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Differences in the rehabilitation period following two methods of anterior cruciate ligament replacement: semitendinosus/gracilis tendon vs. ligamentum patellae

  • Knee
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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

This study compared patient outcome during the early rehabilitation phase following two different methods of anterior cruciate ligament (ACL) reconstruction: ligamentum patellae (LP) and semitendinosus/gracilis tendon (SG) based reconstruction. The study included 50 consecutive patients treated by each method, examined 6 weeks and 3, 6 and 12 months after surgery. Patients in the SG group showed significantly better Lysholm scores at 6 and 12 months, Tegner Activity Scale scores at 3 months, and pain profile assessments at 6 weeks and 3 months than those in the LP group. Significant advantages were observed in LP group in the Overall Knee Score at 6 weeks and in range-of-motion at 6 weeks and 3 and 6 months post-surgery. Stability tests revealed no significant differences between patients in the two groups. SG-based reconstruction of the ACL thus demonstrates advantages over LP-based reconstruction regarding pain and function, while LP-based reconstruction was associated with an earlier return of motion.

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References

  1. Aglietti P, Buzzi R, Zaccherotti G, De Biase P (1994) Patellar tendon versus doubled semitendinosus and gracilis tendons for anterior cruciate ligament reconstruction. Am J Sports Med 22:211–217

    CAS  PubMed  Google Scholar 

  2. Aglietti P, Buzzi R, Menchetti PM, Giron F (1996) Arthroscopically assisted semitendinosus and gracilis tendon graft in reconstruction for acute anterior cruciate ligament injuries in athletes. Am J Sports Med 24:726–731

    Google Scholar 

  3. Aune AK, Ekeland A, Cawley PW (1998) Interference screw fixation of hamstring vs patellar tendon grafts for anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 6:99–102

    CAS  PubMed  Google Scholar 

  4. Balasch H, Schiller M, Friebel H, Hoffmann F (1999) Evaluation of anterior knee joint instability with the Rolimeter. A test in comparison with manual assessment and measuring with the KT-1000 arthrometer. Knee Surg Sports Traumatol Arthrosc 7:204–208

    CAS  PubMed  Google Scholar 

  5. Beynnon BD, Johnson RJ, Fleming BC, Kannus P, Kaplan M, Samani J, Renstrom P (2002) Anterior cruciate ligament replacement: comparison of bone-patellar tendon-bone grafts with two-strand hamstring grafts. A prospective, randomized study. J Bone Joint Surg Am 84:1503–1513

    Google Scholar 

  6. Breitfuss H, Frohlich R, Povacz P, Resch H, Wicker A (1996) The tendon defect after anterior cruciate ligament reconstruction using the midthird patellar tendon-a problem for the patellofemoral joint? Knee Surg Sports Traumatol Arthrosc 3:194–198

    CAS  PubMed  Google Scholar 

  7. Brown CH Jr, Steiner ME, Carson EW (1993) The use of hamstring tendons for anterior cruciate ligament reconstruction. Technique and results. Clin Sports Med 12:723–756

    PubMed  Google Scholar 

  8. Buss DD, Warren RF, Wickiewicz TL, Galinat BJ, Panariello R (1993) Arthroscopically assisted reconstruction of the anterior cruciate ligament with use of autogenous patellar-ligament grafts. Results after twenty-four to forty-two months. J Bone Joint Surg Am 75:1346–1355

    CAS  PubMed  Google Scholar 

  9. Carter TR, Edinger S (1999) Isokinetic evaluation of anterior cruciate ligament reconstruction: hamstring versus patellar tendon. Arthroscopy 15:169–172

    CAS  PubMed  Google Scholar 

  10. Corry IS, Webb JM, Clingeleffer AJ, Pinczewski LA (1999) Arthroscopic reconstruction of the anterior cruciate ligament. A comparison of patellar tendon autograft and four-strand hamstring tendon autograft. Am J Sports Med 27:444–454

    CAS  PubMed  Google Scholar 

  11. Ejerhed L, Kartus J, Sernert N, Kohler K, Karlsson J (2003) Patellar tendon or semitendinosus tendon autografts for anterior cruciate ligament reconstruction? A prospective randomized study with a two-year follow-up. Am J Sports Med 31:19–25

