Skip to main content
SpringerLink
Log in

Augmentation technique with semitendinosus and gracilis tendons in chronic partial lesions of the ACL: clinical and arthrometric analysis

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

Abstract

Most of the techniques described in the literature for the repair of chronic partial ACL tears, don’t spare the intact portion of the ligament. The aim of this study was to perform a prospective analysis of the results of augmentation surgery using gracilis and semitendinosus tendons to treat partial sub-acute lesions of the ACL. This technique involves an “over the top” femoral passage, which enables salvage and strengthening of the intact portion of the ACL. The study included 47 patients treated consecutively at our institute from 1993 to 1998, with a mean injury-surgery interval of 18 weeks (range 12–36). The patients were followed up by clinical and instrumental assessment criteria at 3 months, 1 and 5 years after surgery. Clinical assessment was performed using the IKDC form. Subjective and functional parameters were assessed by the Tegner activity scale. Instrumental evaluation was done using the KT-2000 instrument: the 30-pound passive test and the manual maximum displacement test were performed. We obtained good or excellent results in 95.7% of cases. No recurrences in ligamentous laxity were observed. We believe that the described technique has the advantage of being compatible with ACL anatomy, and enables very rapid functional recovery.

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
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Andersson C, Odensten M, Good L, Gillquist J (1989) Surgical or non surgical treatment of acute rupture of the anterior cruciate ligament: a randomized study with long-term follow-up. J Bone Joint Surg Am 71:965–974

    PubMed  CAS  Google Scholar 

  2. Andersson C, Odensten M, Gillquist J (1991) Knee function after surgical or non surgical treatment of acute rupture of the anterior cruciate ligament: a randomized study with a long-term follow-up period. Clin Orthop 264:255–263

    PubMed  Google Scholar 

  3. Bak K, Scavenius M, Hansen S et al (1997) Isolated partial rupture of the anterior cruciate ligament. Long-term follow-up of 56 cases. Knee Surg Sports Traumatol Arthrosc 5:66–71

    Article  PubMed  CAS  Google Scholar 

  4. Barrack RL, Buckley SL, Bruckner JD et al (1990) Partial versus complete acute anterior cruciate ligament tears. The results of nonoperative treatment. J Bone Joint Surg Br 72(4):622–624

    PubMed  CAS  Google Scholar 

  5. Brandsson S, Faxen E, Kartus J et al (2001) A prospective four- to seven-year follow-up after arthroscopic anterior cruciate ligament reconstruction. Scand J Med Sci Sports 11:23–27

    Article  PubMed  CAS  Google Scholar 

  6. Brandsson S, Karlsson J, Sward L et al (2002) Kinematics and laxity of the knee joint after anterior cruciate ligament reconstruction: pre- and post-operative radiostereometric studies. Am J Sports Med 30:361–367

    PubMed  Google Scholar 

  7. Caborn DNM, Chang HC (2005) Single femoral socket double-bundle anterior cruciate ligament reconstruction using tibialis anterior tendon: description of a new technique. Arthroscopy 21:1273.e1–e8

    Google Scholar 

  8. Danylchuk KD, Finlay JB, Krcek JP (1978) Microstructural organization of human and bovine cruciate ligaments. Clin Orthop 131:294–298

    PubMed  Google Scholar 

  9. Engebresten L, Benum P, Fasting O et al (1990) A prospective, randomized study of three surgical techniques for treatment of acute ruptures of the anterior cruciate ligament. Am J Sports Med 18:585–590

    Google Scholar 

  10. Eriksson K, Anderberg P, Hamberg P et al (2001) A comparison of quadrupled semitendinosus and patellar tendon grafts in reconstruction of the anterior cruciate ligament. J Bone Joint Surg Br 83:348–354

    Article  PubMed  CAS  Google Scholar 

  11. Feagin JA Jr, Curl WW (1976) Isolated tear of the anterior cruciate ligament: 5-year follow-up study. Am J Sports Med 4:95–100

    PubMed  Google Scholar 

  12. Fruensgaard S, Johannsen HV (1989) Incomplete ruptures of the anterior cruciate ligament. J Bone Joint Surg Br 71(3):526–530

