Does Hamstring Graft Size Affect Functional Outcome and Incidence of Revision Surgery After Primary Anterior Cruciate Ligament (ACL) Reconstruction?

Background: The most common joint to be injured in our body is knee joint, and the commonest ligament to be injured is anterior cruciate ligament in the knee.Etiology includes road trafc accidents and sport injuries. The ACL, along with other ligaments, the capsule are the stabilizers of the knee and prevents anterior translation, and limits valgus and rotational stress. The articular cartilage injuries in acute ACL tears constitutes from 16 – 46%, and in chronic tears, the incidence increases further2. For prevention of further worsening of the existing lesions and also to prevent formation of new lesions, stablity of the knee should be achieved.The present study is to assess the functional outcome of arthroscopic anterior cruciate ligament reconstruction using hamstring tendon (gracilis and semitendinosus) autograft in patients with ACL tears. Methods: Study design: Hospital Based Observational study. Study period: September 2019 to August 2021. Sample size: 30 30 consecutive patients who underwent arthroscopic ACL reconstructions with hamstring graft were taken for this study. Results: Out of these, 27 patients were male and 3 were female. Right side affected in 18 patients and left side in 12 patients. The most common mechanism of the injury was sports activity in 17 patients, RTA injuries in 10 patients and other job related injuries in 3 patients. Isolated ACL tears in thirteen patients in our study and rest had associated injuries to menisci in same knee.Better postoperative functional scores are seen with patients with isolated ACL injuries compared to those patients with associated injuries of the knee like meniscal tears. Observations include anterior drawer test was negative in 83.33% of patients at 3 months, 86.67% of patients at 6 months and at 1 year 96.15% of patients had a negative anterior drawer test. Full range of motion attained in 86.67% of patients at 3 months, 93.33% of patients at 6 months and at 1 year 96.15% of patients.Pivot shift test was negative postoperatively for all the patients at any follow-up. Postoperatively at 3 months 25 (83.33%) patients had 5/5 quadriceps power (MRC grading) 92.3% of them had 5/5 power at latest follow up. Complications include Supercial infection and Deep infection in our study. Conclusion: Anterior cruciate ligament tears are most common at a mean age of 28 years with preponderance to male gender. The most common mechanism of the injury was sports activity. Isolated ACL injury is more common than along with associated meniscal injuries.Anatomic single bundle reconstruction with quadrupled hamstring graft gives good functional results.Hamstring graft xation with endobutton and interference screw gives better functional outcome.

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A study on functional outcome of arthroscopic anatomical reconstruction of anterior cruciate ligament using quadrupled hamstring graft

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20172886 ◽

2017 ◽

Vol 3 (4) ◽

pp. 854

Author(s):

Jagdeesh P. C. ◽

Suhail R. Shaikh

Keyword(s):

Anterior Cruciate Ligament ◽

Functional Outcome ◽

Acl Reconstruction ◽

Cruciate Ligament ◽

Scoring Systems ◽

Activity Level ◽

Anatomical Reconstruction ◽

Proper Patient Selection ◽

Anterior Cruciate ◽

Hamstrings Tendon

Background: Various techniques and graft types are now available for the reconstruction of ACL. Opinions differ among experts with regard to the ideal technique and graft type to be used. Arthroscopic anatomical ACL reconstruction using quadrupled hamstring autograft with fixation in the femoral tunnel using tightrope and in the tibial tunnel with interference screw is a relatively new technique. Purpose of this study is to analyze the postoperative outcome in our experience with this procedure.Methods: This was a prospective study of patients with ACL injury who underwent Arthroscopic anatomical ACL reconstruction using quadrupled hamstrings autograft. All patients were operated upon by the same surgeon and had the same rehabilitation protocol. They were followed up for six months at regular intervals using IKDC, LGS scoring systems, tegner activity scale and a subjective questionnaire.Results: About 95% of the patients had a favorable outcome as per three scoring systems. (IKDC, Lysholm score, subjective questionnaire) all three scoring system had a very high correlation around 90% of individuals were able to return to their pre injury activity level.Conclusions: We conclude that the functional outcome of arthroscopic anatomical anterior cruciate ligament reconstruction using quadrupled hamstrings tendon autograft is excellent to good (95%). With proper patient selection and rehabilitation full occupational and recreational activities can be expected for most of the patients within four to six months of the procedure.

