-bone interface in the study group, and a normal insertion-like structure was formed at week 12, which became more mature at week 24. In the control group, however, Sharpey-like fibers could not be observed until week 12, and a normal transition through cartilage from bone to tendon was not observed at any time point. Histologic scores of the tendon-bone interface in the study group were significantly higher than those in the control group at week 6 ( P = .04), week 12 ( P < .001), and week 24 ( P = .04). As compared with the control group via micro-CT, the study group had a significantly smaller bone tunnel area at week 6 ( P = .01) and larger bone volume/total volume at week 3 ( P = .0026) and week 6 ( P = .01). Also, the study group had a significantly higher failure load at weeks 12 and 24 (both P = .03) and a significantly higher stiffness at week 24 ( P < .001) versus the control group. Conclusion: The semitendinosus tendon graft with an intact tibial insertion in ACLR would bypass the graft avascular necrosis stage, which improves tendon-bone healing and biomechanical strength. Clinical Relevance: An alive graft in ACLR could improve tendon-bone healing and the biomechanical strength of the graft, which might be beneficial to early and intensive rehabilitation after ACLR.

scholarly journals Autologous chondrocyte implantation combined with anterior cruciate ligament reconstruction: similar short-term results in comparison with isolated cartilage repair in ligament intact joints

2021 ◽  
Author(s):  
Julian Mehl ◽  
Matthias Feucht ◽  
Andrea Achtnich ◽  
Andreas B. Imhoff ◽  
Philipp Niemeyer ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Defect Size ◽  
Cartilage Defects ◽  
Control Group ◽  
Study Group ◽  
Short Term ◽  
Chondrocyte Implantation ◽  
Anterior Cruciate ◽  
Autologous Chondrocyte

Abstract Purpose Both acute ruptures of the anterior cruciate ligament (ACL) as well as chronic ACL insufficiency show a high association with focal cartilage defects of the knee. However, the results after combined ACL reconstruction and cartilage repair are not well investigated. The aim of the present study was to investigate the short-term outcomes after autologous chondrocyte implantation (ACI) in combination with ACL reconstruction and to compare the results with patients who underwent isolated ACI in ligament intact knees. Methods All patients who were registered in the German Cartilage Registry with ACI for focal cartilage defects in the knee joint in combination with ACL reconstruction and who completed the 24 month follow-up were included in the study group. A matched-pair procedure according to gender, defect location, defect size, and age was used to create a control group of patients with isolated ACI in ACL intact joints. The Knee Injury and Osteoarthritis Outcome Score (KOOS) and the numeric analog scale for pain (NAS) were used to assess the preoperative state as well as the clinical outcomes 12 and 24 months after surgery. Results A total of 34 patients were included in both the study group (age mean 33.3 ± SD 8.8 years) and the control group (33.6 ± 8.4 years) with a median defect size of 466 (25%-75% IQR 375–600) mm2 and 425 (IQR 375–600) mm2, respectively. In comparison with the preoperative state (median 67, IQR 52–75), the study group showed a significant increase of the total KOOS after 12 months (78, IQR 70–86; p = 0.014) and after 24 months (81, IQR 70–84; p = 0.001). The NAS for pain did not change significantly in the postoperative course. In comparison with the control group there was no significant difference for the total KOOS neither preoperative (control group median 67, IQR 52–73) nor at any postoperative time point (12 months: 82, IQR 67–93; 24 months: 81, IQR 71–91). Conclusion The clinical short-term outcomes after ACI at the knee joint in combination with ACL reconstruction are good and similar to the results after isolated ACI in ligament intact knees. Level of evidence III.

scholarly journals Evaluating the functional results and complications of autograft vs allograft use for reconstruction of the anterior cruciate ligament: a systematic review

2017 ◽  
Vol 9 (1) ◽  
Author(s):  
Ojas Pujji ◽  
Nikita Keswani ◽  
Naomi Collier ◽  
Marion Black ◽  
Lucy Doos
Keyword(s):  
Systematic Review ◽  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Functional Results ◽  
Hamstring Tendon ◽  
Reconstruction Technique ◽  
Significant Difference ◽  
Patient Reported ◽  
Anterior Cruciate

