Skip to main content
SpringerLink
Log in

Long-term results after reconstruction of the ACL with hamstrings autograft and transtibial femoral drilling

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

Abstract

Purpose

To evaluate the long-term clinical, patient-reported and radiological outcome of patients reconstructed for anterior cruciate ligament (ACL) insufficiency. We wanted to examine the relationship between clinical findings and patient-reported scores.

Methods

The 96 first successive patients that underwent ACL reconstruction using transtibial technique, hamstrings autograft and tunnel placement ad modum Howell were evaluated 10 years post-operatively. Subjective outcomes were Lysholm score, IKDC 2000 subjective score and Tegner activity scale. The clinical examination included evaluation of rotational and sagittal laxity. Evaluation of osteoarthritis was done radiologically.

Results

Eighty-three patients (86 %) were available for follow-up at mean 10.2 years post-operatively. Three patients had revision ACL surgery prior to the 10-year evaluation. The mean Lysholm score, subjective IKDC 2000 score and Tegner activity scale were 89 (SD 13), 83 (SD 15) and 5 (range, 3–9), respectively. Six patients (8 %) had moderate or severe osteoarthritis. Eighty-six per cent of patients had normal or near-normal anterior–posterior ACL laxity. Twenty per cent of patients had positive pivot shift and 42 % had a pivot glide. The former group had a significant lower Lysholm score compared to the rest of the patients.

Conclusions

Although the mean Lysholm score was classified as good (89) at the 10-year follow-up, a positive pivot shift was found in 20 % of these patients. Compared to patients with normal rotational laxity or pivot glide, this patient group reported significant lower subjective satisfaction at the long-term follow-up.

Level of evidence

Case series, Level IV.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Alentorn-Geli E, Lajara F, Samitier G, Cugat R (2009) The transtibial versus the anteromedial portal technique in the arthroscopic bone-patellar tendon-bone anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 18:1013–1037

    Article  PubMed  Google Scholar 

  2. Anderson AF, Rennirt GW, Standeffer WC (2000) Clinical analysis of the pivot shift tests: description of the pivot drawer test. Am J Sports Med 13:19–24

    CAS  Google Scholar 

  3. Apostolopoulos A, Nakos A, Nikolopoulos D, Theofanopoulos F, Liarokapis S, Mihos I (2009) Anterior cruciate ligament reconstruction with hamstring tendon autografts. EEXOT 60:48–52

    Google Scholar 

  4. Arbes S, Resinger C, Vécsei V, Nau T (2006) The functional outcome of total tears of the anterior cruciate ligament (ACL) in the skeletally immature patient. Int Orthop 31:471–475

    Article  PubMed  Google Scholar 

  5. Bedi A, Musahl V, Steuber V et al (2011) Transtibial versus anteromedial portal reaming in anterior cruciate ligament reconstruction: an anatomic and biomechanical evaluation of surgical technique. Arthroscopy 27:380–390

    Article  PubMed  Google Scholar 

  6. Briggs KK, Lysholm J, Tegner Y, Rodkey WG, Kocher MS, Steadman JR (2009) The reliability, validity, and responsiveness of the Lysholm score and Tegner activity scale for anterior cruciate ligament injuries of the knee: 25 years later. Am J Sports Med 37:890–897

    Article  PubMed  Google Scholar 

  7. Dragoo JL, Braun HJ, Durham JL, Chen MR, Harris AHS (2012) Incidence and risk factors for injuries to the anterior cruciate ligament in National Collegiate Athletic Association football: data from the 2004–2005 through 2008–2009 National Collegiate Athletic Association Injury Surveillance System. Am J Sports Med 40:990–995

    Article  PubMed  Google Scholar 

  8. Ferretti A, Monaco E, Giannetti S, Caperna L, Luzon D, Conteduca F (2010) A medium to long-term follow-up of ACL reconstruction using double gracilis and semitendinosus grafts. Knee Surg Sports Traumatol Arthrosc 19:473–478

    Article  PubMed  Google Scholar 

  9. Galway HR, MacIntosh DL (1980) The lateral pivot shift: a symptom and sign of anterior cruciate ligament insufficiency. Clin Orthop Relat Res 147:45–50

    PubMed  Google Scholar 

  10. Gerhard P, Bolt R, Dück K, Mayer R, Friederich NF, Hirschmann MT (2012) Long-term results of arthroscopically assisted anatomical single-bundle anterior cruciate ligament reconstruction using patellar tendon autograft: are there any predictors for the development of osteoarthritis? Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-012-2001-y

    PubMed  Google Scholar 

  11. Gifstad T, Sole A, Strand T, Uppheim G, Grøntvedt T, Drogset JO (2012) Long-term follow-up of patellar tendon grafts or hamstring tendon grafts in endoscopic ACL reconstructions. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-012-1947-0

    Google Scholar 

  12. Gorschewsky O (2005) Clinical comparison of the tutoplast allograft and autologous patellar tendon (bone-patellar tendon-bone) for the reconstruction of the anterior cruciate ligament: 2- and 6-year results. Am J Sports Med 33:1202–1209