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Allograft Augmentation of Hamstring Anterior Cruciate Ligament Autografts Is Associated With Increased Graft Failure in Children and Adolescents

The American Journal of Sports Medicine ◽

10.1177/0363546519849607 ◽

2019 ◽

Vol 47 (7) ◽

pp. 1576-1582 ◽

Cited By ~ 8

Author(s):

Crystal A. Perkins ◽

Michael T. Busch ◽

Melissa Christino ◽

Mackenzie M. Herzog ◽

S. Clifton Willimon

Keyword(s):

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

Graft Failure ◽

Cruciate Ligament ◽

Hamstring Tendon ◽

Hamstring Graft ◽

Tissue Allograft ◽

Graft Rupture ◽

Anterior Cruciate ◽

Graft Diameter

Background: Anterior cruciate ligament (ACL) reconstruction in adolescents is commonly performed with hamstring tendon autografts. Small graft diameter is one risk factor for graft failure and options to upsize the autologous hamstring graft include allograft augmentation and tripling one or both of the hamstring tendons. Purpose: To evaluate the association of upsized hamstring graft constructs and graft rupture after ACL reconstruction. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective review was performed of patients 19 years of age and younger who underwent hamstring autograft ACL reconstruction with or without soft tissue allograft augmentation from 2012 to 2016. All patients were skeletally mature or had less than 2 years of growth remaining. Graft constructs included 4-strand doubled semitendinosus and gracilis autograft (4-STG), 5-strand tripled semitendinosus and doubled gracilis autograft (5-STG), and 6-strand doubled gracilis and semitendinosus autograft augmented with a soft tissue allograft (6-STGAllo). The primary outcome measure was graft rupture. Results: A total of 354 patients with a mean age of 15.3 years (range, 10-19 years) were included. Graft constructs included 4-STG (198 knees), 5-STG (91 knees), and 6-STGAllo (65 knees). The average diameter of the graft constructs was 8.3 mm for 4-STG, 8.9 mm for 5-STG, and 9.2 mm for 6-STGAllo ( P < .001). The mean follow-up was 26 months (range, 6-56 months). There were 50 (14%) graft ruptures and 24 (7%) contralateral ACL tears. The graft failure rates were 14% for 4-STG, 12% for 5-STG, and 20% for 6-STGAllo ( P = .51). The average time to graft failure was 16 months (range, 2-40 months). After adjusting for age and graft size, patients who had allograft-augmented grafts (6-STGAllo) had 2.6 (95% CI, 1.02, 6.50) times the odds of graft rupture compared with 4-STG. There was no significant difference in failure rate between patients who had 5-STG grafts compared with 4-STG (OR, 1.2; 95% CI, 0.5, 2.7). Conclusion: ACL reconstruction with hamstring tendon autografts augmented with allografts has a significantly increased risk of graft rupture compared with comparably sized hamstring tendon autografts. In situations where the surgeon harvests an inadequately sized 4-strand autograft, we recommend obtaining a larger graft diameter by tripling the semitendinosus rather than augmenting with an allograft.

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Erratum to “Adequacy of Semitendinosus Tendon Alone for Anterior Cruciate Ligament Reconstruction Graft and Prediction of Hamstring Graft Size by Evaluating Simple Anthropometric Parameters”

Anatomy Research International ◽

10.1155/2013/925480 ◽

2013 ◽

Vol 2013 ◽

pp. 1-1 ◽

Cited By ~ 1

Author(s):

S. G. Papastergiou ◽

G. A. Konstantinidis ◽

K. Natsis ◽

E. Papathanasiou ◽

N. Koukoulias ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Anterior Cruciate Ligament Reconstruction ◽

Ligament Reconstruction ◽

Cruciate Ligament ◽

Semitendinosus Tendon ◽

Hamstring Graft ◽

Anthropometric Parameters ◽

Graft Size ◽

Cruciate Ligament Reconstruction ◽

Anterior Cruciate

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Effect of drains on dynamic proprioception after arthroscopically assisted anterior cruciate ligament reconstruction

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20164177 ◽

2016 ◽

Vol 2 (4) ◽

pp. 404

Author(s):

Atul Mahajan

Keyword(s):