The aim of our review is to identify the reconstruction technique that has a superior functional outcome and decreased number of complications for the anterior cruciate ligament (ACL). We have divided our review into 2 sections. Our primary question evaluates the functional results and complications of autografts compared to allografts for ACL reconstruction. Our subsidiary question evaluates the functional results and complications of bone-patellar tendon-bone (BPTB) autografts compared to hamstring tendon autografts. We conducted a systematic review (SR) based on high quality evidence provided by Cochrane, PubMed and National Health Service evidence searches for papers comparing different ACL reconstruction techniques. Results from 2 primary studies, 1 SR and 1 meta-analysis showed no significant statistical difference when comparing clinical outcomes such as pain, range of motion, laxity, International Knee Documentation Committee score, single assessment numerical evaluation score, Tegner activity score and patient reported satisfaction with regards to autografts vs allografts. Allografts had worse outcomes for postoperative tibial tunnelling and graft failure. Results of 3 SRs showed statistically significant differences in incidence of anterior knee pain, kneeling pain and knee stability, which were all found to be greater amongst those who had received a BPTB autograft. Knee extension was significantly reduced in patients with BPTB grafts when compared to patients with Hamstring tendon autografts. However, with regards to return to prior levels of activity, there was no statistically significant difference between those that received BPTB autografts and those that received Hamstring tendon autografts. Autograft reconstruction of the ACL was shown to provide better postoperative outcomes when compared to allograft reconstruction, although the difference was not statistically significant. When researching different autograft options BPTB autografts were associated with greater pain but also greater stability of the knee joint postoperatively when compared to hamstring tendon autografts.

MRI Signal Intensity of Quadriceps Tendon Autograft and Hamstring Tendon Autograft 1 Year After Anterior Cruciate Ligament Reconstruction in Adolescent Athletes

2021 ◽  
pp. 036354652110404
Author(s):  
Alexandra H. Aitchison ◽  
David Alcoloumbre ◽  
Douglas N. Mintz ◽  
Sofia Hidalgo Perea ◽  
Joseph T. Nguyen ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Signal Intensity ◽  
Cruciate Ligament ◽  
Quadriceps Tendon ◽  
Hamstring Tendon ◽  
Skeletally Immature ◽  
Hamstring Tendon Autograft ◽  
Significant Difference ◽  
Anterior Cruciate ◽  
Tendon Autograft

Background: Hamstring tendon autograft (HTA) is a common graft choice for anterior cruciate ligament (ACL) reconstruction (ACLR) in skeletally immature patients. Recently, the use of quadriceps tendon autograft (QTA) has shown superior preliminary outcomes in this population. Purpose: To evaluate graft maturity by comparing magnetic resonance imaging (MRI) signal intensity of HTA versus QTA used in primary ACLR. Study Design: Cohort study; Level of evidence, 3. Methods: All patients under the age of 18 years who underwent a primary ACLR by the senior authors using either an HTA or a QTA were retrospectively reviewed. A total of 70 skeletally immature patients (37 in the HTA group and 33 in the QTA group) with an available MRI at 6 and 12 months postoperatively were included. Signal intensity ratio (SIR) was measured on sagittal MRI by averaging the signal at 3 regions of interest along the ACL graft and dividing by the signal of the tibial footprint of the posterior cruciate ligament. Statistical analysis was performed to determine interrater reliability and differences between time points and groups. Results: Age, sex, and type of surgery were not associated with any differences in SIR. There was no significant difference in SIR between groups on the 6-month MRI. However, the SIR of the QTA group was significantly less than in the HTA group on the 12-month MRI (2.33 vs 2.72, respectively; P = .028). Within the HTA group, there was no significant difference in SIR at either MRI time point. In the QTA group, there was a significant decrease in SIR between the 6-month and 12-month postoperative MRI (2.70 vs 2.33, respectively; P = .045). Conclusion: These findings suggest improved graft maturation, remodeling, and structural integrity of the QTA compared with the HTA between 6 and 12 months postoperatively. This provides evidence that, at 1 year postoperatively, QTA may have a superior rate of incorporation and synovialization as compared with the HTA.

