DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20211619

Arthroscopic anterior cruciate ligament reconstruction using single bundle hamstring tendon autograft

Harpreet Singh, Tilak Patel, Kamal Kumar Agarwal, Parth Patel, Dhruv Patel, Krushna Saoji

Abstract


Background: The present study was designed to analyze the postoperative outcome of arthroscopic anterior cruciate ligament (ACL) reconstruction with anatomical single bundle hamstring tendons autograft fixed in femoral tunnel using endobutton and in the tibial tunnel using interference screws and reinforced by anterior half of peroneus longus tendon (AHPLT), wherever required.

Methods: 39 patients of complete ACL tear underwent arthroscopic anatomical single bundle ACL reconstruction using quadrupled hamstring tendon autograft. It was ensured that the quadrupled graft had a length of at least 7 cm and thickness of at least 8 mm. If either of these requirements were not met, then the graft was supplemented by AHPLT. For functional assessment, international knee documentation committee (IKDC) knee score was taken and clinical tests for antero-posterior stability were done. In addition, the foot and ankle disability index (FADI) scores were used to evaluate the ankle donor site of the AHPLT.

Results: The average graft diameter was 8.74 mm and average graft length was 9.12 cm. There was significant improvement in post op IKDC score when compared with pre op score. There was no antero-posterior instability seen in any of the patients during follow up. 10 patients required an additional graft augmentation with AHPLT. There was no complaint about weakness of the ankle joint after surgery.

Conclusions: Arthroscopic ACL reconstruction with anatomical single bundle hamstring tendon autograft is an excellent treatment option for ACL deficient knees. It gives excellent functional outcome with minimal complications. Graft if small in diameter can be reinforced by AHPLT without any detrimental effect on ankle function.


Keywords


ACL, Hamstring tendon graft, AHPLT, Anatomical single bundle, IKDC score

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References


Levy IM, Torzilli PA, Warren RF. The effect of medial meniscectomy on anterior-posterior motion of the knee. J Bone Joint Surg. 1982;64(6):883-8.

Mascaremhas R, Kropf EJ, Harner CD. Diagnosis and management of ligamentous injuries of the knee. In: Shivananthan S, Sherry E, Warnke P, Miller MD, eds. Mercer’s Textbook of Orthopaedics and Trauma. 10th ed. London: CRC Press; 2012: 805-20.

Daniel DM, Stone ML, Dobson BE, Fithian DC, Rossman DJ, Kaufman KR. Fate of the ACL-injured patient: a prospective outcome study. Americ J Sport Med. 1994;22(5):632-44.

Sanders TL, Kremers HM, Bryan AJ, Fruth KM, Larson DR, Pareek A, Levy BA, Stuart MJ, Dahm DL, Krych AJ. Is anterior cruciate ligament reconstruction effective in preventing secondary meniscal tears and osteoarthritis? Am J Sports Med. 2016;44(7):1699-707.

Dye SF, Wojtys EM, Fu FH, Fithian DC, Gillquist J. Factors contributing to function of the knee joint after injury or reconstruction of the anterior cruciate ligament. Am Aca Orthopaed Surgeons. 1999;48:185-98.

Jorgensen UF, Sonne-Holm ST, Lauridsen FL, Rosenklint AR. Long-term follow-up of meniscectomy in athletes. A prospective longitudinal study. J Bone Joint Surg Br. 1987;69(1):80-3.

Rangger C, Klestil T, Gloetzer W, Kemmler G, Benedetto KP. Osteoarthritis after arthroscopic partial meniscectomy. Am J Sports Med. 1995;23(2):240-4.

Jomha NM, Pinczewski LA, Clingeleffer A, Otto DD. Arthroscopic reconstruction of the anterior cruciate ligament with patellar-tendon autograft and interference screw fixation: the results at seven years. J Bone Joint Surg Br. 1999;81(5):775-9.

Chaudhary D, Monga P, Joshi D, Easwaran R, Bhatia N, Singh AK. Arthroscopic reconstruction of the anterior cruciate ligament using bone-patellar tendon-bone autograft: experience of the first 100 cases. J Orthop Surg. 2005;13(2):147-52.

Liu Z, Zhang X, Jiang Y, Zeng B. Four-strand hamstring tendon autograft versus LARS artificial ligament for anterior cruciate ligament reconstruction. Int Orthop. 2010;34(1):45-9.

