Providing Graft Tension in ACL Reconstruction with Preservation of the Hamstring Tibial Attachment Site: A Report on the Technique and Clinical Results

Abstract Introduction: Anterior cruciate ligament (ACL) rupture is one of the most common lesions in knee traumatology; therefore the number of ACL reconstructions is increasing worldwide. Usually, an anteromedial (AM) accessory portal is required in anatomical positioning of the femoral tunnel, which is not absolutely necessary in this technique. Aim: Assessment of all-inside ACL reconstruction preliminary clinical results with adjustable loops and buttons on both femoral and tibial surfaces. Method: Our prospective study included 28 subjects (19 male, 9 female) with chronic ACL ruptures. The mean age of the study population was 27.72 ± 8.23 years. In all cases ACL reconstruction was carried out with the use of quadrupled semitendinosus auto-grafts with adjustable loops and buttons on the femoral and tibial surfaces and anatomic placement of both tunnels, using an outside-in technique, with flipcutters (Arthrex®). Clinical and radiological evaluations were carried out before surgery and at 3 and 6 months postoperatively, with the Lysholm scoring system, the Tegner activity scale and anterior-posterior and latero-lateral X-rays. Anterior knee laxity was measured in 25° of flexion using a portable arthrometer (RolimeterTM, Aircast®) and maximum manual force. Results: During the final follow-up, the Lysholm score was good and excellent in 27 cases, with a mean Lysholm score of 95.55 ± 4.63; all results were classified as good. The mean preoperative Tegner activity score was 3.46 ± 1.71 (range: 1-7), and the post-operative mean score was 5.75 ± 2.24 (range: 2-10). We found no graft ruptures. Preoperative knee laxity measurements showed a mean displacement of 11.5 ± 3.1 mm and side-to-side differences of 5.6 ± 3.5 mm, while the postoperative measurements at the last follow-up were 6.3 ± 1.54 mm and 2.65 ± 1.86 mm, respectively. Conclusion: Short-term clinical outcomes of all-inside ACL restoration with anatomic placement femoral and tibial tunnels seem to recommend this surgical option, with good subjective and objective results. Additional research will have to prove the long-term success.

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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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Characterizing the Influence of Preconditioning on Initial Tension for Hamstring Tendon and Patella Tendon Grafts

ASME 2007 Summer Bioengineering Conference ◽

10.1115/sbc2007-172333 ◽

2007 ◽

Author(s):

John J. Elias ◽

Surya P. Rai ◽

David M. Weinstein ◽

William J. Ciccone

Keyword(s):

Stress Relaxation ◽

Acl Reconstruction ◽

Knee Laxity ◽

Hamstring Tendon ◽

Patella Tendon ◽

Initial Tension ◽

Graft Tension ◽

Anterior Knee Laxity ◽

Tendon Grafts ◽

Anterior Knee

The primary goal of ACL reconstruction is to limit post-operative anterior knee laxity without over-constraining the knee. For both hamstring tendon and patella tendon grafts used for ACL reconstruction, initial graft tension is applied to limit post-operative knee laxity. Both types of graft stress relax following implantation, decreasing the graft tension. Previous studies have shown that preconditioning reduces the tension decrease due to stress relaxation for both hamstring tendons [1] and patella tendons [2]. While hamstring tendon grafts are typically preconditioned in tension on a graft board prior to implantation to limit stress relaxation, patella tendon grafts are typically implanted without preconditioning. The current study focused on characterizing the influence of preconditioning on stress relaxation for both types of graft. The authors hypothesized that the tension loss due to stress relaxation would be larger for preconditioned hamstring tendon grafts than for preconditioned patella tendon grafts.