PRP on Preventıon of Tunnel Enlargement in ACL Reconstructıon

2018 ◽  
Vol 20 (4) ◽  
pp. 285-291 ◽  
Author(s):  
Serkan Sözkesen ◽  
Huseyin Gokhan Karahan ◽  
Ahmet Kurtulmus ◽  
Cemil Kayali ◽  
Taskin Altay
Keyword(s):  
Acl Reconstruction ◽  
Platelet Rich Plasma ◽  
Cruciate Ligament ◽  
Tibial Tunnel ◽  
Hamstring Tendon ◽  
Control Group ◽  
Tunnel Enlargement ◽  
Hamstring Autograft ◽  
Significant Difference ◽  
Kt 1000

Background. The purpose of this study is to describe the role of Platelet Rich Plasma in preventing tunnel enlargement in anterior cruciate ligament reconstruction with a hamstring autograft Material and methods. Forty-four patients who underwent transtibial reconstructive surgery with a hamstring tendon autograft between March 2014 and July 2015 were included in this study. This study involved two groups. Group A consisted of 18 patients who underwent PRPadministration into the femoral and tibial tunnel. Group B was a control group that included 26 patients who underwent ACL reconstruction surgery with a hamstring autograft without PRP. The patients were evaluated preoperatively and postoperatively with the IKDC score, Lysholm score, Tegner activity scale and a KT-1000 arthrometer device. The diameter of the tibial and femoral tunnels of the operated knees was measured on the first day and at three months postoperatively using CT. Measurements carried out for tomography standardization of the patients were evaluated on coronal, sagittal and axial images from 64-slice MSCT scans. Results. On comparison of radiological data between both groups, there was less tunnel enlargement in PRP-administered group for the femoral tunnel, but the result was not statistically significant. No difference was seen between clinical examination results and the grading scales used. Conclusions. 1. The radiological findings of our study indicated that while there was less tunnel enlargement in the PRP group, there was no statistically significant difference between the groups. 2. Similarly, clinical exa­mination results and scoring scales used did not de­monstrate any intergroup difference. 3. As a result, we donot recommend routine use of PRP for the prevention of tunnel enlargement after ACL reconstruction.

scholarly journals Validation of a Composite Test for Assessment of Readiness for Return to Sports After Anterior Cruciate Ligament Reconstruction: The K-STARTS Test

2018 ◽  
Vol 10 (6) ◽  
pp. 515-522 ◽  
Author(s):  
William G. Blakeney ◽  
Hervé Ouanezar ◽  
Isabelle Rogowski ◽  
Gregory Vigne ◽  
Meven Le Guen ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Intraclass Correlation ◽  
Control Group ◽  
Diagnostic Study ◽  
Return To Sports ◽  
Sensitivity To Change ◽  
Significant Difference ◽  
Anterior Cruciate

Background: There is limited information on the appropriate timing of return to sports after anterior cruciate ligament (ACL) reconstruction. A composite test was developed to assess the athlete’s ability to return to sports after ACL reconstruction: the Knee Santy Athletic Return To Sport (K-STARTS) test. Hypothesis: The K-STARTS test meets validation criteria for an outcome score assessing readiness for return to sports after ACL reconstruction. Study Design: Diagnostic study. Level of Evidence: Level 3. Methods: A prospective comparative study identified 410 participants: 371 participants who had undergone ACL reconstruction and a control group of 39 healthy participants. The K-STARTS score is calculated as the sum of 7 tests (8 components), for a maximal value of 21 points. Construct validity, internal consistency, discriminant validity, and sensitivity to change were used to validate this new test. Results: The K-STARTS assessment showed a high completion rate (100%), high reproducibility (intraclass correlation coefficient, 0.87; coefficient of variation, 7.8%), and high sensitivity to change. There was moderate correlation with the ACL Return to Sports after Injury scale (ACL-RSI) and hop tests. There were no ceiling or floor effects. There was a significant difference between K-STARTS scores assessed at 6 and 8 months postoperatively (11.2 ± 2.7 vs 17.1 ± 3.2; P < 0.001). The K-STARTS score in the control group was significantly higher than that in the ACL reconstruction group (17.3 ± 2.1 and 13.7 ± 3.8, respectively; P < 0.001). Conclusion: The K-STARTS test is an objective outcome measure for functional improvement after ACL reconstruction. Clinical Relevance: It is important for the clinician to determine when return to sports is optimal after ACL reconstruction to reduce the current high risk of reinjury.