    PubMed  Google Scholar 

  12. Eriksson K, Anderberg P, Hamberg P, Lofgren AC, Bredenberg M, Westman I, Wredmark T (2001) A comparison of quadruple semitendinosus and patellar tendon grafts in reconstruction of the anterior cruciate ligament. J Bone Joint Surg Br 83:348–354

    Article  CAS  PubMed  Google Scholar 

  13. Eriksson K, Anderberg P, Hamberg P, Olerud P, Wredmark T (2001) There are differences in early morbidity after ACL reconstruction when comparing patellar tendon and semitendinosus tendon graft. A prospective randomized study of 107 patients. Scand J Med Sci Sports 11:170–177

    CAS  Google Scholar 

  14. Feagin JA Jr, Wills RP, Lambert KL, Mott HW, Cunningham RR (1997) Anterior cruciate ligament reconstruction. Bone-patella tendon-bone versus semitendinosus anatomic reconstruction. Clin Orthop 341:69–72

    PubMed  Google Scholar 

  15. Feller JA, Webster KE, Gavin B (2001) Early post-operative morbidity following anterior cruciate ligament reconstruction: patellar tendon versus hamstring graft. Knee Surg Sports Traumatol Arthrosc 9:260–266

    Article  CAS  PubMed  Google Scholar 

  16. Fleming BC, Renstrom PA, Beynnon BD, Engstrom B, Peura G (2000) The influence of functional knee bracing on the anterior cruciate ligament strain biomechanics in weightbearing and nonweightbearing knees. Am J Sports Med 28:815–824

    CAS  PubMed  Google Scholar 

  17. Freedman KB, D'Amato MJ, Nedeff DD, Kaz A, Bach BR Jr (2003) Arthroscopic anterior cruciate ligament reconstruction: a metaanalysis comparing patellar tendon and hamstring tendon autografts. Am J Sports Med 31:2–11

    PubMed  Google Scholar 

  18. Ganko A, Engebretsen L, Ozer H (2000) The Rolimeter: a new arthrometer compared with the KT-1000. Knee Surg Sports Traumatol Arthrosc 8:36–39

    CAS  PubMed  Google Scholar 

  19. Harilainen A, Sandelin J, Osterman K, Vanhanen I (1993) Prospective preoperative evaluation of anterior cruciate ligament instability of the knee joint and results of reconstruction with patellar ligament. Clin Orthop 297:17–22

    PubMed  Google Scholar 

  20. Harter RA, Osternig LR, Singer KM (1989) Instrumented Lachman tests for the evaluation of anterior laxity after reconstruction of the anterior cruciate ligament. J Bone Joint Surg Am 1:975–983

    Google Scholar 

  21. Holmes PF, James SL, Larson RL, Singer KM, Jones DC (1991) Retrospective direct comparison of three intraarticular anterior cruciate ligament reconstructions. Am J Sports Med 19:596–599

    CAS  PubMed  Google Scholar 

  22. Hoser C, Fink C, Benedetto KP, Gabl M (1996) Knee scoring systems. Arthroskopie 9:196–201

    Google Scholar 

  23. Jansson KA, Linko E, Sandelin J, Harilainen A (2003) A prospective randomized study of patellar versus hamstring tendon autografts for anterior cruciate ligament reconstruction. Am J Sports Med 31:12–18

    PubMed  Google Scholar 

  24. Johnson RJ, Beynnon BD, Nichols CE, Renstrom PA (1992) The treatment of injuries of the anterior cruciate ligament. J Bone Joint Surg Am 74:140–151

    CAS  PubMed  Google Scholar 

  25. Lysholm J, Gillquist J (1982) Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med 10:150–154

    CAS  PubMed  Google Scholar 

  26. MacDonald PB, Hedden D, Pacin O, Huebert D (1995) Effects of an accelerated rehabilitation program after anterior cruciate ligament reconstruction with combined semitendinosus-gracilis autograft and a ligament augmentation device. Am J Sports Med 23:588–592

