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

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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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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A Modified Oblique Incision in Hamstring Tendon Graft Harvesting During ACL Reconstruction

10.21203/rs.3.rs-129850/v1 ◽

2020 ◽

Author(s):

Biao Zhu ◽

XueLei Li ◽

Tengteng Lou

Keyword(s):

Acl Reconstruction ◽

Cruciate Ligament ◽

Hamstring Tendon ◽

Tendon Graft ◽

Sensory Loss ◽

Functional Score ◽

Hamstring Tendons ◽

Prick Test ◽

Significant Difference ◽

Oblique Incision

Abstract Background: During anterior cruciate ligament(ACL)reconstruction, different methods of harvesting hamstring tendon may lead to different degrees of injury to the inferior patellar branch of the saphenous nerve(IPBSN). Most of recent studies in the literature suggest that the classic oblique incision(COI) can reduce the incidence of IPBSN injury. We proposed a modified oblique incision(MOI) and compared it with the COI in terms of the resulting levels of injury and sensory loss and the clinical outcome.Methods: Patients with ACL injury admitted to our hospital from April 2015 to July 2019 were randomly selected and included in our study. Thirty patients underwent the COI to harvest hamstring tendons, and the other 32 patients underwent the MOI. The pin prick test was performed to detect the sensation loss at 2 weeks, 6 months and 1 year after the operation. Digital photos of the region of hypoesthesia area were taken, and then computer software (Adobe Photoshop CS6, 13.0.1) was used to calculate the area of the hypoesthesia. The length of the incision and knee joint functional score were also recorded. Results: At the final follow-up, the incidence of IPBSN injury in COI and MOI were 33.3% and 9.4%, and the areas of paresthesia were 26.4±2.4 cm2 and 9.8±3.4 cm2 respectively. There was no significant difference in the incision length or knee functional score between the two groups.Conclusion: The MOI can significantly reduce the risk of injury to the IPBSN, reduce the area of hypoesthesia and lead to high subjective satisfaction. Therefore, compared with the COI, the MOI is a better method of harvesting hamstring tendons in ACL reconstruction.

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A modified oblique incision in hamstring tendon graft harvesting during ACL reconstruction

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02341-5 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Biao Zhu ◽

Xuelei Li ◽

Tengteng Lou

Keyword(s):

Acl Reconstruction ◽

Cruciate Ligament ◽

Hamstring Tendon ◽

Tendon Graft ◽

Sensory Loss ◽

Functional Score ◽

Hamstring Tendons ◽

Prick Test ◽

Significant Difference ◽

Oblique Incision

Abstract Background During anterior cruciate ligament (ACL) reconstruction, different methods of harvesting hamstring tendon may lead to different degrees of injury to the inferior patellar branch of the saphenous nerve (IPBSN). Most of recent studies in the literature suggest that the classic oblique incision (COI) can reduce the incidence of IPBSN injury. We proposed a modified oblique incision (MOI) and compared it with the COI in terms of the resulting levels of injury and sensory loss and the clinical outcome. Methods Patients with ACL injury admitted to our hospital from April 2015 to July 2019 were randomly selected and included in our study. Thirty patients underwent the COI to harvest hamstring tendons, and the other 32 patients underwent the MOI. The pin prick test was performed to detect the sensation loss at 2 weeks, 6 months, and 1 year after the operation. Digital photos of the region of hypoesthesia area were taken, and then, a computer software (Adobe Photoshop CS6, 13.0.1) was used to calculate the area of the hypoesthesia. The length of the incision and knee joint functional score were also recorded. Results At the final follow-up, the incidence of IPBSN injury in COI and MOI were 33.3% and 9.4%, and the areas of paresthesia were 26.4±2.4 cm2 and 9.8±3.4 cm2 respectively. There was no significant difference in the incision length or knee functional score between the two groups. Conclusion The MOI can significantly reduce the risk of injury to the IPBSN, reduce the area of hypoesthesia, and lead to high subjective satisfaction. Therefore, compared with the COI, the MOI is a better method of harvesting hamstring tendons in ACL reconstruction.

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Comparative study between aperture and suspensary fixation of hamstring autografts on femoral side in ACL reconstruction: clinical and radiological outcome assessment

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20170789 ◽

2017 ◽

Vol 3 (2) ◽

pp. 298

Author(s):

Manoj R. Kashid ◽

Rahool S. ◽

Amit Chaudhry ◽

Rajshekhar . ◽

Varunendra Bahadur Singh ◽

...