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The Influence of Anterior Cruciate Ligament Remnant on Postoperative Clinical Results in Patients with Remnant Preserving Anterior Cruciate Ligament Reconstruction

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2017.096 ◽

2017 ◽

Vol 5 (5) ◽

pp. 624-629 ◽

Cited By ~ 4

Author(s):

Alan Goce Andonovski ◽

Sonja Topuzovska ◽

Milan Samardziski ◽

Zoran Bozinovski ◽

Biljana Andonovska ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

Cruciate Ligament ◽

Clinical Results ◽

Control Group ◽

Single Bundle ◽

Knee Stability ◽

The Mean ◽

Anterior Cruciate ◽

Proprioceptive Function

BACKGROUND: Anterior Cruciate Ligament (ACL) remnants have important biomechanical, vascular and proprioceptive function.AIM: To determine the influence of the ACL residual remnants after partial and complete ACL ruptures on postoperative clinical results in patients with remnant preserving ACL reconstruction.PATIENTS AND METHODS: The study included 66 patients divided into two groups. In patients from the investigation group remnant preserving ACL reconstruction was performed, in patients from the control group single bundle ACL reconstruction was performed. The results were assessed by Rolimeter measurements, Lysholm and Tegner scores and proprioception evaluation.RESULTS: The mean side-to-side difference of anterior tibia displacement (mm) was improved from 4.4 ± 1.06 to 0.4 ± 0.7 in the investigation group, and from 4.6 ± 0.68 to 1.9 ± 0.64 in the control group (p < 0.001). Difference in the angles in which the knee was placed by the device and the patient has improved from 1.5 ± 0.96° to 0.5 ± 0.53° in the investigation group and from 1.8 ± 0.78° to 1.3 ± 0.97° in the control group (p < 0.05). Tegner and Lysholm scores showed no difference between the groups.CONCLUSION: Preservation of the ACL residual bundle provides a better knee stability and proprioceptive function.

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A Closer Look is necessary: Traumatic luxation of the patella as a co-injury of an acl-rupture

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00327 ◽

2020 ◽

Vol 8 (5_suppl4) ◽

pp. 2325967120S0032

Author(s):

Kai Fehske ◽

Rainer Meffert ◽

Lars Eden

Keyword(s):

Acl Reconstruction ◽

Medial Collateral Ligament ◽

External Rotation ◽

Knee Injuries ◽

Clinical Results ◽

Acl Rupture ◽

Mpfl Reconstruction ◽

Collateral Ligament ◽

Complete Rupture ◽

Patella Luxation

Aims and Objectives: The rupture of the acl is considered to be one of the most common knee injuries in sports traumatology. Many patients report that they felt the sensation of a luxated patella during their knee distorsion. In many cases patients patients with the suspicion of a traumatic patella luxation showed in the mri a complete rupture of the acl. Materials and Methods: We report about 10 patients consulting our department within the last year after a significant knee trauma. In the mri as well as during the arthroscopic evaluation they showed a complete rupture of the acl as well as the findings of a fresh, traumatic patella luxation. We evaluated and analysed the preoperative and intraoperative pictures (mri and arthrosopy). Results: All patients showed in the posttraumatic mri a complete rupture of the acl as well as an at least partial rupture of the mpfl and a rupture of the medial retinaculum. 4 patients showed a persistent subluxation of the patella, 8 patients showed also a rupture of the medial collateral ligament. During the operation we verified a significant instability of the patella in 8 patients so that a stabilization of the patella was performed (open medial stabilization or mpfl reconstruction) in the same operation the acl was reconstructed (semi-t). Eventhough the patients were treated with only one operation and the regaining of motion was prolonged compared with isolated acl-reconstruction, after 12 months postoperatively all patients had a satisfactory range of motion. Conclusion: The typical trauma mechanism for an acl rupture is a valgus position of the knee in combination with an external rotation of the tibia, which leads to an enlargement of the q-angle which is considered a predisposition for a patella luxation. If an acl rupture occurs, the patella can luxate within the same trauma. In the posttraumatic mri the rupture of the mpfl is often misinterpreted as a rupture of the medial collateral ligament, particularly if the patella is, as in most cases, in full reposition. Within an acl-rupture a luxation of the patella can occur simultaneously, leading to a significant instability which needs to be treated (medial stabilization or mpfl-reconstruction). Our data shows that a single stage treatment with acl-reconstruction and medial stabilization is technical practicable and mid-term investigation shows good clinical results without a higher risk of an arthrofibrosis.