    CAS  PubMed  Google Scholar 

  27. Maeda A, Shino K, Horibe S, Nakata K, Buccafusca G (1996) Anterior cruciate ligament reconstruction with multistranded autogenous semitendinosus tendon. Am J Sports Med 24:504–509

    Google Scholar 

  28. Marcacci M, Zaffagnini S, Iacono F, Neri MP, Petitto A (1995) Early versus late reconstruction for anterior cruciate ligament rupture. Results after five years of followup. Am J Sports Med 23:690–693

    CAS  PubMed  Google Scholar 

  29. Marder RA, Raskind JR, Carroll M (1991) Prospective evaluation of arthroscopically assisted anterior cruciate ligament reconstruction. Patellar tendon versus semitendinosus and gracilis tendons. Am J Sports Med 19:478–484

    CAS  PubMed  Google Scholar 

  30. Muller W, Biedert R, Hefti F, Jakob RP, Munzinger U, Staubli HU (1988) OAK knee evaluation. A new way to assess knee ligament injuries. Clin Orthop 232:37–50

    PubMed  Google Scholar 

  31. Muneta T, Sekiya I, Ogiuchi T, Yagishita K, Yamamoto H, Shinomiya K (1998) Effects of aggressive early rehabilitation on the outcome of anterior cruciate ligament reconstruction with multi-strand semitendinosus tendon. Int Orthop 22:352–356

    CAS  PubMed  Google Scholar 

  32. O'Neill DB (1996) Arthroscopically assisted reconstruction of the anterior cruciate ligament. A prospective randomized analysis of three techniques. J Bone Joint Surg Am 78:803–813

    CAS  PubMed  Google Scholar 

  33. Pässler HH, Shelbourne KD (1993) Biological, biomechanical and clinical concepts of after-care following knee ligament surgery. Orthopade 22:421–435

    PubMed  Google Scholar 

  34. Pinczewski LA, Deehan DJ, Salmon LJ, Russell VJ, Clingeleffer A (2002) A five-year comparison of patellar tendon versus four-strand hamstring tendon autograft for arthroscopic reconstruction of the anterior cruciate ligament. Am J Sports Med 30:523–536

    PubMed  Google Scholar 

  35. Röpke M, Becker R, Urbach D, Nebelung W (2001) Semitendinosus tendon vs. patellar ligament. Results of a prospective randomized study after anterior cruciate ligament reconstruction. Unfallchirurg 104 312–316

    Google Scholar 

  36. Sernert N, Kartus J, Kohler K, Stener S, Larsson J, Eriksson BI, Karlsson J (1999) Analysis of subjective, objective and functional examination tests after anterior cruciate ligament reconstruction. A follow-up of 527 patients. Knee Surg Sports Traumatol Arthrosc 7:160–165

    CAS  PubMed  Google Scholar 

  37. Shaieb MD, Kan DM, Chang SK, Marumoto JM, Richardson AB (2002) A prospective randomized comparison of patellar tendon versus semitendinosus and gracilis tendon autografts for anterior cruciate ligament reconstruction. Am J Sports Med 30:214–220

    PubMed  Google Scholar 

  38. Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop 198:43–49

    PubMed  Google Scholar 

  39. Yunes M, Richmond JC, Engels EA, Pinczewski LA (2001) Patellar versus hamstring tendons in anterior cruciate ligament reconstruction: a meta-analysis. Arthroscopy 17:248–257

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Trauma and Reconstructive Surgery, University of Leipzig, Liebigstrasse 20a, 04103, Leipzig, Germany

    Tim Rose, Thomas Engel, Joachim Bernhard, Pierre Hepp, Christoph Josten & Helmut Lill

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  1. Tim Rose
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  2. Thomas Engel
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Correspondence to Tim Rose.

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Rose, T., Engel, T., Bernhard, J. et al. Differences in the rehabilitation period following two methods of anterior cruciate ligament replacement: semitendinosus/gracilis tendon vs. ligamentum patellae. Knee Surg Sports Traumatol Arthrosc 12, 189–197 (2004). https://doi.org/10.1007/s00167-003-0438-8

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