Dataset Information

Anterior Cruciate Ligament Reconstruction Using Combined Graft of Hamstring and Fascia Lata With Extra-articular Tenodesis. A Technique in Case of Insufficient Hamstrings.

ABSTRACT: A technique for augmentation of the anterior cruciate ligament (ACL) with hamstring graft and lateral extra-articular tenodesis is presented. The patient is positioned supine with the knee flexed 90°. First, intra-articular injuries are addressed arthroscopically, and then autologous hamstring tendons are harvested and measured; the present technique is a resource for cases with a very small graft diameter (less than 8 mm), due to thin tendons or to tendon breakage, even after tripling the hamstring graft, which is prepared using a facia lata strip long enough to fit the lengths of the femoral tunnel, the anterior cruciate ligament graft, and the tibial tunnel. A single femoral tunnel is performed and only 2 interference screws are needed for fixation.

SUBMITTER: Espejo-Reina A

PROVIDER: S-EPMC7695551 | biostudies-literature | 2020 Nov

REPOSITORIES: biostudies-literature

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Anterior Cruciate Ligament Reconstruction Using Combined Graft of Hamstring and Fascia Lata With Extra-articular Tenodesis. A Technique in Case of Insufficient Hamstrings.

Espejo-Reina Alejandro A Espejo-Reina María Josefa MJ Lombardo-Torre Maximiano M Ruiz-Del Pino Joaquina J Espejo-Baena Alejandro A

Arthroscopy techniques 20201023 11

A technique for augmentation of the anterior cruciate ligament (ACL) with hamstring graft and lateral extra-articular tenodesis is presented. The patient is positioned supine with the knee flexed 90°. First, intra-articular injuries are addressed arthroscopically, and then autologous hamstring tendons are harvested and measured; the present technique is a resource for cases with a very small graft diameter (less than 8 mm), due to thin tendons or to tendon breakage, even after tripling the hamst ...[more]

PMID: 33294323

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Project description:BackgroundIt is still controversial whether the combination of anterior cruciate ligament (ACL) reconstruction and extra-articular reconstruction (EAR) have good clinical efficacy. This meta-analysis aims systematically to compare the clinical effectiveness of ACL reconstruction and combined reconstruction.MethodsElectronic databases, including Medline/PubMed, Embase and the Cochrane Library, were systematically searched to identify targeted studies. A meta-analysis were performed to pool the outcome estimates of interest, such as the Lysholm, International Knee Documentation Committee (IKDC) and Tegner scores and the results from the KT-1000/2000 arthrometer test, the Lachman test and the pivot shift test.ResultsTwelve studies involving 1146 knees were identified. Compared with single ACL reconstruction, combined reconstruction had better results for a pivot shift of grade 1 (relative ratio [RR]?=?0.88, 95% CI: 0.83-0.94) and grade 2 (RR?=?0.95, 95% CI: 0.91-0.99) rather than grade 3 (RR?=?0.98, 95% CI: 0.90-1.06) and no statistically significant difference for both Lachman grade 1 (RR?=?0.96, 95% CI: 0.89-1.05) and grade 2 (RR?=?0.96, 95% CI: 0.90-1.03). Combined reconstruction resulted in significant improvements on the instrumented joint laxity test when considering a failure standard of more than 5?mm (a side-to-side arthrometric difference) (RR?=?0.94, 95% CI: 0.89-0.98) rather than 3?mm (RR?=?0.94, 95% CI: 0.86-1.03). Moreover, combined reconstruction increased the IKDC score at the 12-month (weighted mean difference [WMD]?=?-?6.38, 95% CI: -?9.66 to -?3.10), 24-month (WMD?=?-?5.60, 95% CI: -?8.54 to -?2.66) and 36-month follow-ups (WMD?=?-?4.71, 95% CI: -?7.59 to -?1.83) and the Tegner score at the 36-month follow-up (WMD?=?-?0.53, 95% CI: -?0.97 to -?0.09), but it did not increase the Lysholm score at the 36-month follow-up (WMD?=?-?0.84, 95% CI: -?2.02 to 0.34).ConclusionWith the advances in reconstruction techniques, combined reconstructions were found to be effective in improving rotational stability and to lead to good functional scores. However, obviously, the combined reconstruction technique is more time-consuming and requires an additional incision, which is not suitable for all ACL-deficient patients. Therefore, programs should be personalized and customized for the specific situation of each patient.

Dataset Information

Anterior Cruciate Ligament Reconstruction Using Combined Graft of Hamstring and Fascia Lata With Extra-articular Tenodesis. A Technique in Case of Insufficient Hamstrings.

Publications

Anterior Cruciate Ligament Reconstruction Using Combined Graft of Hamstring and Fascia Lata With Extra-articular Tenodesis. A Technique in Case of Insufficient Hamstrings.

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