Abstract
The purposes of this paper are to summarize the concepts relating to the use of a combined intra-articular and extra-articular reconstructive procedure in the arthroscopic treatment of a torn ACL and to review several operative techniques utilizing gracilis and semitendinosus tendons that are currently in use to treat this instability. The highly satisfactory results obtained over the time show that a combination of intra- and extra-articular procedures for ACL reconstruction is a valid surgical option.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
Howe JG, Johnson RJ, Kaplan MJ, et al. Anterior cruciate ligament reconstruction using quadriceps patellar tendon graft. Part I. Long-term follow-up. Am J Sports Med. 1991;19:447–57.
Lemaire M. Chronic knee instability. Technics and results of ligament plasty in sports injuries. J Chir (Paris). 1975;110:281–94.
MacIntosh DL, Darby JA. Lateral substitution reconstruction. Proceedings of the Canadian Orthopaedic Association. J Bone Joint Surg Br. 1976;58:142.
Schmid F. Injuries of the medial collateral ligament and anterior cruciate ligament of the knee joint and Lemaire surgical functional treatment. Long-term outcome. Unfallchirurgie. 1996;22:124–9.
Vail TP, Malone TR, Bassett FH. Long-term functional results in patients with anterolateral rotatory instability treated by iliotibial band transfer. Am J Sports Med. 1992;20:274–82.
Zarins B, Rowe CR. Combined anterior cruciate-ligament reconstruction using semitendinosus tendon and iliotibial tract. J Bone Joint Surg Am. 1986;68:160–77.
•• Marcacci M, Zaffagnini S, Giordano G, et al. Anterior cruciate ligament reconstruction associated with extra-articular tenodesis: a prospective clinical and radiographic evaluation with 10- to 13-year follow-up. Am J Sports Med. 2009;37:707–14. This study demonstrates the good clinical and radiological long-term results of a combined intra-articular “over-the-top” and extra-articular lateral plasty ACL reconstruction technique using semitendinosus and gracilis tendons.
Marcacci M, Zaffagnini S, Iacono F, et al. Arthroscopic intra- and extra-articular anterior cruciate ligament reconstruction with gracilis and semitendinosus tendons. Knee Surg Sports Traumatol Arthrosc. 1998;6:68–75.
Marcacci M, Zaffagnini S, Iacono F, et al. Intra- and extra-articular anterior cruciate ligament reconstruction utilizing autogeneous semitendinosus and gracilis tendons: 5-year clinical results. Knee Surg Sports Traumatol Arthrosc. 2003;11:2–8.
Buscayret C, Buscayret F, Farenq C. Intra- and extra-articular hamstring reconstruction of anterior cruciate ligament tears. Rev Chir Orthop Reparatrice Appar Mot. 2001;87:276–80.
Colombet PD. Navigated intra-articular ACL reconstruction with additional extra-articular tenodesis using the same hamstring graft. Knee Surg Sports Traumatol Arthrosc. 2010;19:384–9.
Ferretti A, Conteduca F, Monaco E, et al. Revision anterior cruciate ligament reconstruction with doubled semitendinosus and gracilis tendons and lateral extra-articular reconstruction. J Bone Joint Surg Am. 2006;88:2373–9.
Imbert P. Minimally invasive extra-articular anterolateral reinforcement: a new technique. Arthroscopy. 2007;23:907–1004.
Engebretsen L, Lew WD, Lewis JL, Hunter RE. The effect of an iliotibial tenodesis on intraarticular graft forces and knee joint motion. Am J Sports Med. 1990;18:169–76.
• Bignozzi S, Zaffagnini S, Lopomo N, et al. Does a lateral plasty control coupled translation during antero-posterior stress in single-bundle ACL reconstruction? An in vivo study. Knee Surg Sports Traumatol Arthrosc. 2009;17:65–70.
Krackow KA, Brooks RL. Optimization of knee ligament position for lateral extraarticular reconstruction. Am J Sports Med. 1983;11:293–302.
Draganich LF, Reider B, Ling M, Samuelson M. An in vitro study of an intraarticular and extraarticular reconstruction in the anterior cruciate ligament deficient knee. Am J Sports Med. 1990;18:262–6.
Draganich LF, Hsieh YF, Reider B. Iliotibial band tenodesis: a new strategy for attachment. Am J Sports Med. 1995;23:186–95.
Pearl AJ, Bergfeld JA, editors. Extraarticular reconstruction in the anterior cruciate ligament deficient knee. Champaign: Human Kinetics Books; 1992.
Karlson JA, Steiner ME, Brown CH, Johnston J. Anterior cruciate ligament reconstruction using gracilis and semitendinosus tendons. Comparison of through-the-condyle and over-the-top graft placements. Am J Sports Med. 1994;22:659–66.
• Zaffagnini S, Marcacci M, Lo Presti M, et al. Prospective and randomized evaluation of ACL reconstruction with three techniques: a clinical and radiographic evaluation at 5 years follow-up. Knee Surg Sports Traumatol Arthrosc. 2006;14:1060–9. This “in vivo” study showed that the addition of an extra-articular tenodesis to single-bundle ACL reconstruction may be effective in controlling knee laxities.
Disclosure
No conflicts of interest relevant to this article were reported.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Marcacci, M., Zaffagnini, S., Marcheggiani Muccioli, G.M. et al. Arthroscopic intra- and extra-articular anterior cruciate ligament reconstruction with gracilis and semitendinosus tendons: a review. Curr Rev Musculoskelet Med 4, 73–77 (2011). https://doi.org/10.1007/s12178-011-9075-x
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12178-011-9075-x