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Anterior Cruciate Ligament Reconstruction with a Four-Strand Hamstring Tendon Autograft

Williams, Riley J. III MD; Hyman, Jon MD; Petrigliano, Frank MD; Rozental, Tamara MD; Wickiewicz, Thomas L. MD

Journal of Bone & Joint Surgery - American Volume: February 2004 - Volume 86 - Issue 2 - p 225–232
Scientific Articles

Background: In this study, we analyzed the clinical outcomes at a minimum of two years following reconstruction of the anterior cruciate ligament with use of a four-strand hamstring tendon autograft in patients who had presented with a symptomatic torn anterior cruciate ligament.

Methods: One hundred and twenty-two consecutive patients who had an isolated, symptomatic anterior tibial subluxation associated with rupture of the anterior cruciate ligament were treated with reconstruction of the anterior cruciate ligament with a four-strand autologous semitendinosus-gracilis tendon graft. One surgeon performed all of the operations. Prior to surgery and at the follow-up examination, physical findings and functional scores were recorded and knee radiographs were analyzed. Following surgery, a six-month rehabilitation regimen was implemented.

Results: Eighty-five patients (70%) were available for follow-up, which included physical examination, scoring of function, KT-1000 arthrometric testing, and radiographs, at a mean of twenty-eight months. Seventy-six (89%) of the patients had negative Lachman and pivot shift tests. The mean Lysholm score improved from 55 points preoperatively to 91 points at the time of follow-up (p < 0.01). The mean Tegner score improved from 5 to 6 points (p < 0.01). Sixty-five patients had <3 mm of knee translation on arthrometric testing, but six patients with marked laxity were not tested. Three patients (4%) had a positive pivot shift test but had no history of additional trauma to the knee. Six patients (7%) had a traumatic rupture of the graft, occurring at a mean of 10.7 months postoperatively. Assessment of the follow-up radiographs demonstrated no evidence of progressive degenerative change compared with the appearance on the preoperative radiographs. However, tunnel expansion was noted in all patients. The tibial tunnel expanded a mean of 17% (range, 0% to 32%), and the femoral tunnel expanded a mean of 29% (range, 0% to 40%).

Conclusions: Reconstruction of the anterior cruciate ligament with use of a four-strand hamstring tendon autograft eliminated anterior tibial subluxation in 89% of patients who were examined at a minimum of two years postoperatively. The overall rate of failure was 11%. The functional knee scores were significantly increased at the time of follow-up, but these results did not correlate with the results of knee arthrometric testing.

Level of Evidence: Therapeutic study, Level IV (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence.

1 The Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021

2 5671 Peachtree-Dunwoody N.E., Suite 700, Atlanta, GA 30342

3 University of Pennsylvania Health System, 3400 Spruce Street, Philadelphia, 19104

Copyright 2004 by The Journal of Bone and Joint Surgery, Incorporated
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