J Korean Orthop Assoc.  2007 Aug;42(4):498-504. 10.4055/jkoa.2007.42.4.498.

The Midterm Results of Arthroscopic Anterior Cruciate LigamentReconstruction with Hamstring Tendon and Ligament Anchor Screw

• Song EK
• Seon JK
• Park SJ
• Park JK

• KMID: 2186512
• DOI: http://doi.org/10.4055/jkoa.2007.42.4.498

Abstract

PURPOSE: To evaluate the clinical and radiological results of an arthroscopic ACL reconstruction with a hamstring tendon and Ligament Anchor (LA) screw.
MATERIALS AND METHODS
48 cases among 47 patients with a minimum 5 year follow up after the ACL reconstruction were examined. The clinical results (Lysholm Knee score, Tegner activity scale, Lachmann test, Pivot-shift test, and complications) were evaluated, and the radiological results (osteoarthritis, bony tunnel enlargement, instrumented anterior laxity test with Telos?) were assessed.
RESULTS
The Lysholm Knee score showed significant improvement from 65.8 to 96.7 at the final follow up. The Tegner activity scale also showed significant improvement from 3.5 preoperatively to 6.0 at the final follow-up. The Lachmann test showed that 42 cases had converted to negative. The Pivot-shift test was negative in 39 cases and mild positive in 9 cases. The side to side difference using the instrumented anterior laxity test was 12.5 mm preoperatively and 3.2 mm at the final follow-up. Degenerative osteoarthritis was observed in 9 (19%) knees. The femoral and tibial tunnel were widened by 21.6 and 20.9% in the AP view and 16.3 and 19.0% in the lateral view, respectively (p<0.05).
CONCLUSION
An ACL reconstruction with a hamstring tendon and LA screw can restore the knee stability with satisfactory clinical results and few complications.

Keyword

Anterior cruciate ligament; Arthrosopic ACL reconstruction; Hamstring tendon; LA screw

MeSH Terms

Anterior Cruciate Ligament
Follow-Up Studies
Humans
Knee
Ligaments*
Osteoarthritis
Tendons*

Figure

• 

  Fig. 1 Radiographic measurement of the bony tunnel. The actual tunnel size was calculated by correcting the measured tunnel size with a correction ratio that was obtained by dividing the real diameter of the LA screw by the measured diameter of the LA screw. The bony tunnel was measured at the point of the maximal tunnel width in well-defined sclerotic margins.

• 

  Fig. 2 (A) Anteroposterior and lateral radiographs before surgery showed no evidence of osteoarthritis. (B) Anteroposterior and Lateral radiographs of a 67 year old patient taken 7.8 years after the reconstruction showed evidence of grade III osteoarthritis on the all compartments of the reconstructed knee.

• 

  Fig. 3 The radiographs taken 6.7 years after surgery. (A) Anteroposterior and lateral radiographs of the left knee show proper placement of the graft and LA screw. (B) Side to side difference in the instrumented anterior laxity test with Telos® had improved to 2 mm at the follow up.

Reference

1. Aglietti P, Buzzi R, Giron F, Simeone AJ, Zaccherotti G. Arthroscopic-assisted anterior cruciate ligament reconstruction with the central third patellar tendon. A 5-8-year follow-up. Knee Surg Sports Traumatol Arthrosc. 1997. 5:138–144.

2. Aglietti P, Zaccherotti G, De Biase P, Taddei I. A comparison between medial meniscus repair, partial meniscectomy, and normal meniscus in anterior cruciate ligament reconstructed knees. Clin Orthop Relat Res. 1994. 307:165–173.

3. Almekinders LC, Pandarinath R, Rahusen FT. Knee stability following anterior cruciate ligament rupture and surgery. The contribution of irreducible tibial subluxation. J Bone Joint Surg Am. 2004. 86:983–987.

4. Aune AK, Ekeland A, Cawley PW. Interference screw fixation of hamstring vs patellar tendon grafts for anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 1998. 6:99–102.

5. Bach BR Jr, Tradonsky S, Bojchuk J, Levy ME, Bush-Joseph CA, Khan NH. Arthroscopically assisted anterior cruciate ligament reconstruction using patellar tendon autograft. Five- to nine-year follow-up evaluation. Am J Sports Med. 1998. 26:20–29.

6. Balkfors B. The course of knee-ligament injuries. Acta Orthop Scand. 1982. Suppl. 1–99.

7. Brown CH Jr, Steiner ME, Carson EW. The use of hamstring tendons for anterior cruciate ligament reconstruction. Technique and result. Clin Sports Med. 1993. 12:723–756.