Comparative Study of the Reconstruction of Anterior Cruciate Ligament with Peroneal Longus Tendon and Hamstring Tendon Based on Magnetic Resonance Imaging

2020 ◽  
Vol 10 (6) ◽  
pp. 1327-1332
Author(s):  
Ming He ◽  
Xu Sun ◽  
Yonghui Fu
Keyword(s):  
Treatment Group ◽  
Magnetic Resonance ◽  
Cruciate Ligament ◽  
Hamstring Tendon ◽  
Control Group ◽  
Early Recovery ◽  
Significant Difference ◽  
Ikdc Score ◽  
Anterior Cruciate ◽  
Better Than

Objective: To compare the effect of reconstruction of anterior cruciate ligament (ACL) with peroneal longus tendon (PLT) and hamstring tendon (HT) using magnetic resonance image (MRI). Methods: Fifty-six patients with ACL rupture were treated with ACL reconstruction. Among them, 28 patients were treated with PLT reconstruction (treatment group) and 28 patients were treated with HT reconstruction (control group). There were no significant differences in gender, age, injury side, course of disease, preoperative Lachman test, Lysholm score, IKDC score, joint mobility, MRI image between the two groups (P > 0.05). Result: The incision healed in the first stage after operation in both groups, and there were no significant neurovascular injuries and knee synovitis complications. Comparing the MRI of the two groups after operation, the effect of the treatment group was better than that of the control group. There were no complications in both groups. The Lysholm score and IKDC score of the treatment group were better than those of the control group at 6 and 12 months after operation (P > 0.05). There was no significant difference in Lachman test between the two groups at 6 and 12 months after operation (P > 0.05). At 3 and 12 months after operation, the joint activity of the treatment group was better than that of the control group, with no significant difference (P > 0.05). The degree of tibial anterior displacement decreased significantly in both groups before and after operation (P < 0.05), but there was no significant difference between the two groups (P > 0.05). Discussion: MRI scanning technology can significantly expand the scope of human body examination, improve the detection rate and diagnostic accuracy of lesions. In traditional surgery, HT is often used as reconstruction material. However, there are many factors to be considered in the formulation of operation plan for double cruciate ligament injury, such as limb blood supply, accompanied by a variety of structural injuries, so the requirement for reconstruction is high. There was no significant difference in the recovery of knee stability between the two groups, but in terms of early recovery of knee function and subjective satisfaction of patients, the reconstruction of PLT was superior to that of HT. Conclusion: Magnetic resonance imaging can effectively diagnose the curative effect, and it is worth popularizing and applying widely. Compared with HT, ACL reconstruction with PLT is easier to operate, and the early recovery of knee joint function and it is worth popularizing and applying widely.

scholarly journals Intraoperative Conversion to Five-Strand Hamstring Autograft Configuration Significantly Increases Anterior Cruciate Ligament Graft Diameter Independent of Patient Characteristics

2019 ◽  
Author(s):  
Brian E. Walczak ◽  
Scott J. Hetzel ◽  
Craig Chike Akoh ◽  
Geoffrey S. Baer
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Patient Characteristics ◽  
Hamstring Tendon ◽  
Hamstring Autograft ◽  
Significant Difference ◽  
Anterior Cruciate ◽  
Intraoperative Conversion ◽  
Graft Diameter