Keyword(s):

Clinical Outcomes ◽

Acl Reconstruction ◽

Femoral Condyle ◽

Lysholm Score ◽

Tunnel Widening ◽

Knee Score ◽

Hamstring Graft ◽

Fixation Methods ◽

Suspensory Fixation ◽

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

The American Journal of Sports Medicine ◽

10.1177/0363546517752918 ◽

2018 ◽

Vol 46 (5) ◽

pp. 1143-1149 ◽

Cited By ~ 15

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.

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No difference in clinical results between femoral transfixation and bio-interference screw fixation in hamstring tendon ACL reconstruction

The Knee ◽

10.1016/j.knee.2008.02.003 ◽

2008 ◽

Vol 15 (3) ◽

pp. 174-179 ◽

Cited By ~ 24

Author(s):

Luca Capuano ◽

Philippe Hardy ◽

Umile Giuseppe Longo ◽

Vincenzo Denaro ◽

Nicola Maffulli

Keyword(s):

Acl Reconstruction ◽

Screw Fixation ◽

Clinical Results ◽

Hamstring Tendon ◽

Interference Screw ◽

Interference Screw Fixation

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Interference Screw Fixation Strength of a Quadrupled Hamstring Tendon Graft Is Directly Related to Bone Mineral Density and Insertion Torque

The American Journal of Sports Medicine ◽

10.1177/03635465000280051501 ◽

2000 ◽

Vol 28 (5) ◽

pp. 705-710 ◽

Cited By ~ 161

Author(s):

Jeff C. Brand ◽

David Pienkowski ◽

Eric Steenlage ◽

Doris Hamilton ◽

Darren L. Johnson ◽

...

Keyword(s):

Bone Mineral Density ◽

Screw Fixation ◽

Hamstring Tendon ◽

Tendon Graft ◽

Interference Screw ◽

Fixation Strength ◽

Insertion Torque ◽

Mineral Density ◽

Hamstring Tendon Graft ◽

Interference Screw Fixation

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In Vitro Testing of 2 Adjustable-Loop Cortical Suspensory Fixation Systems Versus Interference Screw for Anterior Cruciate Ligament Reconstruction

Orthopaedic Journal of Sports Medicine ◽

10.1177/23259671211031652 ◽

2021 ◽

Vol 9 (9) ◽

pp. 232596712110316

Author(s):

Gerardo L. Garcés ◽

Oscar Martel ◽

Alejandro Yánez ◽

Ignacio Manchado-Herrera ◽

Luci M. Motta

Keyword(s):

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

Failure Load ◽

Cruciate Ligament ◽

Interference Screw ◽

Yield Load ◽

Ultimate Failure Load ◽

Significant Difference ◽

Ultimate Failure ◽

Anterior Cruciate

Background: It is not clear whether the mechanical strength of adjustable-loop suspension devices (ALDs) in anterior cruciate ligament (ACL) reconstruction is device dependent and if these constructs are different from those of an interference screw. Purpose: To compare the biomechanical differences of 2 types of ALDs versus an interference screw. Study Design: Controlled laboratory study. Methods: ACL reconstruction was performed on porcine femurs and bovine extensor tendons with 3 types of fixation devices: interference screw, UltraButton (UB) ALD, and TightRope (TR) ALD (n = 10 for each). In addition to specimen testing, isolated testing of the 2 ALDs was performed. The loading protocol consisted of 3 stages: preload (static 150 N load for 5 minutes), cyclic load (50-250 N at 1 Hz for 1000 cycles), and load to failure (crosshead speed 50 mm/min). Displacement at different cycles, ultimate failure load, yield load, stiffness, and failure mode were recorded. Results: In specimen testing, displacement of the ALDs at the 1000th cycle was similar (3.42 ± 1.34 mm for TR and 3.39 ± 0.92 mm for UB), but both were significantly lower than that of the interference screw (7.54 ± 3.18 mm) ( P < .001 for both). The yield load of the UB (547 ± 173 N) was higher than that of the TR (420 ± 72 N) ( P = .033) or the interference screw (386 ± 51 N; P = .013), with no significant difference between the latter 2. In isolated device testing, the ultimate failure load of the TR (862 ± 64 N) was significantly lower than that of the UB (1879 ± 126 N) ( P < .001). Conclusion: Both ALDs showed significantly less displacement in cyclic loading at ultimate failure than the interference screw. The yield load of the UB was significantly higher than that of the other 2. The ultimate failure occurred at a significantly higher load for UB than it did for TR in isolated device testing. Clinical Relevance: Both UB and TR provided stronger fixation than an interference screw. Although difficult to assess, intrinsic differences in the mechanical properties of these ALDs may affect clinical outcomes.

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