Noyes FR, Butler DL, Grood ES, Zernicke RF, Hefzy MS. Biomechanical analysis of human ligament grafts used in knee-ligament repairs and reconstructions. J Bone Joint Surg Am. 1984;66(3):344-52.

Siebold R, Branch TP, Freedberg HI, Jacobs CA. A matched pair’s comparison of single-versus double-bundle anterior cruciate ligament reconstructions, clinical results, and manual laxity testing. Knee Surg Sports Traumatol Arthrosc. 2011;19(1):4-11.

Järvelä T, Moisala AS, Sihvonen R, Järvelä S, Kannus P, Järvinen M. Double-bundle anterior cruciate ligament reconstruction using hamstring autografts and bioabsorbable interference screw fixation: prospective, randomized, clinical study with 2-year results. Am J Sports Med. 2008;36(2):290-7.

Torzilli PA, Greenberg RL, Hood RW, Pavlov HE, Insall JN. Measurement of anterior-posterior motion of the knee in injured patients using a biomechanical stress technique. J Bone Joint Surg Am. 1984;66(9):1438-42.

Irrgang JJ, Anderson AF, Boland AL, Harner CD, Kurosaka M, Neyret P, et al. Development and validation of the international knee documentation committee subjective knee form. Am J Sports Med. 2001;29(5):600-13.

Martin RL, Burdett RG, Irrgang JJ. Development of the foot and ankle disability index (FADI). J Orthop Sports Phys Ther. 1999;29(1):32-3.

Dandy DJ, Jonathan LH. Anterior Cruciate Ligament reconstruction. J Bone Joint Surg. 1998;80(2)189-90.

Brown TN, Palmieri-Smith RM, McLean SG. Sex and limb differences in hip and knee kinematics and kinetics during anticipated and unanticipated jump landings: implications for anterior cruciate ligament injury. Br J Sports Med. 2009;43(13):1049-56.

Lewis DW, Chan D, Fisher O, Lechford R, Mintowt-Czyz WJ, Lewis MW. Incidence of meniscal and chondral injuries at the time of ACL reconstruction, and their relationship with outcome at 2 years. Orthopaedic Proceedings. 9th ed. London: Bone and Joint Publishing; 2012:41.

Kumar PA, Rambabu P, Srinivasarao K, Krishna KV, Krishna CV, Sekhar SC, et al. Functional outcome of arthroscopic reconstruction of anterior cruciate ligament tears. J Evol Med Dental Sci. 2016;5(10):427-33.

Khan RM, Prasad V, Gangone R, Kinmont JC. Anterior cruciate ligament reconstruction in patients over 40 years using hamstring autograft. Knee Surg Sports Traumatol Arthrosc. 2010;18(1):68-72.

Aparajit P, Koichade MR, Jain N. Study of Arthroscopic Reconstruction of Anterior Cruciate Ligament Injury. Int J Biomed Res. 2020;7(6):329-36.

Williams RJ, Hyman J, Petrigliano F, Rozental T, Wickiewicz TL. Anterior cruciate ligament reconstruction with a four strand hamstring tendon autograft. J Bone Join Surg. 2005;87 (1):51-66.

Kerimoğlu S, Aynaci O, Saraçoğlu M, Aydin H, Turhan AU. Anterior cruciate ligament reconstruction with the peroneus longus tendon. Acta Orthopaed Traumatol Turc. 2008;42(1):38.

Cao H, Liang J, Xin J. Treatment of anterior cruciate ligament injury with peroneus longus tendon. Zhonghua Yi Xue Za Zhi. 2012;92(35):2460-2.

Feller JA, Siebold R, Webster KE. ACL reconstruction in females: patellar tendon versus hamstring tendon autograft. Orthopaedic Proceedings. 3rd ed. London: Bone and Joint Publishing; 2005: 305.

Grood ES, Walz-Hasselfeld KA, Holden JP, Noyes FR, Levy MS, Butler DL, et al. The correlation between anterior-posterior translation and cross-sectional area of anterior cruciate ligament reconstructions. J Orthop Res. 1992;10(6):878-85.

Hamada M, Shino K, Horibe S, Mitsuoka T, Toritsuka Y, Nakamura N. Changes in cross-sectional area of hamstring anterior cruciate ligament grafts as a function of time following transplantation. Arthroscopy. 2005;21(8):917-22.