EVALUATION OF ARTHROSCOPIC A CRUCIATE LIGAMENT ECONSTRUCTION WITH HAMSTRINGS TENDON GRAFT
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ABSTRACT
Objective: Treatment of rupture of anterior cruciate ligament (ACL) aims to restore normal/near normal stability and function of the knee, preventing
further damage to other knee structures. We studied the functional outcome of arthroscopic guided ACL reconstruction using quadrupled hamstring
tendon graft (QHTG) and evaluated the complications.
Methods: In this prospective study, evaluation parameters Lachman test, Pivot test, and hamstring strength were assessed pre- and post-operatively
at months 3, 6, 12, 18, and 24; Lysholm test was assessed postoperatively. Intravenous ceftriaxone+tazobactam 1 g b.d × 2 days followed by oral
cefpodoxime 200 mg b.d was prescribed till suture removal. Post-operative ACL rehabilitation protocol was followed for all patients.
Result: A total of sixteen male patients with a mean age of 26.5 years were evaluated. Injury due to road traffic accident (7) and sports activity (6)
was a common cause. Preoperatively, all patients had positive Pivote and anterior drawer test, 4+ score of Lachman test, 4/5 muscle strength with
restriction of movement to <10°. Mean±standard deviation Lysholm score at months 3, 6, and 12 were 81.19±10.21, 83.86±12.44, and 89.17±8.32,
respectively. At month 3, negative Lachman test was seen in 75% (12/16) patients, 18.75% (3/16) had 1+ laxity, and only one had 2+ laxity. None had
pivot shift test positive. At month 3, 81.25% (13/16) patients had normal range of motion of the operated knee; at month 6 and 12, 85.71% (12/14)
and 91.67% (11/12), respectively, had equal range of motion compared to normal contralateral side. At months 3 and 12, 37.5% (6/16) and 100%
(12/12) had a grade of 5/5 power in hamstring muscles. 12 post-operative complications were seen in 10 patients.
Conclusion: Autologous ipsilateral QHTG is a good choice in arthroscopic guided ACL reconstruction and is associated with fewer complications.
Focus on regaining hamstring power is essential for a successful surgery.
Keywords: Anterior cruciate ligament tear, Hamstring strength, Lysholm score, Pivote test, Quadrupled hamstring tendon graft, Range of movement.
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REFERENCES
Arnold JA, Coker TP, Heaton LM, Park JP, Harris WD. Natural history
of anterior cruciate tears. Am J Sports Med 1979;7(6):305-13.
Noyes FR, Mooar PA, Matthews DS, Butler DL. The symptomatic
anterior cruciate-deficient knee. Part I: The long-term functional
disability in athletically active individuals. J Bone Joint Surg Am
;65(2):154-62.
McGinty JB. Arthroscopic surgery in sports injuries. Orthop Clin North
Am 1980;11(4):787-99.
Rowden NJ, Sher D, Rogers GJ, Schindhelm K. Anterior cruciate
ligament graft fixation. Initial comparison of patellar tendon and
semitendinosus autografts in young fresh cadavers. Am J Sports Med
;25(4):472-8.
Aglietti P, Buzzi R, Zaccherotti G, De Biase P. Patellar tendon versus
doubled semitendinosus and gracilis tendons for anterior cruciate
ligament reconstruction. Am J Sports Med 1994;22(2):211-7.
Torg JS, Conrad W, Kalen V. Clinical diagnosis of anterior cruciate
ligament instability in the athlete. Am J Sports Med 1976;4(2):84-93.
Slocum DB, James SL, Larson RL, Singer KM. Clinical test for
anterolateral rotary instability of the knee. Clin Orthop Relat Res
(118):63-9.
Galway HR, MacIntosh DL. The lateral pivot shift: A symptom and
sign of anterior cruciate ligament insufficiency. Clin Orthop Relat Res
(147):45-50.
Magee DJ, editor. Principles and concepts. In: Orthopaedic Physical
Assessment. 2
ed. Philadelphia: W. B. Saunders Co.; 1992. p. 1-33.
Williams JS Jr, Bach BR Jr. Operative and nonoperative rehabilitation
nd
of the ACL injured knee. Sports Medicine and Arthroscopy Review
;4(1):69-147.
Slone HS, Romine SE, Premkumar A, Xerogeanes JW. Quadriceps
tendon autograft for anterior cruciate ligament reconstruction: A
comprehensive review of current literature and systematic review of
clinical results. Arthroscopy 2015;31(3):541-54.
Middleton KK, Hamilton T, Irrgang JJ, Karlsson J, Harner CD, Fu
FH. Anatomic anterior cruciate ligament (ACL) reconstruction: A
global perspective. Part 1. Knee Surg Sports Traumatol Arthrosc
;22(7):1467-82.