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

Cruciate Ligament ◽

Hamstring Graft ◽

Balance Test ◽

Suction Drain ◽

Arthroscopically Assisted ◽

Drain Group ◽

Anterior Cruciate ◽

Dynamic Posture

Background: Decrease in proprioception and kinesthesia occurs after ACL injury. Changes occurring within the joint following injury affect normal recruitment and firing patterns of the surrounding musculature. There are little data in the literature with reference to drain use after arthroscopic procedures on the knee or ACL reconstruction. The objective of the study was to determine the effect of postoperative drain use on proprioception after arthroscopically assisted anterior cruciate ligament (ACL) reconstruction with quadrupled hamstring graft.Methods: In this study, 54 arthroscopic ACL reconstruction patients were randomized for either intra-articular suction drain group or non-drain group. Outcome Assessment was done at 1 month, 3, 6 and 12 months after the surgery in which patients were assessed using Star excursion balance test by measuring excursion distances in each of the 8 directions.Results: Excursion distances in eight directions showed more increment in drainage tube (DT) group compared to no DT group. However it was found to be statistically significant only for posteromedial (p =0.018) and medial directions (p <0.001).Conclusions: Postoperative drain should be used after arthroscopically assisted anterior cruciate ligament (ACL) reconstruction with quadrupled hamstring graft for improving the deficits in dynamic posture control.

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Comparing the Width of Hamstring Grafts Prepared Using Wet and Dry Gauze Methods in Anterior Cruciate Ligament Reconstruction Surgery

Journal of Research in Orthopedic Science ◽

10.32598/jrosj.7.4.519.2 ◽

2020 ◽

Vol 7 (4) ◽

pp. 153-158

Author(s):

Fardin Mirzatolooei ◽

◽

Ali Tabrizi ◽

Solmaz Gholizadeh ◽

◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Ligament Reconstruction ◽

Preparation Method ◽

Cruciate Ligament ◽

Hamstring Tendon ◽

Hamstring Graft ◽

Graft Size ◽

The Mean ◽

Anterior Cruciate ◽

Hamstring Grafts

Background: The anterior cruciate ligament surgery commonly uses a hamstring tendon. The hamstring grafts are usually prepared by wrapping in a wet gauze under tension. Objectives: The placement of a hamstring tendon in a dry gauze affects the size of the graft, without any change in its collagen volume. The present study aimed to prove that the preparation method could affect the hamstring graft width. Methods: A total number of 32 patients who had undergone the anterior cruciate ligament reconstruction were enrolled in this analytical descriptive study. Initially, the width of the 4-layered extracted graft was measured using the sizer system, after placement under traction. Then, 16 patients were operated on, based on the dry gauze preparation method, and the other 16, based on the wet gauze preparation method. The grafts were remeasured after traction. Six months after the surgery, all patients received a clinical evaluation, in which the integrity of the graft was evaluated based on clinical criteria. Results: The Mean±SD width of the 4-layered extracted grafts was 7.44±0.54 mm and 7.41±0.33 mm in the dry gauze and wet gauze groups, respectively. However, these values did not significantly differ (P=0.96). After traction, the Mean±SD graft width of the dry gauze group was reduced to 6.97±0.62 mm. The traction led to no change in the graft width of the wet gauze group. The changes in the graft size significantly differed between the two groups (P=0.032). Moreover, 4 patients (25%) exhibited no certain endpoint in the Lachman test, also, the pivot shift-test was positive in 5 patients (31.2%). Conclusion: The hamstring graft preparation technique affects the tunnel graft size. Besides, the use of dry gauzes procures the need for a narrower tunnel in the tibia and femur.

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Role of Anthropometric Data in Assessing Hamstring Graft Size in Anterior Cruciate Ligament Reconstruction

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i48a33200 ◽

2021 ◽

pp. 1-9

Author(s):

Sathesh Kumar Murthy ◽

M. Sai Deiv Ramkumar ◽

Niranjan M. Raghavn ◽

B. Pooja ◽

Shanmuga Sundaram

Keyword(s):

