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Chronic anterior cruciate ligament insufficiency results in inferior quality hamstring autografts

European Journal of Orthopaedic Surgery & Traumatology volume 29, pages 1481–1484 (2019)Cite this article

Abstract

Background

Availability of a good quality autograft of adequate length is the first step towards a successful knee ligament reconstruction. Being able to predict the quality and length of hamstring autograft can go a long way in making the surgeon’s pre-operative planning a lot easier. The purpose of this study was to find out if any correlation existed between the duration of ACL injury with history of repeated instability episodes and the quality and length of Hamstring graft that was harvested.

Methods

Forty consecutive patients who underwent ACL reconstruction using quadrupled Hamstring tendon graft were evaluated with regard to the duration of injury, number of instability episodes and graft characteristics like difficulty in harvesting the graft, quality and length of the graft.

Results

We found a statistically significant difference between the usable length of harvested Hamstring tendon in patients with acute and chronic injury (p = 0.004). There was a significantly high risk of the graft being shorter and of poor quality in patients with chronic injury (odds ratio = 5.7).

Conclusion

Chronicity of ACL injury with repeated strains can cause fibrosis at the musculotendinous junction and result in harvest of a poor quality and short hamstring autograft. A detailed history with regard to duration of injury and repeated instability episodes will help a surgeon plan better when anticipating a sub-optimal graft.

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References

  1. Middleton KK, Hamilton T, Irrgang JJ, Karlsson J, Harner CD, Fu FH (2014) Anatomic anterior cruciate ligament (ACL) reconstruction: a global perspective. Part 1. Knee Surg Sports Traumatol Arthrosc 22(7):1467–1482

    CAS  Article  Google Scholar 

  2. Scott WN, Insall JN (1996) Injuries of the knee. In: Rockwood CA Jr, Green DP, Bucholz RW (eds) Rockwood and green’s fractures in adults. Lippincott Williams and Wilkins, Philadelphia, pp 1799–1816

    Google Scholar 

  3. Samuelsson K, Andersson D, Ahldén M, Fu FH, Musahl V, Karlsson J (2013) Trends in surgeon preferences on anterior cruciate ligament reconstructive techniques. Clin Sports Med 32(1):111–126

    Article  Google Scholar 

  4. Janssen RP, van der Velden MJ, van den Besselaar M, Reijman M (2015) Prediction of length and diameter of hamstring tendon autografts for knee ligament surgery in Caucasians. Knee Surg Sports Traumatol Arthrosc 25(4):1199–1204

    Article  Google Scholar 

  5. Charalambous CP, Alvi F, Phaltankar P, Gagey O (2009) Hamstring tendon harvesting—effect of harvester on tendon characteristics and soft tissue disruption; cadaver study. Knee 16(3):183–186

    CAS  Article  Google Scholar 

  6. Jebaseelan DD, Pathak SS, Acharya AR, Joseph C, Rajan DV (2008) Biomechanical analysis of two different tibial fixation methods for anterior cruciate ligament reconstruction using soft tissue graft: an experimental study in sheep knees. Trends Biomater Artif Organs 21(2):79–84

    Google Scholar 

  7. Yasumoto M, Deie M, Sunagawa T, Adachi N, Kobayashi K, Ochi M (2006) Predictive value of preoperative 3-dimensional computer tomography measurement of semitendinosus tendon harvested for anterior cruciate ligament reconstruction. Arthroscopy 22(3):259–264

    Article  Google Scholar 

  8. Pinheiro B, Percope A, Teixeira M et al (2011) Intra-operative four-stranded hamstring tendon graft diameter evaluation. Knee Surg Sports Traumatol Arthrosc 19(5):811–815

    Article  Google Scholar 

  9. Stergios PG, Georgios KA, Konstantinos N, Efthymia P, Nikolaos K, Alexandros PG (2012) Adequacy of semitendinosus tendon alone for anterior cruciate ligament reconstruction graft and prediction of hamstring graft size by evaluating simple anthropometric parameters. Anat Res Int 2012:8. https://doi.org/10.1155/2012/424158

    Article  Google Scholar 

  10. Chiang ER, Ma HL, Wang ST, Hung SC, Liu CL, Chen TH (2012) Hamstring graft sizes differ between Chinese and Caucasians. Knee Surg Sports Traumatol Arthrosc 20(5):916–921

    Article  Google Scholar 

  11. Liu CT, Lu YC, Huang CH (2015) Half-peroneus-longus-tendon graft augmentation for unqualified hamstring tendon graft of anterior cruciate ligament reconstruction. J Orthop Sci 20(5):854–860

    Article  Google Scholar 

  12. George K, Connell DA, Brukner P, Schneider-Kolsky M (2007) Magnetic resonance imaging parameters for assessing risk of recurrent hamstring injuries in elite athletes. Am J Sports Med 35(9):1500–1506

    Article  Google Scholar 

  13. Garrett WE Jr (1996) Muscle strain injuries. Am J Sports Med 24(6):S2–S8

    Article  Google Scholar 

  14. Orchard JW (2001) Intrinsic and extrinsic risk factors for muscle strains in Australian football. Am J Sports Med 29(3):300–303

    CAS  Article  Google Scholar 

  15. Garrett W, Lohnes J (1990) Cellular and matrix response to mechanical injury at the myotendinous junction. In: Leadbetter WB, Buckwalter JA, Gordon SL (eds) Sports-induced inflammation. AAOS, Rosemont, pp 215–224

    Google Scholar 

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Author information

Affiliations

  1. Spire Alexandra Hospital, Kent, UK

    Arjun Naik

  2. Father Muller Medical College Hospital, Mangalore, India

    Prashant Acharya

Authors
  1. Arjun Naik
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  2. Prashant Acharya
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Correspondence to Arjun Naik.

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Conflict of interest

The conflict of interest disclosure form is signed by both the authors and attached with the other documents. Dr. Arjun Ajith Naik and Dr. Prashant Acharya declare that they have no conflict of interest.

Ethical Approval

All human and animal studies have been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Specific national laws have been observed.

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Naik, A., Acharya, P. Chronic anterior cruciate ligament insufficiency results in inferior quality hamstring autografts. Eur J Orthop Surg Traumatol 29, 1481–1484 (2019). https://doi.org/10.1007/s00590-019-02467-7

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  • DOI: https://doi.org/10.1007/s00590-019-02467-7

Keywords

  • Hamstring
  • ACL
  • Instability