8. Daniel DM, Stone ML, Dobson BE, Fithian DC, Rossman DJ, Kaufman KR. Fate of the ACL-injured patient. A prospective outcome study. Am J Sports Med. 1994. 22:632–644.

9. Ferretti A, Conteduca F, De Carli A, Fontana M, Mariani PP. Osteoarthritis of the knee after ACL reconstruction. Int Orthop. 1991. 15:367–371.

10. Fetto JF, Marshall JL. The natural history and diagnosis of anterior cruciate ligament insufficiency. Clin Orthop Relat Res. 1980. 147:29–38.

11. Franklin JL, Rosenberg TD, Paulos LE, France EP. Radiographic assessment of instability of the knee due to rupture of the anterior cruciate ligament. A quadricepscontraction technique. J Bone Joint Surg Am. 1991. 73:365–372.

12. Furman W, Marshall JL, Girgis FG. The anterior cruciate ligament. A functional analysis based on postmorterm studies. J Bone Joint Surg Am. 1976. 58:179–185.

13. Gillquist J, Messner K. Anterior cruciate ligament reconstruction and the long-term incidence of gonathrosis. Sports Med. 1999. 27:143–156.

14. Giove TP, Miller SJ, Kent BE, Sanford TL, Garrick JG. Non-operative treatment of the torn anterior cruciate ligament. J Bone Joint Surg Am. 1983. 65:184–192.

15. Giron F, Aglietti P, Cuomo P, Mondanelli N, Ciardullo A. Anterior cruciate ligament reconstruction with doublelooped semitendinosus and gracilis tendon graft directly fixed to cortical bone: 5-year results. Knee Surg Sports Traumatol Arthrosc. 2005. 13:81–91.

16. Jomha NM, Borton DC, Clingeleffer AJ, Pinczewski LA. Long-term osteoarthritic changes in anterior cruciate ligament reconstructed knees. Clin Orthop Relat Res. 1999. 358:188–193.

17. Kellgren JH, Lawrence JS. Radiological assessment of osteoarthrosis. Ann Rheum Dis. 1957. 16:494–502.

18. L'Insalata JC, Klatt B, Fu FH, Harner CD. Tunnel expansion following anterior cruciate ligament reconstruction: a comparison of hamstring and patellar tendon autografts. Knee Surg Sports Traumatol Arthrosc. 1997. 5:234–238.

19. McDaniel WJ Jr, Dameron TB Jr. Untreated ruptures of the anterior cruciate ligament. A follow-up study. J Bone Joint Surg Am. 1980. 62:696–705.

20. Noyes FR, Barber-Westin SD. Anterior cruciate ligament reconstruction with autogenous patellar tendon graft in patients with articular cartilage damage. Am J Sports Med. 1997. 25:626–634.

21. Shelbourne KD, Gray T. Anterior cruciate ligament reconstruction with autogenous patellar tendon graft followed by accelerated rehabilitation: A two- to nine-year followup. Am J Sports Med. 1997. 25:786–795.

22. Sommerlath K, Lysholm J, Gillquist J. The long-term course after treatment of acute anterior cruciate ligament ruptures. A 9 to 16 year followup. Am J Sports Med. 1991. 19:156–162.

23. Song EK, Kim HS, Park CH. Parapatellar complications after ACL reconstruction using bone-patellar tendon-bone autograft. J Korean Orthop Assoc. 1999. 34:917–921.

24. Song EK, Lee KB, Shin SG, Kim HJ. Clinical results of anterior cruciate ligament reconstruction using hamstring tendon. J Korean Orthop Sports Med. 2002. 1:21–25.

25. Song EK, Seon JK, Yoon TR, Seo HY, Yim JH. Osteoarthritis after ten year follow-up of ACL reconstruction using patellar tendon autograft. J Korean Orthop Assoc. 2006. 41:122–128.

26. Song EK, Yoon TR, Jung JW, Jeong KC. Widening of bony tunnel after ACL reconstruction using hamstring tendon with ligament anchor (LA) screw. J Korean Arthro Soc. 2001. 5:69–73.

27. Steiner ME, Hecker AT, Brown CH Jr, Hayes WC. Anterior cruciate ligament graft fixation. Comparison of hamstring and patellar tendon grafts. Am J Sports Med. 1994. 22:240–246.