Anterior Cruciate Ligament ◽

Anterior Cruciate Ligament Reconstruction ◽

Ligament Reconstruction ◽

Cruciate Ligament ◽

Hamstring Graft ◽

Graft Size ◽

Anthropometric Measures ◽

Thigh Circumference ◽

Cruciate Ligament Reconstruction ◽

Anterior Cruciate

Background and Objective: Preoperative information of hamstring graft size for anterior cruciate ligament reconstruction (ACL) is critical for making optimal graft selections. The aim of the present study was to view whether anthropometric parameters including height, weight, BMI and thigh circumference have any bearing on the size of hamstring tendon grafts used in anterior cruciate ligament replacement. Methods: Pre-operative anthropometric measurements were taken on 72 patients undergoing primary ACL reconstruction, including age, gender, height, weight, BMI, and thigh circumference. The Person correlation coefficient was used to assess the correlation of these anthropometric variables and simple logistic regression was used to evaluate the correlation of these anthropometric variables on the size of the graft that was acquired. Results: Gracilis tendon [GT] length correlates with height (r 1/4 0,432), and semitendinosus [ST] length correlates with thigh circumference (r 1/4 0,255). Women's graft diameter (7.16 ± 0.82 mm) smaller than that of men (7.39 ± 0.63 mm) (p > 0.05), although not statistically significant. The diameter of the autograft was shown to be strongly linked with parameters. Conclusion: As a consequence, our findings suggest that anthropometric measures can be used in the preoperative planning and prediction of hamstring graft length and diameter in anterior cruciate ligament reconstruction.

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Autograft diameter in ACL reconstruction: size does matter

SICOT-J ◽

10.1051/sicotj/2021018 ◽

2021 ◽

Vol 7 ◽

pp. 16

Author(s):

Fahad N.A. Alkhalaf ◽

Sager Hanna ◽

Mohammed Saleh Hattab Alkhaldi ◽

Fares Alenezi ◽

Aliaa Khaja

Keyword(s):

Anterior Cruciate Ligament ◽

Revision Surgery ◽

Cruciate Ligament ◽

Case Series ◽

Failure Rates ◽

Graft Size ◽

Level Of Evidence ◽

Acl Injuries ◽

Tertiary Center ◽

Anterior Cruciate

Background: Anterior cruciate ligament injuries are commonly seen in orthopedic surgery practice. Although anterior cruciate ligament reconstruction (ACLR) has come a long way, the causes of failure have yet to be fully understood. Objective: The aim of this study was to investigate whether or not the intraoperative 4-strand hamstring autograft diameter does in fact influence the failure rates of ACLR. Methods: Retrospective intraoperative data were collected from ACLR patients from the only tertiary center available in Kuwait. Patients who underwent ACLR from 2012 to 2018 for isolated ACL injuries were included in this study, allowing for a 24 month follow-up period The cohorts were categorized into 3 groups: patients with graft size≤8mm, 2, patients with graft sizes≥8mm with 4-strands and patients with graft sizes≥8mm with 4-strands or more. ANOVA analysis was applied to address group differences between mean graft size and strand numbers and subsequently the failure rates for each group. In addition, the Mann–Whitney U test was used to investigate the relationship between revision and initial ACL graft size. Results: Out of the 711 out of 782 patients were included in this study. Only 42.6% of the patients did not need more than 4-strands to achieve an 8mm sized autograft. The patients who had autografts≤8mm in this study accounted for 17.1% of the population. About 7.2% of these patients required revision surgery. Patients with a 4-strand autograft size that was less than 8mm were 7.2 times more at risk for ACLR failure (RR=7.2, 95% CI: 6.02; 8.35, p=0.007). Conclusions: There is a significant correlation between 4-strand autograft diameter size and the need for ACLR revision surgery. Level of evidence: IV case series

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Femoral tunnel in revision anterior cruciate ligament reconstruction

Joints ◽

10.11138/jts/2013.1.3.126 ◽

2013 ◽

Vol 01 (03) ◽

pp. 126-129 ◽

Cited By ~ 5

Author(s):

Francesco Giron ◽

Michele Losco ◽

Luca Giannini ◽

Roberto Buzzi

Keyword(s):

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

Revision Surgery ◽

Femoral Tunnel ◽

Cruciate Ligament ◽

Three Dimensional ◽

Surgical Techniques ◽

Dimensional Reconstruction ◽

Sporting Activities ◽

Anterior Cruciate

The failure rate after anterior cruciate ligament (ACL) reconstruction performed by expert surgeons is estimated to be in the range of 10-15%, and only 60% of patients undergoing this surgery are able to resume sporting activities comparable to those they engaged in prior to the traumatic incident.Incorrect femoral tunnel placement is one of the main causes of failed ACL reconstruction and this must be remembered when undertaking revision surgery.There are various possible errors that can be committed and, to plan revision surgery correctly, it is fundamental to study the position of the existing femoral tunnel(s) both on classic anteroposterior and lateral plain radiographs and on computed tomography scans with frontal, sagittal, and coronal sections, and also using three-dimensional reconstruction.In-depth anatomical knowledge and familiarity with the various possible surgical techniques are also mandatory for a successful surgical outcome.

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