    PubMed  CAS  Google Scholar 

  13. Freuensgaard S, Kroner K, Riis J (1992) Suture of the torn anterior cruciate ligament: 5-year follow-up of 60 cases using an instrumental stability test. Acta Orthop Scand 63:323–325

    Article  Google Scholar 

  14. Gabriel MT, Wong EK, Woo SL-Y et al (2004) Distribution of in situ forces in the anterior cruciate ligament in response to rotatory loads. J Orthop Res 22:85–89

    Article  PubMed  Google Scholar 

  15. Girgis FG, Marhall JL, Monajem ARSA (1975) The cruciate ligaments of the knee joint. Anatomical, functional and experimental analysis. Clin Orthop 106:216–231

    Article  PubMed  Google Scholar 

  16. Halbrecht J (2005) Long-term failure of thermal shinkage for laxity of the anterior cruciate ligament. Am J Sports Med 33(7):990–995

    Article  PubMed  Google Scholar 

  17. Hamada M, Shino K, Horibe S et al (2001) Single- versus bi-socket anterior cruciate ligament reconstruction using autogenous multiple stranded hamstring tendons with EndoButton femoral fixation: a prospective study. Arthroscopy 17:801–807

    Article  PubMed  CAS  Google Scholar 

  18. Hara K, Kubo T, Suginoshita T et al (2000) Reconstruction of the anterior cruciate ligament using a double bundle. Arthroscopy 16:860–864

    Article  PubMed  CAS  Google Scholar 

  19. Indelli PF, Dillingham MF, Fanton GS et al (2003) Monopolar thermal treatment of symptomatic anterior cruciate ligament instability. Clin Orthop 407:139–147

    PubMed  Google Scholar 

  20. Jacquot L, Selmi TAS, Servien E et al (2003) Lésions ligamentaires récentes du genou. In: Encyclopédie medico-chirurgicale appareil locomoteur. Editions Scientifiques et Médicales Elsevier SAS Paris, 14–080-A-20

  21. Kanamori A, Woo SL-Y, Ma CB et al (2000) The forces in the anterior cruciate ligament and knee kinematics during a simulated pivot shift test: a human cadaveric study using robotic technology. Arthroscopy 16:633–639

    Article  PubMed  CAS  Google Scholar 

  22. Krueger-Franke M, Siebert CH, Schupp A (1998) Refixation of femoral anterior cruciate ligament tears combined with a semitendinosus tendon augmentation. Technique and results. Arch Orthop Trauma Surg 117(1–2):68–72

    Article  PubMed  CAS  Google Scholar 

  23. Liljedahl SO, Lindvall N, Wetterfors J (1965) Early diagnosis and treatment of acute ruptures of the anterior cruciate ligament; a clinical and arthrographic study of forty-eight cases. J Bone Joint Surg Am 47(8):1503–1513

    PubMed  CAS  Google Scholar 

  24. Marcacci M, Molgora AP, Zaffagnini S (2003) Anatomic double-bundle anterior cruciate ligament reconstruction with hamstrings. Arthroscopy 19:540–546

    Article  PubMed  Google Scholar 

  25. Markolf KL, Burchfield DM, Shapiro MM et al (1995) Combined knee loading states that generate high anterior cruciate ligament forces. J Orthop Res 13:930–935

    Article  PubMed  CAS  Google Scholar 

  26. Muneta T, Sekiya I, Yagishita K et al (1999) Two-bundle reconstruction of the anterior cruciate ligament using semiendinosus tendon with EndoButtons: operative technique and preliminary results. Arthroscopy 15:618–624

    Article  PubMed  CAS  Google Scholar 

  27. Noyes FR, Bassett RW, Grood ES et al (1980) Arthroscopy in acute traumatic hemarthrosis of the knee. Incidence of anterior cruciate tears and other injuries. J Bone Joint Surg Am 62(5):687–695, 757

    Google Scholar 

  28. Noyes FR, Mooar LA, Moorman CT III et al (1989) Partial tears of the anterior cruciate ligament. Progression to complete ligament deficiency. J Bone Joint Surg Br 71(5):825–833

    PubMed  CAS  Google Scholar 

  29. Odensten M, Lysholm J, Gillquist J (1984) Suture of fresh ruptures of the anterior cruciate ligament: a 5-year follow-up. Acta Orthop Scand 55:270–272