AbstractIntraoperative conversion of a four-strand hamstring autograft to a five-strand configuration during an anterior cruciate ligament (ACL) reconstruction has been reported. However, the expected change in graft size and the dependence on patient characteristics are currently not well described. The purpose of this study was to determine the effective change in hamstring graft diameter and reliance on patient characteristics when intraoperatively converting a four-strand hamstring autograft into a five-strand configuration during an ACL reconstruction. A prospective, paired cohort study design was used to measure individual hamstring autograft diameter intraoperatively using traditional four-strand configuration followed by a five-strand configuration. All hamstring tendons included were long enough to consider a five-strand configuration. Five-strand hamstring autograft increased graft diameter in all patients. Hamstring tendon graft diameter increased by an average of 0.99 mm (95% confidence interval [CI]: 0.84–1.11) in the five-strand configuration compared with the traditional four-strand configuration (mean: 7.8 mm). There was no significant difference in the average increase in graft diameter between males (1.04 mm) and females (0.92 mm) (p = 0.323). Eighty-three percent (95% CI: 57.8–95.6) of average graft diameters ≤ 8 mm in the four-strand configuration achieved an average graft diameter of >8 mm in the five-strand configuration, and 70% (95% CI: 35.4– 91.9) of four-strand configuration average diameters < 8 mm achieved an average graft diameter > 8.0 mm in the five-strand configuration. Five-strand hamstring autograft reliably increased intraoperative hamstring tendon autograft diameter, with an average of 1 mm, compared with traditional four-strand configuration. This increase in diameter is independent of sex and remained significant when controlling for age, laterality, body mass index, and semitendinosus length.

scholarly journals Early Outcomes of Adolescent ACL Reconstruction With Hybrid Hamstring Tendon Autograft-Allograft Versus Hamstring Tendon Autograft Alone

2021 ◽  
Vol 9 (1) ◽  
pp. 232596712097998
Author(s):  
Benton E. Heyworth ◽  
Evan T. Zheng ◽  
Patrick Vavken ◽  
Elizabeth S. Liotta ◽  
Dennis E. Kramer ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Small Diameter ◽  
Hamstring Tendon ◽  
Control Group ◽  
Hamstring Tendon Autograft ◽  
Significant Difference ◽  
Anterior Cruciate ◽  
Tendon Autograft

Background: Small-diameter semitendinosus-gracilis tendon autografts may be encountered intraoperatively during anterior cruciate ligament reconstruction (ACLR); these have been shown to be at increased risk of graft rupture. One option that surgeons have pursued to reduce the theoretical failure rate of these smaller-diameter grafts is augmenting them with allograft material, thereby forming a larger-diameter hybrid autograft-allograft construct. Purpose/Hypothesis: The purpose of this study was to compare outcomes in adolescent athletes of primary ACLR using a hybrid autologous hamstring tendon and soft tissue allograft construct versus ACLR using small-diameter hamstring tendon autograft. The hypothesis was that the hybrid hamstring autograft-allograft construct would provide superior short-term results. Study Design: Cohort study; Level of evidence, 3. Methods: We performed a retrospective analysis of 47 patients aged between 12 and 20 years who underwent hybrid graft ACLR (mean diameter, 9.1 mm) at a single institution. Electronic medical records including clinic notes, radiographic images, operative notes, and pathology reports were reviewed for study analysis. A control group of 64 patients who underwent small-diameter hamstring reconstruction (mean diameter, 7.1 mm) without allograft supplementation was compiled. Corresponding clinical, radiographic, and surgical characteristics were collected for the control group to allow for comparative analysis. Results: Mean follow-up was 2.7 years for the hybrid cohort and 2.3 years for the control group. Despite a significantly larger mean graft diameter in the hybrid group as compared with the control group ( P < .001), no significant difference in retear rate was seen between cohorts (hybrid, 9%; control, 13%; P = .554). Patients with hybrid anterior cruciate ligament constructs also underwent a comparable number of reoperations overall ( P = .838). Functionally, all patients with adequate follow-up returned to sports, with no significant difference in time to return to sports between the groups ( P = .213). Radiographically, hybrid graft constructs did not undergo a significantly larger degree of tunnel lysis ( P = .126). Conclusion: A cohort of adolescents with hybrid anterior cruciate ligament grafts was shown to have retear rates and overall clinical results comparable with those of a control group that received small-diameter hamstring tendon autografts alone.

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