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Medicina dello Sport 2005 December;58(4):303-11


language: English

Anterior cruciate ligament replacement with distally inserted doubled hamstring graft: prospective clinical and instrumental evaluation

Buda R., Verni E., Ferruzzi A., Di Caprio F., Giannini S.

Orthopaedic Clinic, Rizzoli Orthopaedic Institute, University of Bologna, Bologna


Background. In ACL reconstruction with gracilis and semitendinous tendons, a relevant problem is the tibial fixation of the graft. Preserving the tibial insertion of the hamstring can assure a stable fixation. Study design: Prospective nonrandomized clinical trial.
Methods. 60 patients with chronic unilateral ACL disruption consecutively had a two-incision arthroscopically assisted ACL replacement with four-strand semitendinous and gracilis graft. The graft was left inserted at the tibial attachment and placed proximally in over the top (OTT) fixation. The free end of the graft, carried back to the tibia, was fixed out of the tibial tunnel on the insertion of the pes anserinus. Subjective evaluation was assessed by the Tegner Activity Scale. Objective data were collected following the IKDC form guidelines. Instrumental test was performed by measuring comparative side-to-side arthrometrical difference. Subjective, clinical, arthrometrical and X-ray investigation were taken six months and seven years after surgery.
Results. Two patients had a complete traumatic rupture of the graft during sport activity while two subjects demonstrated atraumatic graft failure. IKDC overall scores improved significantly from six months to the final follow-up but differences between the subgroups were not significant over time. The knees rated stable by KT-2000 at six months were stable at seven, but the group rated 3 to 5 mm at six months showed a significant trend toward a greater translation. Return to sport was closely related to Tegner activity scale. A second surgery (four cases) did not affect the final result.
Conclusions. Hamstring quadrupled graft is very useful to restore knee stability in ACL chronic insufficiency. The choice to place the graft in OTT fixation, leaving intact the tibial hamstring insertion, does not affect the overall outcome. In particular no patient had problems with the tibial fixation of the tendons.

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