Early Superimposed NMES Training is Effective to Improve Strength and Function Following ACL Reconstruction with Hamstring Graft regardless of Tendon Regeneration

The study aimed at investigating the effects of neuromuscular electrical stimulation superimposed on functional exercises (NMES+) early after anterior cruciate ligament reconstruction (ACLr) with hamstring graft, on muscle strength, knee function, and morphology of thigh muscles and harvested tendons. Thirty-four participants were randomly allocated to either NMES+ group, who received standard rehabilitation with additional NMES of knee flexor and extensor muscles, superimposed on functional movements, or to a control group, who received no additional training (NAT) to traditional rehabilitation. Participants were assessed 15 (T1), 30 (T2), 60 (T3), 90 (T4) and at a mean of 380 days (T5) after ACLr. Knee strength of flexors and extensors was measured at T3, T4 and T5. Lower limb loading asymmetry was measured during a sit-to-stand-to-sit movement at T1, T2, T3, T4 and T5, and a countermovement-jump at T4 and T5. An MRI was performed at T5 to assess morphology of thigh muscles and regeneration of the harvested tendons. NMES+ showed higher muscle strength for the hamstrings (T4, T5) and the quadriceps (T3, T4, T5), higher loading symmetry during stand-to-sit (T2, T3, T4, T5), sit-to-stand (T3, T4) and countermovement-jump (T5) than NAT. No differences were found between-groups for morphology of muscles and tendons, nor in regeneration of harvested tendons. NMES+ early after ACLr with hamstring graft improves muscle strength and knee function in the short- and long-term after surgery, regardless of tendon regeneration.

Predicting Diameter Increase Using a Quadriceps Tendon Augmentation for Undersized Hamstring Grafts in ACL Reconstruction

Background The failure rate for ACL reconstruction varies between 5 to 25% depending on the population. Recent studies found a higher failure rate with grafts of 8 millimeters in diameter or less. Various options are described when the graft’s diameter is inferior to the target value, but little literature helps us predict the final diameter during surgeries. Therefore, this study’s goal is to describe a new technique supplementing a hamstring graft folded in half with a quadricipital tendon band of partial width and thickness (4S+Q), and to predict the final diameter. Methods Thirty-three cadaveric knees were dissected in order to harvest semitendinosus and gracilis tendons (4S) along with a 6mm wide tendon band from the rectus femoris. Harvesting was done according to the usual surgical technique. Measures of length and diameter in 4S and 4S+Q configurations were performed separately by three evaluators. Results The threshold diameter of 8,5 mm was attained in only 30% of 4S grafts within our population in comparison with 88% when augmented with a quadriceps band. The average diameter increase with the 4S+Q configuration was 1,49 mm. A threshold of 7,5 mm was established for the applicability of this augmentation technique considering that 93% of the grafts measuring 7,5 mm or more reached the 8,5mm target. Conclusions The 4S+Q configuration offers a salvage option worth adding to one’s arsenal, significantly increasing the graft’s diameter. The width of the quadricipital tendon sample can be adjusted and will need further study.

Chronic Patellar Tendon Rupture Reconstructed with Hamstring Graft – A Case Report

Neglected patella tendon rupture which are presented 6 weeks after injury are rare but it can be disabling. Aim of study is to determine the outcomes of chronic patellar tendon rupture reconstructed using hamstring graft. This case report concerns a 26 year-old man who came with complaints of weakness of legs, difficulty in climbing stairs up and down, difficulty in getting up from squatting position. X-ray of Right knee showed high riding patella. MRI showed full thickness rupture of ACL. The patient was operated with a combination of Chen et al and ganga hospital SR Sundararajan7. Our outcome was also excellent with no extensor lag, Kujala score was 94.1, Lysholm score was 92.3. From our study it is found that even in chronic neglected cases of patellar tendon rupture, good functional results can be obtained by repair using hamstring graft.

Analgesic Impact of a Popliteal Plexus Block to Standard Adductor Canal Block in Arthroscopic Anterior Cruciate Ligament Reconstruction: A Randomized Blind Clinical Trial

Background. Damage to the anterior cruciate ligament (ACL) is crippling and often requires an arthroscopic outpatient surgery. Nevertheless, many patients experience severe pain during the first day after ACL reconstruction (ACLR). The adductor canal block (ACB) has yielded conflicting results for post-ACLR pain relief. This research investigated the effect of a supplemental popliteal plexus block on postoperative pain outcomes compared to a sole ACB. Methods. Following a randomized design, 60 cases scheduled for knee arthroscopy with ACLR using an ipsilateral hamstring graft were separated into two categories. Subjects in group A (n = 30) received an ACB only, while subjects in group B (n = 30) received combined ACB and popliteal plexus block (PPB). Results. We found significant differences between the two groups. The time of the first analgesic request (TFR) was later for the combined ACB and PPB (median 8 h) compared to the ACB only group (median 0.5 h). Morphine consumption was lower for patients who received combined ACB and PPB (median 12 mg) compared to ACB only (median 30 mg). The number of the requested doses was lower for the combined ACB and PPB group (median 3 doses) compared to the ACB only group (median 7 doses). Conclusions. The addition of PPB to ACB was associated with improved analgesia and a reduced need for opioid-based sedatives following ACLR with an ipsilateral hamstring graft (https://clinicaltrials.gov/ct2/show/NCT04020133).

FUNCTIONAL OUTCOME OF ARTHROSCOPIC ACL RECONSTRUCTION WITH HAMSTRING GRAFT

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.

Return-to-Sport Outcomes After Primary Ulnar Collateral Ligament Reconstruction With Palmaris Versus Hamstring Tendon Grafts: A Systematic Review

Background: Ulnar collateral ligament (UCL) reconstruction is the current gold standard of treatment for overhead athletes with a symptomatic, deficient UCL of the elbow who have failed nonoperative treatment and wish to return to sport (RTS) at a high level. The palmaris longus and hamstring tendons are common graft choices, but no study has analyzed the existing literature to assess whether one graft is superior to the other. Purpose: To systematically report on the outcomes of UCL reconstruction using palmaris and hamstring autografts. Study Design: Systematic review; Level of evidence, 4. Methods: A combination of the terms “ulnar collateral ligament,” “valgus instability,” “Tommy John surgery,” “hamstring,” and “palmaris longus” were searched in PubMed, Embase, and the Cochrane Library. RTS and return-to-same-level (RSL) rates, patient-reported outcomes, and complications were included for analysis. We used the modified Coleman Methodology Score and risk-of-bias tool for nonrandomized studies to assess the quality of the included studies. Results: This review included 6 studies (combined total of 2154 elbows) that directly compared palmaris and hamstring graft use in UCL reconstruction. Follow-up ranged from 24 to 80.4 months, and the mean patient age across all studies was 21.8 years. The mean RSL across all studies and grafts was 79.0%, and the mean RTS was 84.1%, consistent with results previously reported in the literature. The mean RTS and RSL rates for the palmaris graft group were 84.6% and 82%, respectively; the hamstring graft group showed mean RTS and RSL rates of 80.8% and 80.8%. Meta-analysis revealed no significant difference in RSL between the 2 graft groups (odds ratio, 1.06; 95% CI, 0.77-1.46). The combined complication rate of the included studies was 18.2%, with failure rates ranging from 0% to 7.1%. Conclusion: Results of this review indicated that both palmaris and hamstring tendon grafts are viable options for primary UCL reconstruction. Graft choice should be determined by a combination of patient and surgeon preference.

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

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.