    PubMed  CAS  Google Scholar 

  30. Odensten M, Hamberg P, Nordin M et al (1985) Surgical or conservative treatment of acutely torn anterior cruciate ligament: a randomized study with short-term follow-up observations. Clin Orthop 198:87–93

    PubMed  Google Scholar 

  31. Patel JV, Church JS, Hall AJ (2000) Central third bone-patellar tendon-bone anterior cruciate ligament reconstruction: a 5 year follow-up. Arthroscopy 16:67–70

    Article  PubMed  CAS  Google Scholar 

  32. Pederzini L, Adriani E, Botticella C et al (2000) Double tibial tunnel using quadriceps tendon in anterior cruciate ligament reconstruction. Arthroscopy 16:E9

    Google Scholar 

  33. Perry JJ, Higgins LD (2000) Anterior and posterior cruciate ligament rupture after thermal treatment. Arthroscopy 16:732–736

    Article  PubMed  CAS  Google Scholar 

  34. Pinczewski LA, Deehan DJ, Salmon LJ et al (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. Ruiz AL, Kelly M, Nutton RW (2002) Arthroscopic ACL reconstruction: a 5–9 year follow-up. Knee 9:197–200

    Article  PubMed  CAS  Google Scholar 

  36. Sandberg R, Balkfors B (1987) Partial rupture of the anterior cruciate ligament. Natural course. Clin Orthop 220:176–178

    PubMed  Google Scholar 

  37. Sekiya JK, Golladay GJ, Wojtys EM (2000) Autodigestion of a hamstring anterior cruciate ligament autograft following thermal shrinkage: a case report and sentinel of concern. J Bone Joint Surg 82-A:1454–1457

    PubMed  CAS  Google Scholar 

  38. Sherman MF, Lieber L, Bonamo JR et al (1991) The long-term follow-up of primary anterior cruciate ligament repair. Defining a rationale for augmentation. Am J Sports Med 19:243–255

    PubMed  CAS  Google Scholar 

  39. Takeuchi R Saito T, Mituhashi S et al (2002) Double-bundle anterior cruciate ligament reconstruction using bone-hamstring-one composite graft. Arthroscopy 18:550–555

    Article  Google Scholar 

  40. Thabit G III (1998) The arthroscopic monopolar radiofrequency treatment of chronic anterior cruciate ligament instability. Op Tech Sports Med 6:157–160

    Article  Google Scholar 

  41. Woo SL-Y, Kanamori A, Zeminski J et al (2002) The effectiveness of reconstruction of the anterior cruciate ligament with hamstrings and patellar tendon. A cadaveric study comparing anterior tibial and rotational loads. J Bone Joint Surg Am 84:907–914

    PubMed  Google Scholar 

  42. Yao L, Gentili A, Petrus L et al (1995) Partial ACL rupture: an MR diagnosis?. Skeletal Radiol 24(4):247–251

    Article  PubMed  CAS  Google Scholar 

  43. Yasuda K, Kondo E, Ichiyama H et al (2004) Anatomical reconstruction of the antero-medial and postero-lateral bundles of the anterior cruciate ligament using hamstring tendon grafts. Arthroscopy 20:1015–1025

    Article  PubMed  Google Scholar 

  44. Yasuda K, Kondo E, Ichiyama H et al (2005) Surgical and biomechanical concepts of anatomic anterior cruciate ligament reconstruction. Oper Tech Orthop 15:96–102

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Rizzoli Orthopaedic Institute, University of Bologna, Via Pupilli 1, Bologna, Italy

    Roberto Buda, Alberto Ferruzzi, Francesca Vannini, Lisa Zambelli & Francesco Di Caprio

Authors
  1. Roberto Buda
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alberto Ferruzzi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Francesca Vannini
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lisa Zambelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Francesco Di Caprio
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Roberto Buda.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Buda, R., Ferruzzi, A., Vannini, F. et al. Augmentation technique with semitendinosus and gracilis tendons in chronic partial lesions of the ACL: clinical and arthrometric analysis. Knee Surg Sports Traumatol Arthrosc 14, 1101–1107 (2006). https://doi.org/10.1007/s00167-006-0117-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-006-0117-7

Keywords

Search

Navigation