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Is quadruple semitendinosus tendon strands autograft a better choice than hamstring autograft for anterior cruciate ligament reconstruction? A comparative study with a mean follow-up of 3 years

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

The purpose of this study was to compare the clinical outcomes of ST4 with those of STGs with a minimum follow-up of 3 years. The hypothesis was that functional outcomes of the ST4 technique are at least as good as those of the STG technique.

Study design

Cohort study. Level of evidence, 3

Methods

Eighty-seven consecutive patients underwent isolated ACL reconstruction, 50 with the ST4 and 37 with STG. At the femoral side for both groups, the system of the fixation of the graft used a cortical fixation support and at the tibial side the group STG used an interference screw and the ST4 group used a tape locked system fixed by an interference screw. Clinical results were compared: IKDC score, KT-1000 arthrometry, radiologic evaluation of the differential laxity, as well as the Tegner score and the KOOS score.

Results

Two patients had a rerupture (STG), one in the ST4 group. The analysis of the subjective clinical results showed no statistically significant difference between the 2 groups. Differential laximetry was 0.7 mm ± 0.4 (0 to 2 mm) for the ST4 group and 1.6 ± 0.5 mm (0 to 3 mm) for the STG group with a statistically significant difference in favor of the ST4 group (p < 0.05). Age, sex, and presence of meniscal lesions were the factors influencing the KOOS score.

Conclusion

This study comparing the clinical and laximetric results at the minimum 3-year follow-up of 2 ACL reconstruction techniques (ST4 vs STG) confirms the working hypothesis with an overall better score for the ST4 group.

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References

  1. Andersson D, Samuelsson K, Karlsson J (2009) Treatment of anterior cruciate ligament injuries with special reference to surgical technique and rehabilitation: an assessment of randomized controlled trials. Arthroscopy 25(6):653–685

    Article  Google Scholar 

  2. Biau DJ, Katsahian S, Kartus J et al (2009) Patellar tendon versus hamstring tendon autografts for reconstructing the anterior cruciate ligament: a meta-analysis based on individual patient data. Am J Sports Med 37(12):2470–2478

    Article  Google Scholar 

  3. Murray MM (2009) Current status and potential of primary ACL repair. Clin Sports Med 28(1):51–61

    Article  Google Scholar 

  4. Nakamura N, Horibe S, Sasaki S et al (2002) Evaluation of active knee flexion and hamstring strength after anterior cruciate ligament reconstruction using hamstring tendons. Arthroscopy 18:598–602

    Article  Google Scholar 

  5. Oiestad BE, Engebretsen L, Storheim K, Risberg MA (2009) Knee osteoarthritis after anterior cruciate ligament injury: a systematic review. Am J Sports Med 37(7):1434–1443

    Article  Google Scholar 

  6. Poehling-Monaghan KL, Salem H, Ross KE et al (2017) Long-term outcomes in anterior cruciate ligament reconstruction: a systematic review of patellar tendon versus hamstring autografts. Orthop J Sports Med 5(6):2325967117709735

    Article  Google Scholar 

  7. Roos EM, Lohmander LS (2003) The knee injury and osteoarthritis outcome score (KOOS): from joint injury to osteoarthritis. Health Qual Life Outcomes 3(1):64

    Article  Google Scholar 

  8. Schurz M, Tiefenboeck TM, Winnisch M et al (2016) Clinical and functional outcome of all-Inside anterior cruciate ligament reconstruction at a minimum of 2 years' follow-up. Arthroscopy 32(2):332–337

    Article  Google Scholar 

  9. Tashiro T, Kurosawa H, Kawakami A et al (2003) Influence of medial hamstring tendon harvest on knee flexor strength after anterior cruciate ligament reconstruction. A detailed evaluation with comparison of single and double tendon harvest. Am J Sports Med 31:522–529

    Article  Google Scholar 

  10. Van Eck CF, Schreiber VM, Mejia HA et al (2010) Anatomic anterior cruciate ligament reconstruction: a systematic review of surgical techniques and reporting of surgical data. Arthroscopy 26(9 Suppl):S2–12

    PubMed  Google Scholar 

  11. Xie X, Liu X, Chen Z et al (2015) A meta-analysis of bone-patellar tendon-bone autograft versus four-strand hamstring tendon autograft for anterior cruciate ligament reconstruction. Knee 22:100–110

    Article  Google Scholar 

  12. Yasen SK, Borton ZM, Eyre-Brook AI et al (2017) Clinical outcomes of anatomic, all-inside, anterior cruciate ligament (ACL) reconstruction. Knee 24(1):55–62

    Article  Google Scholar 

  13. Collette M, Cassard X (2011) The tape locking screw technique (TLS): A new ACL reconstruction method using a short hamstring graft. Orthop Traumatol Surg Res 97:555–559

