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The effect of graft placement on the clinical outcome of the anterior cruciate ligament reconstruction: a prospective study

Knee Surgery, Sports Traumatology, Arthroscopy volume 15, pages 879–887 (2007)Cite this article

Abstract

The effect of the graft placement on the clinical outcome of patients after anterior cruciate ligament (ACL) reconstruction has been studied sparsely. We conducted a prospective follow-up of 140 patients who underwent an arthroscopic ACL reconstruction with a hamstring graft. One hundred and four of them (74%) could be examined at the 2-year follow-up. Clinical examination included Lysholm, Tegner, and International Knee Documentation Committee rating scores, arthrometric anterior–posterior knee laxity assessment, and muscle strength assessments. The graft placement was measured from lateral radiographs using a system recommended for measuring the attachment positions of the cruciate ligaments as well as a method called ‘the sumscore of the graft placement’, which takes into account both the femoral and the tibial graft placements simultaneously. The sumscore was smaller in knees with normal anterior–posterior knee laxity in the Lachman test (P = 0.002) and normal rotational knee laxity in the pivot shift test (P = 0.01) than in those with abnormal laxity. The tibial graft placement was more anterior when the Lachman test was normal (P = 0.04). The Lysholm score was better when the femoral graft placement was more posterior (r = −0.20, P = 0.04). The optimal femoral graft placement was between 25 and 29% of length of the femoral condyle along the Blumensaat’s line from posterior to anterior. The optimal tibial graft placement was between 32 and 37% of the length of the tibial plateau from the anterior corner, and the optimal sumscore was between 61 and 66. The sumscore and its components (the femoral and tibial graft placements) showed a clear association with the clinical outcome of the patients. The best outcome was achieved when the sumscore was small; that is the graft placement showed posterior enough in the femur, and anterior enough in the tibia.

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Affiliations

  1. Medical School, University of Tampere, Kalevantie 4, 33014, Tampere, Finland

    Anna-Stina Moisala & Markku Järvinen

  2. Department of Orthopaedics and Traumatology, Hatanpää Hospital, Tampere, Finland

    Timo Järvelä

  3. Orton Hospital, Helsinki, Finland

    Arsi Harilainen & Jerker Sandelin

  4. Accident and Trauma Research Center, UKK Institute, Tampere, Finland

    Pekka Kannus

  5. Division of Orthopaedics and Traumatology, Department of Trauma, Musculoskeletal Surgery and Rehabilitation, Tampere University Hospital, Tampere, Finland

    Pekka Kannus & Markku Järvinen

Authors
  1. Anna-Stina Moisala
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  2. Timo Järvelä
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  3. Arsi Harilainen
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  4. Jerker Sandelin
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  5. Pekka Kannus
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  6. Markku Järvinen
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Correspondence to Anna-Stina Moisala.

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Moisala, AS., Järvelä, T., Harilainen, A. et al. The effect of graft placement on the clinical outcome of the anterior cruciate ligament reconstruction: a prospective study. Knee Surg Sports Traumatol Arthr 15, 879–887 (2007). https://doi.org/10.1007/s00167-007-0295-y

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  • DOI: https://doi.org/10.1007/s00167-007-0295-y

Keywords

  • Anterior cruciate ligament
  • Reconstruction
  • Graft placement
  • Clinical outcome
  • Sumscore