    Article  PubMed  Google Scholar 

  13. Granan LP, Forssblad M, Lind M, Engebretsen L (2009) The Scandinavian ACL registries 2004–2007: baseline epidemiology. Acta Orthop 80:563–567

    Article  PubMed  Google Scholar 

  14. Heming JF, Rand J, Steiner ME (2007) Anatomical limitations of transtibial drilling in anterior cruciate ligament reconstruction. Am J Sports Med 35:1708–1715

    Article  PubMed  Google Scholar 

  15. Holm I, Oiestad BE, Risberg MA, Aune AK (2010) No difference in knee function or prevalence of osteoarthritis after reconstruction of the anterior cruciate ligament with 4-strand hamstring autograft versus patellar tendon-bone autograft: a randomized study with 10-year follow-up. Am J Sports Med 38:448–454

    Article  PubMed  Google Scholar 

  16. Hoshino Y, Araujo P, Ahlden M et al (2011) Standardized pivot shift test improves measurement accuracy. Knee Surg Sports Traumatol Arthrosc 20:732–736

    Article  PubMed  Google Scholar 

  17. Howell SM, Gittins ME, Gottlieb JE, Traina SM, Zoellner TM (2001) The relationship between the angle of the tibial tunnel in the coronal plane and loss of flexion and anterior laxity after anterior cruciate ligament reconstruction. Am J Sports Med 29:567–574

    PubMed  CAS  Google Scholar 

  18. Howell SM, Wallace MP, Hull ML, Deutsch ML (1999) Evaluation of the single-incision arthroscopic technique for anterior cruciate ligament replacement. A study of tibial tunnel placement, intraoperative graft tension, and stability. Am J Sports Med 27:284–293

    PubMed  CAS  Google Scholar 

  19. Höher J, Bach T, Münster A, Bouillon B, Tiling T (1997) Does the mode of data collection change results in a subjective knee score? Self-administration versus interview. Am J Sports Med 25:642–647

    Article  PubMed  Google Scholar 

  20. Hussein M, van Eck CF, Cretnik A, Dinevski D, Fu FH (2012) Prospective randomized clinical evaluation of conventional single-bundle, anatomic single-bundle, and anatomic double-bundle anterior cruciate ligament reconstruction: 281 cases with 3- to 5-year follow-up. Am J Sports Med 40:512–520

    Article  PubMed  Google Scholar 

  21. Ibrahim SA-R, Al-Kussary IM, Al-Misfer ARK, Al-Mutairi HQ, Ghafar SA, El Noor TA (2005) Clinical evaluation of arthroscopically assisted anterior cruciate ligament reconstruction: patellar tendon versus gracilis and semitendinosus autograft. Arthroscopy 21:412–417

    Article  PubMed  Google Scholar 

  22. Kaseta MK, DeFrate LE, Charnock BL, Sullivan RT, Garrett WE Jr (2008) Reconstruction technique affects femoral tunnel placement in ACL reconstruction. Clin Orthop Rel Res 466:1467–1474

    Article  Google Scholar 

  23. Kleipool A, Zijl J, Willems WJ (1998) Arthroscopic anterior cruciate ligament reconstruction with bone-patellar tendon-bone allograft or autograft. A prospective study with an average follow up of 4 years. Knee Surg Sports Traumatol Arthrosc 6:224–230

    Article  PubMed  CAS  Google Scholar 

  24. Larson AI, Bullock DP, Pevny T (2012) Comparison of 4 femoral tunnel drilling techniques in anterior cruciate ligament reconstruction. Arthroscopy 28:972–979

    Article  PubMed  Google Scholar 

  25. Lawhorn KW, Howell SM (2003) Scientific justification and technique for anterior cruciate ligament reconstruction using autogenous and allogeneic soft-tissue grafts. Orthop Clin North Am 34:19–30

    Article  PubMed  Google Scholar 

  26. Melnyk M, Faist M, Gothner M, Claes L, Friemert B (2007) Changes in stretch reflex excitability are related to “giving way” symptoms in patients with anterior cruciate ligament rupture. J Neurophysiol 97:474–480

    Article  PubMed  CAS  Google Scholar 

  27. Murray JRD, Lindh AM, Hogan NA et al (2012) Does anterior cruciate ligament reconstruction lead to degenerative disease? Thirteen-year results after bone-patellar tendon-bone autograft. Am J Sports Med 40:404–413

    Article  PubMed  Google Scholar 

  28. Musahl V (2005) Varying femoral tunnels between the anatomical footprint and isometric positions: effect on kinematics of the anterior cruciate ligament-reconstructed knee. Am J Sports Med 33:712–718

    Article  PubMed  Google Scholar 

  29. Musahl V, Hoshino Y, Ahlden M et al (2012) The pivot shift: a global user guide. Knee Surg Sports Traumatol Arthrosc 20:724–731