Rahr-Wagner L, Thillemann TM, Pedersen AB, Lind M. Comparison
of hamstring tendon and patellar tendon grafts in anterior cruciate
ligament reconstruction in a nationwide population-based cohort study:
Results from the Danish registry of knee ligament reconstruction. Am J
Sports Med 2014;42(2):278-84.
Chechik O, Amar E, Khashan M, Lador R, Eyal G, Gold A. An
international survey on anterior cruciate ligament reconstruction
practices. Int Orthop 2013;37(2):201-6.
Kubiak G, Fabis J. Evaluation of treatment strategy of acute knee
infection after ACL reconstruction with hamstring. Pol Orthop
Traumatol 2013;78:235-8.
Torn W. ACL. eMedicine Health. Available from: http://www.
emedicinehealth.com/torn_acl/page4_em.htm. [Last updated 2015
Jul 30, Accessed on 2016 Jan 25].
Ali MS, Kumar A, Adnaan Ali S, Hislop T. Anterior cruciate ligament
reconstruction using hamstring tendon graft without detachment of the
tibial insertion. Arch Orthop Trauma Surg 2006;126(9):644-8.
Roe J, Pinczewski LA, Russell VJ, Salmon LJ, Kawamata T, Chew M.
A 7-year follow-up of patellar tendon and hamstring tendon grafts for
arthroscopic anterior cruciate ligament reconstruction: Differences and
similarities. Am J Sports Med 2005;33(9):1337-45.
Bali T, Nagraj R, Kumar MN, Chandy T. Patellar tendon or hamstring
graft anterior cruciate ligament reconstructions in patients aged above
years. Indian J Orthop 2015;49(6):615-9.
Williams RJ 3
, Hyman J, Petrigliano F, Rozental T, Wickiewicz TL.
Anterior cruciate ligament reconstruction with a four-strand hamstring
tendon autograft. Surgical technique. J Bone Joint Surg Am
;87 Suppl 1:51-66.
Williams RJ 3
rd
, Hyman J, Petrigliano F, Rozental T, Wickiewicz TL.
Anterior cruciate ligament reconstruction with a four-strand hamstring
tendon autograft. J Bone Joint Surg Am 2004;86-A(2):225-32.
rd
Corry IS, Webb JM, Clingeleffer AJ, Pinczewski LA. Arthroscopic
reconstruction of the anterior cruciate ligament. A comparison of
patellar tendon autograft and four-strand hamstring tendon autograft.
Am J Sports Med 1999;27(4):444-54.
Shi DL, Yao ZJ. Knee function after anterior cruciate ligament
reconstruction with patellar or hamstring tendon: A meta-analysis. Chin
Med J (Engl) 2011;124(123):4056-62.
Sun K, Zhang J, Wang Y, Xia C, Zhang C, Yu T, et al. Arthroscopic
anterior cruciate ligament reconstruction with at least 2.5 years’
follow-up comparing hamstring tendon autograft and irradiated
allograft. Arthroscopy 2011;27(9):1195-202.
Wipfler B, Donner S, Zechmann CM, Springer J, Siebold R,
Paessler HH. Anterior cruciate ligament reconstruction using patellar
tendon versus hamstring tendon: A prospective comparative study with
-year follow-up. Arthroscopy 2011;27(5):653-65.
Zelic Z, Jovanovic S, Wertheimer V, Saric G, Biuk E, Gulan G. Results
of the surgical reconstruction of the anterior cruciate ligament. Coll
Antropol 2012;36(1):201-6.
Heijne A, Ang BO, Werner S. Predictive factors for 12-month outcome
after anterior cruciate ligament reconstruction. Scand J Med Sci Sports
;19(6):842-9.
Maletis GB, Inacio MC, Reynolds S, Desmond JL, Maletis MM,
Funahashi TT. Incidence of postoperative anterior cruciate ligament
reconstruction infections: Graft choice makes a difference. Am J Sports
Med 2013;41(8):1780-5.
Barker JU, Drakos MC, Maak TG, Warren RF, Williams RJ 3
,
Allen AA. Effect of graft selection on the incidence of postoperative
rd
Asian J Pharm Clin Res, Vol 9, Issue 3, 2016, 295-299
Bhargav et al.
infection in anterior cruciate ligament reconstruction. Am J Sports Med
;38(2):281-6.
Ristic V, Maljanovic M, Harhaji V, Milankov M. Infections after
reconstructions of anterior cruciate ligament. Med Pregl 2014;67
(1-2):11-5.
Plaweski S, Rossi J, Merloz P. Anterior cruciate ligament reconstruction:
Assessment of the hamstring autograft femoral fixation using the
EndoButton CL. Orthop Traumatol Surg Res 2009;95(8):606-13.
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