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Comparison of Clinical Results According to Amount of Preserved Remnant in Arthroscopic ACL Reconstruction using Quadrupled Hamstring Graft

The Journal of the Korean Orthopaedic Association ◽

10.4055/jkoa.2005.40.3.284 ◽

2005 ◽

Vol 40 (3) ◽

pp. 284 ◽

Cited By ~ 3

Author(s):

Byung Ill Lee ◽

Jun Bum Kim ◽

Kyung Dae Min ◽

Hyung Suk Choi ◽

Je Pil Eom

Keyword(s):

Acl Reconstruction ◽

Clinical Results ◽

Hamstring Graft

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Good clinical results can be obtained along with reduced risk of tunnel communication with a new technique in concomitant meniscus transplantation and ACL reconstruction

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-017-4576-9 ◽

2017 ◽

Vol 26 (2) ◽

pp. 622-627

Author(s):

Murat Bozkurt ◽

Mesut Tahta ◽

Mustafa Akkaya ◽

Cetin Isik ◽

Safa Gursoy

Keyword(s):

Acl Reconstruction ◽

Clinical Results ◽

New Technique ◽

Meniscus Transplantation ◽

A New Technique ◽

Reduced Risk

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All-inside technique in ACL reconstruction: mid-term clinical outcomes and comparison with AM technique (Hamstrings and BpTB grafts)

European Journal of Orthopaedic Surgery & Traumatology ◽

10.1007/s00590-020-02798-w ◽

2020 ◽

Author(s):

Andrea Pautasso ◽

Marcello Capella ◽

Luca Barberis ◽

Luca Drocco ◽

Riccardo Giai Via ◽

...

Keyword(s):

Clinical Outcomes ◽

Acl Reconstruction ◽

Young Patients ◽

Clinical Results ◽

Reconstruction Technique ◽

Medium Term ◽

Significant Difference ◽

Kt 1000 ◽

Surgical Duration

Abstract Purpose The aim of this study was to define the subjective and objective clinical results of all-inside surgical technique at a medium-term follow-up and to compare these results with those obtained from antero-medial (AM) ACL reconstruction technique using hamstrings (HS) or bone-patellar tendon-bone (BpTB) grafts to detect eventual superiority of one technique to another. Methods A retrospective analysis of routinely collected data was conducted. Inclusion criteria were ACL reconstruction through all-inside technique or AM technique with HS or BpTB performed between January 2015 and May 2018; age between 15 and 30 year old; minimum 24 months’ available follow-up. Exclusion criteria were contralateral ACL reconstruction; need for any other associated procedures during surgery. Clinical outcomes were assessed with KOOS, Lysholm, Tegner scores and KT-1000 device. Results According to the selection criteria, 157 patients were enrolled and divided subsequently into 3 groups: all-inside (51 patients), AM-HS (53 patients) and AM-BpTB (53 patients). A significant postoperative improvement of each score in all groups was detected. The mean KT-1000 was 3.1 ± 1.0 mm in all-inside group, while 3.3 ± 1.4 mm and 2.5 ± 0.4 mm in AM-HS and AM-BpTB groups, respectively. Comparing the results obtained, no statistically significant difference was found between the three techniques (p = 0.27). Statistically significant differences were highlighted in surgical duration: all-inside method was the longest (117′), followed by AM-BpTB surgery (101′) and AM-HS technique (87′). Conclusions The all-inside technique showed good postoperative results at medium-term follow-up. It could be a valuable solution for ACL reconstruction, especially in young patients due to its less invasiveness, despite surgical skills and time needed. Levels of evidence Level IV.

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