Short term functional outcome following arthroscopic ACL reconstruction using a combination of quadruple hamstring tendon, adjustable cortical suspensory fixation device on femoral side and bio-screw on tibial side

Background: Arthroscopically aided anterior cruciate ligament reconstruction using hamstring graft can be fixed to femoral condyle by suspensory and aperture fixation methods. The following study was undertaken to investigate whether there is any difference in functional outcomes with these fixation methods as measured by the Lysholm knee score and to determine tunnel widening post operatively with these two methods and does it affect the functional outcome.Methods: 50 patients of clinically and radiologic ally diagnosed ACL tear fulfilling the inclusion and exclusion criteria were randomized into two groups to undergo arthroscopic ACL reconstruction using quadrupled hamstring graft with suspensory (n=25) and aperture (n=25) fixation methods on femoral side. They were compared post operatively with Lysholm score, clinical laxity tests and percentage of tunnel enlargement using computed tomograms at 01 year.Results: At the end of 6 months there was no much difference in Lysholm score between both the groups (P =0.663) and at the end of 01 year aperture group had slightly better outcome. However, the difference was not statistically significant (p =0.173). There was more tunnel widening in the suspensory group especially of the femoral tunnel in the coronal plane. However, the amount of tunnel widening in both the groups was not significant statistically (P =0.071 and P =0.963). Tunnel widening is not associated with inferior clinical outcomes or functional knee score.Conclusions: Aperture and Suspensory fixation methods of hamstring graft at femoral condyle in ACL reconstruction are comparable clinically and there is no advantage of one particular method over other. Although comparatively more tunnel widening is seen in suspensory fixation methods; it does not affect the final clinical outcomes or functional knee scores.

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Clinical comparison between femoral transfixation and bioscrew fixation using hamstring tendon graft for ACL reconstruction

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20174664 ◽

2017 ◽

Vol 3 (6) ◽

pp. 1099

Author(s):

Anil Kumar Mishra ◽

Barun Datta ◽

Varunendra Bahadur Singh ◽

Biraj Gogoi ◽

S. K. Rai ◽

...

Keyword(s):

Acl Reconstruction ◽

Femoral Condyle ◽

Knee Laxity ◽

Hamstring Tendon ◽

Tendon Graft ◽

Interference Screw ◽

Fixation Technique ◽

Significant Difference ◽

Hamstrings Tendon ◽

Femoral Side

Background: One of the popular graft choices for ACL reconstruction have been Hamstrings tendon autograft. There is no consensus on the ideal technique of fixation of hamstrings graft to femoral condyle. Theoretically we hypothesized that transfixation method of hamstrings graft fixation to femoral condyle should be superior to bio-interference screw fixation technique. Hence aim of our study is to compare this two fixation methods of hamstrings autografts clinically.Methods: 50 clinically and radiologically proven ACL deficient fighting soldiers are selected for the study. In group A; 25 patients underwent ACL reconstruction with Bioscrew using aperture technique on femoral side. Other 25 patients in group B underwent ACL reconstruction with transfixation screw using cortico-cancellous fixation technique on femoral side. In both groups quadrupled semitendinosus autograft is utilized. All the patients evaluated for functional outcome at the end of 6 weeks and at 6 months and at the end of 1 year following the procedure. The subjects are evaluated using the modified Lysholm knee score and knee laxity is measured by Rolimeter.Results: At 01 year post op. there was no statistically significant difference in both groups in terms of Manual laity tests,Rollimeter laity measurement and Lysholm knee score.The overall satisfactory result (Excellent + Good) in both the groups at 01 year follow up were 98% by Lysholm score.Conclusions: Transfixation and Bioscrew fixation showed comparable results in manual knee laxity tests, instrumental knee laxity tests using Rolimeter, Lyslohm scores and high patient satisfaction, with almost 96% of patients in both groups returned to their pre-injury levels.

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Combined endoscopic and mini-open repair of chronic complete proximal hamstring tendon avulsion: a novel approach and short-term outcomes

Journal of Hip Preservation Surgery ◽

10.1093/jhps/hnab006 ◽

2021 ◽

Author(s):

Shai Factor ◽

Amal Khoury ◽

Ran Atzmon ◽

Matias Vidra ◽

Eyal Amar ◽

...