    Article  CAS  Google Scholar 

  14. Lubowitz JH (2012) All-inside anterior cruciate ligament graft link: graft preparation technique. Arthrosc Tech 1(2):165–168

    Article  Google Scholar 

  15. Robert H, Bowen M, Odry G et al (2015) A comparison of four tibial-fixation systems in hamstring-graft anterior ligament reconstruction. Eur J Orthop Surg Traumatol 25(2):339–347

    Article  Google Scholar 

  16. Collette M, Courville J, Forton M, Gagnière B (2012) Objective evaluation of anterior knee laxity; comparison of the KT-1000 and GNRB® arthrometers. Knee Surg Sports Traumatol Arthrosc 20(11):2233–2238

    Article  Google Scholar 

  17. 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(3):150–154

    Article  CAS  Google Scholar 

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

    Google Scholar 

  19. Hefti F, Müller W, Jakob RP, Stäubli HU (1993) Evaluation of knee ligament injuries with the IKDC form. Knee Surg Sports Traumatol Arthrosc 1(3–4):226–234

    Article  CAS  Google Scholar 

  20. Bressy G, Brun V, Ferrier A et al (2016) Lack of stability at more than 12 months of follow-up after anterior cruciate ligament reconstruction using all-inside quadruple-stranded semitendinosus graft with adjustable cortical button fixation in both femoral and tibial sides. Orthop Traumatol Surg Res 102(7):867–872

    Article  CAS  Google Scholar 

  21. Karimi-Mobarakeh M, Mardani-Kivi M, Mortazavi A et al (2015) Role of gracilis harvesting in four-strand hamstring tendon anterior cruciate ligament reconstruction: a double-blinded prospective randomized clinical trial. Knee Surg Sports Traumatol Arthrosc 23(4):1086–1091

    Article  Google Scholar 

  22. Kyung HS, Lee HJ, Oh CW, Hong HP (2015) Comparison of results after anterior cruciate ligament reconstruction using a four-strand single semitendinosus or a semitendinosus and gracilis tendon. Knee Surg Sports Traumatol Arthrosc 23(11):3238–3243

    Article  Google Scholar 

  23. Streich NA, Reichenbacher S, Barié A, Buchner M, Schmitt H (2013) Long-term outcome of anterior cruciate ligament reconstruction with an autologous four-strand semitendinosus tendon autograft. Int Orthop 37(2):279–284

    Article  Google Scholar 

  24. Cooley VJ, Deffner KT, Rosenberg TD (2001) Quadrupled semitendinosus anterior cruciate ligament reconstruction: 5-year results in patients without meniscus loss. Arthroscopy 17(8):795–800

    Article  CAS  Google Scholar 

  25. Conte EJ, Hyatt AE, Gatt CJ Jr, Dhawan (2014) A Hamstring autograft size can be predicted and is a potential risk factor for anterior cruciate ligament reconstruction failure. Arthroscopy 30(7):882–890

    Article  Google Scholar 

  26. Bouguennec N, Odri GA, Graveleau N, Colombet P (2015) Comparative reproducibility of TELOS™ and GNRB® for instrumental measurement of anterior tibial translation in normal knees. Orthop Traumatol Surg Res 101(3):301–305

    Article  CAS  Google Scholar 

  27. Lustig S, Magnussen R, Cheze L, Neyret P (2012) The KneeKG system: a review of the literature. Knee Surg Sports Traumatol Arthrosc 20(4):633–638

    Article  Google Scholar 

  28. Mannering N, Young T, Spelman T, Choong PF (2017) Three-dimensional knee kinematic analysis during treadmill gait slow imposed speed versus normal self-selected speed. Bone Joint Res 6(8):514–521

    Article  CAS  Google Scholar 

  29. Musahl V, Griffith C, Irrgang JJ et al (2016) Pivot study group. Validation of quantitative measures of rotatory knee laxity. Am J Sports Med 44(9):2393–2398

    Article  Google Scholar 

  30. Zaffagnini S, Urrizola F, Signorelli C et al (2016) Current use of navigation system in ACL surgery: a historical review. Knee Surg Sports Traumatol Arthrosc 24(11):3396–3409

    Article  CAS  Google Scholar 

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Correspondence to Stéphane Plaweski.

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Plaweski, S., Lanternier, H. Is quadruple semitendinosus tendon strands autograft a better choice than hamstring autograft for anterior cruciate ligament reconstruction? A comparative study with a mean follow-up of 3 years. Eur J Orthop Surg Traumatol 30, 1473–1479 (2020). https://doi.org/10.1007/s00590-020-02729-9

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  • DOI: https://doi.org/10.1007/s00590-020-02729-9

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