    Article  PubMed  Google Scholar 

  30. Noyes FR, Bassett RW, Grood ES, Butler DL (1980) Arthroscopy in acute traumatic hemarthrosis of the knee. J Bone Jt Surg 62:687–695

    CAS  Google Scholar 

  31. Oiestad BE, Holm I, Aune AK et al (2010) Knee function and prevalence of knee osteoarthritis after anterior cruciate ligament reconstruction: a prospective study with 10 to 15 years of follow-up. Am J Sports Med 38:2201–2210

    Article  PubMed  Google Scholar 

  32. Scanlan SF, Lai J, Donahue JP, Andriacchi TP (2011) Variations in the three-dimensional location and orientation of the ACL in healthy subjects relative to patients after transtibial ACL reconstruction. J Orthop Res 30:910–918

    Article  PubMed  Google Scholar 

  33. Shelbourne KD, Gray T (2009) Minimum 10-year results after anterior cruciate ligament reconstruction: how the loss of normal knee motion compounds other factors related to the development of osteoarthritis after surgery. Am J Sports Med 37:471–480

    Article  PubMed  Google Scholar 

  34. Silva A, Sampaio R, Pinto E (2011) ACL reconstruction: comparison between transtibial and anteromedial portal techniques. Knee Surg Sports Traumatol Arthrosc 20:896–903

    Article  PubMed  Google Scholar 

  35. Simmons R, Howell SM, Hull ML (2003) Effect of the angle of the femoral and tibial tunnels in the coronal plane and incremental excision of the posterior cruciate ligament on tension of an anterior cruciate ligament graft: an in vitro study. J Bone Jt Surg 85:1018–1029

    Google Scholar 

  36. Steiner ME (2009) Independent drilling of tibial and femoral tunnels in anterior cruciate ligament reconstruction. J Knee Surg 22:171–176

    Article  PubMed  Google Scholar 

  37. Strauss EJ, Barker JU, McGill K, Cole BJ, Bach BR, Verma NN (2011) Can anatomic femoral tunnel placement be achieved using a transtibial technique for hamstring anterior cruciate ligament reconstruction? Am J Sports Med 39:1263–1269

    Article  PubMed  Google Scholar 

  38. Sujay DK, Khan WS, Rohit S (2012) Anterior cruciate ligament graft choices: a review of current concepts. Open Orthop J 6:281–286

    Article  Google Scholar 

  39. Tashman S, Kopf S, Fu FH (2008) The kinematic basis of anterior cruciate ligament reconstruction. Oper Tech Sports Med 16:116–118

    Article  PubMed  Google Scholar 

  40. Tompkins M, Milewski MD, Brockmeier SF, Gaskin CM, Hart JM, Miller MD (2012) Anatomic femoral tunnel drilling in anterior cruciate ligament reconstruction: use of an accessory medial portal versus traditional transtibial drilling. Am J Sports Med 40:1313–1321

    Article  PubMed  Google Scholar 

  41. Wagemakers HP, Luijsterburg PA, Boks SS et al (2010) Diagnostic accuracy of history taking and physical examination for assessing anterior cruciate ligament lesions of the knee in primary care. Arch Phys Med Rehabil 91:1452–1459

    Article  PubMed  Google Scholar 

  42. Wipfler B, Donner S, Zechmann CM, Springer J, Siebold R, Paessler HH (2011) Anterior cruciate ligament reconstruction using patellar tendon versus hamstring tendon: a prospective comparative study with 9-year follow-up. Arthroscopy 27:653–665

    Article  PubMed  Google Scholar 

  43. Xu Y, Ao Y, Wang J, Yu J, Cui G (2011) Relation of tunnel enlargement and tunnel placement after single-bundle anterior cruciate ligament reconstruction. Arthroscopy 27:923–932

    Article  PubMed  Google Scholar 

  44. Zantop T, Kubo S, Petersen W, Musahl V, Fu FH (2007) Current techniques in anatomic anterior cruciate ligament reconstruction. Arthroscopy 23:938–947

    Article  PubMed  Google Scholar 

  45. International Knee Documentation Committee (2000). IKDC forms available at: http://www.sportsmed.org/research/IKDC_forms

Download references

Conflict of interest

No conflict of interest reported from any of the authors.

Author information

Authors and Affiliations

  1. Surgical Department, Haraldsplass Deaconess Hospital, Pb 6165, 5152, Bergen, Norway

    Eivind Inderhaug, Torbjørn Strand, Cornelia Fischer-Bredenbeck & Eirik Solheim

  2. Department of Surgical Sciences, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway

    Eirik Solheim

Authors
  1. Eivind Inderhaug
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Torbjørn Strand
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Cornelia Fischer-Bredenbeck
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Eirik Solheim
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Eivind Inderhaug.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Inderhaug, E., Strand, T., Fischer-Bredenbeck, C. et al. Long-term results after reconstruction of the ACL with hamstrings autograft and transtibial femoral drilling. Knee Surg Sports Traumatol Arthrosc 21, 2004–2010 (2013). https://doi.org/10.1007/s00167-012-2330-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-012-2330-x

Keywords

Search

Navigation