Keyword(s):

Functional Outcome ◽

Open Repair ◽

Hamstring Tendon ◽

Activity Level ◽

Short Term ◽

The Mean ◽

Proximal Hamstring ◽

Tendon Avulsion ◽

Mini Open

To evaluate the outcome of a novel, combined endoscopic and mini-open repair (CEMR) of a chronic complete retracted proximal hamstring tendon avulsion (PHA). A retrospective case series of a single-surgeon database for all patients, with a minimum of 1-year follow-up, who underwent CEMR between July 2015 and September 2019 was performed. Patients were evaluated for their functional outcome using the Perth Hamstring Assessment Tool (PHAT). At the latest follow-up, patients were evaluated for their muscle strength, subjective satisfaction and post-operative complications. Twelve patients who underwent endoscopic surgery for chronic PHA were identified, of which seven patients underwent CEMR. After exclusion of one patient from the study due to an open claim for health insurance, six patients (five males) with a mean age of 48 years (range 20–61 years) were evaluated. The mean time from injury to surgery was 12 months (range 2–43 months). At a mean follow-up of 28 months (range 12–55 months), the average PHAT score was 73 (range 70–80). The mean subjective activity level percentage improved from 34 (range 20–50) pre-surgery to 81 (range 75–90) post-surgery. The mean strength of the quadriceps, hamstring at 30°, and hamstring at 90° of the operated leg compared to the uninjured leg did not differ significantly. One patient underwent adhesiolysis 1 year after the index procedure for treatment of subcutaneous adhesions. CEMR is a viable and safe option for the treatment of chronic complete proximal hamstring tears, with good to excellent short-term functional outcome. Level of evidence: IV.

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CLINICAL COMPARISON BETWEEN FEMORAL TRANSFIXATION AND BIOSCREW FIXATION USING HAMSTRING TENDON GRAFT FOR ACL RECONSTRUCTION AT ORTHOPAEDICS DEPARTMENT OF JLNMCH, BHAGALPUR, BIHAR

10.36106/ijsr/4026688 ◽

2020 ◽

pp. 65-67

Author(s):

Rakesh Ramdayal Singh ◽

Yogesh Kumar ◽

Maseeh Azam ◽

D. K. Singh ◽

Debarshi Jana

Keyword(s):

Acl Reconstruction ◽

Femoral Condyle ◽

Knee Laxity ◽

Hamstring Tendon ◽

Tendon Graft ◽

Interference Screw ◽

Fixation Technique ◽

Significant Difference ◽

Hamstrings Tendon ◽

Femoral Side

Background: One of the popular graft choices for ACL reconstruction have been Hamstrings tendon autograft. Thereis no consensus on the ideal technique of fixation of hamstrings graft to femoral condyle. Theoretically we hypothesized that transfixation method of hamstrings graft fixation to femoral condyle should be superior to bio-interference screw fixation technique. Hence aim of our study is to compare this two fixation methods of hamstrings autografts clinically. Methods: 50 clinically and radiologically proven ACL deficient fighting soldiers are selected for the study. In groupA; 25 patients underwent ACL reconstruction with Bioscrew using aperture technique on femoral side. Other 25 patients in group B underwent ACL reconstruction with transfixation screw using cortico-cancellous fixation technique on femoral side. In both groups quadrupled semitendinosus autograft is utilized. All the patients evaluated for functional outcome at the end of 6 weeks and at 6 months and at the end of 1 year following the procedure. The subjects are evaluated using the modified Lysholm knee score and knee laxity is measured by Rolimeter. Results: At 01 year post op. there was no statistically significant difference in both groups in terms of Manual laitytests,Rollimeter laity measurement and Lysholm knee score.The overall satisfactory result (Excellent + Good) in both the groups at 01 year follow up were 98% by Lysholm score. Conclusions: Transfixation and Bioscrew fixation showed comparable results in manual knee laxity tests,instrumental knee laxity tests using Rolimeter, Lyslohm scores and high patient satisfaction, with almost 96% of patients in both groups returned to their pre-injury levels.

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Arthroscopic ACL Reconstruction with Autologous Hamstring Tendon using Bioabsorbable Cross Pin Fixation on the Femoral Side

The Journal of the Korean Orthopaedic Association ◽

10.4055/jkoa.2005.40.6.659 ◽

2005 ◽

Vol 40 (6) ◽

pp. 659 ◽

Cited By ~ 1

Author(s):

Jin Hwan Ahn ◽

Jun Sic Park ◽

Young Jin Cho ◽

Yi Sack Joung

Keyword(s):

Acl Reconstruction ◽

Hamstring Tendon ◽

Pin Fixation ◽

Femoral Side

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A comparative study on functional outcome of ACL reconstruction: Quadriceps versus hamstring tendon autograft

Journal of Arthroscopy and Joint Surgery ◽

10.1016/j.jajs.2018.09.005 ◽

2019 ◽

Vol 6 (1) ◽

pp. 61-64

Author(s):

Sandeep Yadav Tirupathi ◽

Divyanshu Goyal ◽

Vidyasagar Jvs

Keyword(s):

