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Five-Strand Hamstring Anterior Cruciate Ligament Reconstruction: Presentation of a New Technique With Better Stability at 7- to 9-Year Follow Up Than 4 Strand

Prodromos, Chadwick M.D.; Joyce, Brian B.A.

doi: 10.1097/01.bto.0000177264.50076.b2
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Summary: Even in the highest stability four-strand hamstring (4HS) or BTB ACL reconstruction series, KT 1000 side-to-side differences of ≥2mm are generally seen in at least a third of all knees. We hypothesized that a stronger, stiffer five-strand HS graft using three-strand-Semitendinosus/two-strand-Gracilis, would result in higher stability rates than 4HS using two-strand-Semitendinosus/two-strand-Gracilis.

Materials and Methods: 20 consecutive patients had 5HS ACL reconstruction using 3ST/2Gr. 18 returned for evaluation 89-112 months postoperatively. Results were compared with a previously reported cohort of 133 knees reconstructed by the same surgeon using four-strand HS grafts evaluated at 24-104 months postoperatively. Both had suspensory-cortical- femoral and whip-stitch-cortical-screw tibial fixation. KT-1000, Noyes, Lysholm and SANE ratings were performed.

Results: All 5HS and 4HS knees were clinically stable, with no graft failures or reinjuries. Average KT-1000 side-to-side difference was 0.44mm for 5HS vs. 1.0mm for 4HS for (p = 0.01). A reconstructed knee laxity increase of ≤1mm versus the normal knee was found in 89% of 5HS vs. 66% of 4HS (p = 0.03); of 2-3mm in 11% 5HS vs. 31% 4HS; of 4mm in 0% 5HS vs. 3% 4HS; and of >4mm in 0% 5HS and 4HS. 5HS/4HS clinical ratings were high and did not significantly differ.

Conclusions: 5HS ACLR had higher stability than a high stability 4HS cohort. Since sufficient ST graft is usually available to fashion a 3strand-ST instead of 2strand-ST graft to combine with the 2strand-Gr, we believe 5HS is preferable to 4HS for ACL reconstruction, especially for double bundle techniques.

From Illinois Sportsmedicine and Orthopaedic Centers, Glenview, Illinois.

Address correspondence and reprint requests to Chadwick C. Prodromos, MD, Illinois Sportsmedicine and Orthopaedic Centers, Glenview, IL. E-mail: prodromos@earthlink.net.

© 2005 Lippincott Williams & Wilkins, Inc.