Dataset Information

Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction with Hamstring Tendon Autograft through Single Femoral Tunnel and Single Branched Tibial Tunnel.

ABSTRACT: Conventional single-bundle anterior cruciate ligament (ACL) reconstruction cannot improve the rotational stability of the knee. Traditional double-bundle ACL reconstruction requires is demanding, complex, time- and implant consuming, and associated with a high incidence of complications. Double-bundle ACL reconstruction using a free quadriceps tendon autograft through 3 independent tunnels provides some advantage, but the antegrade graft passage, tibial tunnel confluence, and graft site morbidity represent disadvantages. This Technical Note describes a modification of double-bundle ACL reconstruction using the hamstring tendon autograft through a single branched tibial tunnel and a single femoral tunnel using 2 interference screws (Arthrex, Naples, FL). The gracilis tendon autograft is passed through tibial tunnel stem to the posterolateral tibial tunnel branch to the posterolateral position in the femoral tunnel. The semitendinosus tendon autograft is passed through the tibial tunnel stem to the anteromedial tibial tunnel branch to the anteromedial position in the femoral tunnel. Both grafts are fixed by 2 interference screws: 1 at the femoral tunnel and 1 at the tibial tunnel stem with the knee at 20° flexion.

SUBMITTER: Selim NM

PROVIDER: S-EPMC6203690 | biostudies-literature | 2018 Oct

REPOSITORIES: biostudies-literature

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Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction with Hamstring Tendon Autograft through Single Femoral Tunnel and Single Branched Tibial Tunnel.

Selim Naser Mohamed NM

Arthroscopy techniques 20180910 10

Conventional single-bundle anterior cruciate ligament (ACL) reconstruction cannot improve the rotational stability of the knee. Traditional double-bundle ACL reconstruction requires is demanding, complex, time- and implant consuming, and associated with a high incidence of complications. Double-bundle ACL reconstruction using a free quadriceps tendon autograft through 3 independent tunnels provides some advantage, but the antegrade graft passage, tibial tunnel confluence, and graft site morbidit ...[more]

PMID: 30377578

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Project description:PurposeTo assess the clinical outcomes comparing rectangular bone-tendon-bone (BTB) grafts and double-bundle hamstring tendon (HM) grafts used for anatomic anterior cruciate ligament (ACL) reconstruction in young female athletes.MethodsFrom January 2014 to November 2017, young female athletes 20 years or younger who underwent primary ACL reconstructions by a single surgeon were identified. Patients with concomitant injuries, not being a regular sports participant, the existence of contralateral ACL reconstruction, and who did not have a minimum of 1-year follow-up were excluded. We searched the rate and time for return-to-play, clinical outcomes including chronological instrumental side-to-side tibial translation difference, and muscle strength. Second ACL injury rates between the 2 groups during follow-up period were evaluated.ResultsTwenty-seven BTB ACL reconstructions and 29 HM ACL reconstructions were performed. The mean follow-up periods were 35.2 months in the BTB group and 33.8 months in the HM group. The BTB group showed better knee stability in mean side-to-side translational difference via arthrometric testing of 0.6 mm in the BTB versus 1.7 mm in the HM group at 5 months (P = .01) and 1.1 mm and 2.0 mm at 12 months, respectively (P = .02). There was no significant side-by-side difference in quadriceps muscle strength ratio, but the hamstring muscle strength was significantly better in the BTB group. The graft reinjury rate in the BTB group and the HM group was 0% (0/27) and 10.3% (3/29) (P = .09), respectively. In contrast, contralateral ACL injuries occurred in 17.3% (4/27) of the BTB group and 3.5% (1/29) of the HM group (P = .12).ConclusionsFor young female athletes aged 20 years or younger, the BTB group had better knee instrumental stability than the HM group without range of motion loss or knee extensor muscle strength deficit. Although there was no statistical significance in terms of second ACL injury, we observed fewer graft rerupture and an increasing rate of contralateral ACL injuries in the BTB group.Level of evidenceLevel III, retrospective comparative study.

Project description:Background: ACL rupture has a high morbidity in productive-age population. The increasing incidence and proper management has become a point of interest in the musculoskeletal sport injury. Choosing the best graft has become the main focus in searching for a better outcome regarding ACL reconstruction in these patient population. Currently, single bundle hamstring tendon (SBHT) autograft was preferred in Asian population compared to bone quadriceps tendon (BQT) autograft. However, there are some problems such as short and small in diameter of SBHT. This study is focused on evaluation of the clinical outcome between BQT and SBHT in arthroscopic-assisted ACL reconstruction patients.Materials and methods: In this prospective cohort study, 30 subjects were divided into 2 groups (BQT and SBHT). Sampling was taken between February 2017-2018 (1 year) in one orthopaedic center. The instruments used for evaluation are rolimeter and patient-reported outcome (PRO) questionnaires (IKDC, Tegner-Lysholm, and KOOS) with data mining between 3 months, 6 months, and 1 year post operation. This study has been reported in line with the STROCSS criteria.Results: Mean difference of quadriceps (3.12 ± 0.94) and hamstring (3.87 ± 0.61) in rolimeter measurement 1 year post operation is statistically significant (p = 0.015). Side-to-side difference shows better result in quadriceps (0.34 ± 0.70) compared to hamstring (0.84 ± 0.60) with p value 0.04. IKDC scores in one month (p = 0.002; CI95% [8.81-31.79]) and three months (p = 0.004; CI95% [4.85-20.39]) post operative is better in quadriceps group. Tegner-Lysholm assessment 1 month post operative showed consistent results between numeric (p = 0.004) and categoric data (p = 0.050) in quadriceps group. There was an improvement during six months and one year post operative KOOS sub-item scales; pain (p = 0.034) and symptoms (p = 0.001).Conclusion: Functional outcome of patient undergoing arthroscopic-assisted ACL reconstruction is better in BQT group compared to SBHT group, both in subjective and objective parameters given.

Dataset Information

Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction with Hamstring Tendon Autograft through Single Femoral Tunnel and Single Branched Tibial Tunnel.

Publications

Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction with Hamstring Tendon Autograft through Single Femoral Tunnel and Single Branched Tibial Tunnel.

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