Comparative Study ◽

Functional Outcome ◽

Acl Reconstruction ◽

Hamstring Tendon ◽

Hamstring Tendon Autograft ◽

Tendon Autograft

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Suspensory Versus Aperture Fixation of a Quadrupled Hamstring Tendon Autograft in Anterior Cruciate Ligament Reconstruction: A Meta-analysis

The American Journal of Sports Medicine ◽

10.1177/0363546516680995 ◽

2017 ◽

Vol 45 (10) ◽

pp. 2418-2427 ◽

Cited By ~ 24

Author(s):

William M. Browning ◽

Melissa A. Kluczynski ◽

Christian Curatolo ◽

John M. Marzo

Keyword(s):

Acl Reconstruction ◽

Pivot Shift ◽

Cruciate Ligament ◽

Meta Analysis ◽

Hamstring Tendon ◽

Significant Difference ◽

Fixation Techniques ◽

Suspensory Fixation ◽

Aperture Fixation ◽

Anterior Cruciate

Background: Hamstring grafts have become a popular choice for anterior cruciate ligament (ACL) reconstruction; however, the most effective means of fixation of these soft tissue grafts is unknown. Purpose: To determine whether suspensory or aperture fixation of hamstring tendon autografts provides better stability and clinical outcomes in ACL reconstruction. Study Design: Meta-analysis. Methods: A literature search of studies reporting single-bundle ACL reconstructions using 4-stranded hamstring tendon autografts with aperture or suspensory fixation with a minimum 24-month follow-up was conducted. Stability and clinical outcomes were compared for aperture versus suspensory fixation. Knee stability was measured with the Lachman or pivot-shift test or KT-1000 arthrometer side-to-side difference (SSD), and outcomes were determined with the International Knee Documentation Committee (IKDC), Tegner, and Lysholm scores as well as graft failures. A random-effects model with a pooled estimate for the between-study variance was used to estimate proportions or means for each outcome and its corresponding 95% CI. Results: Forty-one studies were included, of which 20 utilized suspensory fixation techniques and 21 utilized aperture fixation techniques. A >3-mm SSD was seen more often in the aperture group than the suspensory group, which was statistically significant ( P < .0001), but there was no significant difference between groups for a >5-mm SSD ( P = .53). The aperture group demonstrated significantly more graft ruptures than did the suspensory group ( P = .03). There were no statistically significant differences in Lachman grade 0 ( P = .76), grade 1 ( P = .89), and grade 2 ( P = .55) or pivot-shift grade 0 ( P = .72), grade 1 ( P = .97), and grade 2 ( P = .28). There was no statistically significant difference in mean continuous IKDC ( P = .80), Tegner ( P = .34), or Lysholm ( P = .84) scores. Conclusion: This meta-analysis demonstrated improved overall arthrometric stability and fewer graft ruptures using suspensory fixation compared with aperture fixation of a quadrupled hamstring tendon autograft in ACL reconstruction. There were no differences in IKDC, Lysholm, Lachman, and pivot-shift outcomes between suspensory and aperture fixation.

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Bone tunnel impaction reduced the tibial tunnel enlargement

Open Medicine ◽

10.1515/med-2017-0016 ◽

2017 ◽

Vol 12 (1) ◽

pp. 99-106 ◽

Cited By ~ 2

Author(s):

Huan Xu ◽

Rongzong Zheng ◽

Jinhe Ying

Keyword(s):

Acl Reconstruction ◽

Tibial Tunnel ◽

Hamstring Tendon ◽

Bone Tunnel ◽

Tunnel Widening ◽

Tunnel Enlargement ◽

Fixation Devices ◽

Suspensory Fixation ◽

Group A ◽

The Mean

AbstractThe purpose of this study was to investigate whether the bone tunnel impaction technique performed by dilators could dwindle the tibial tunnel enlargement after anterior cruciate ligament (ACL) reconstruction with hamstring tendon using both extracortical suspensory fixation devices at femoral and tibial site.Thirty-one consecutive patients undergoing primary ACL reconstruction with the hamstring autograft were enrolled in this research. Patients were randomly allotted to group A (bone tunnel impaction technique using dilators) or group B (regular extraction bone tunnel drilling).ResultsThe average follow-up was 16.2 months. The mean femoral tunnel widening was 1.05 mm and 1.02 mm respectively in group A and B. The mean tibial tunnel widening was 0.61 mm and 1.08 mm respectively in group A and B. There was no statistical difference for tunnel enlargement between the two groups at the femoral site (P = 0.62) but significant difference at the tibial site (P < 0.0001).ConclusionBone tunnel impaction technique leaded to a reduction of tibial bone tunnel enlargement after ACL reconstruction with hamstring tendon using both extracortical suspensory fixation devices at femoral and tibial site.

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