Functional Outcome of Arthroscopic Reconstruction of Single Bundle Anterior Cruciate Ligament with 5 Strand Hamstring Autograft

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Authors

  • Associate Professor, Department of Orthopedics, Dr. Vasantrao Pawar Medical College, Nashik – 422003, Maharashtra ,IN
  • Assistant Professor, Department of Orthopedics, Dr. Vasantrao Pawar Medical College, Nashik – 422003, Maharashtra ,IN
  • Former PG Resident, Department of Orthopedics, Dr. Vasantrao Pawar Medical College, Nashik – 422003, Maharashtra ,IN
  • Former PG Resident, Department of Orthopedics, Dr. Vasantrao Pawar Medical College, Nashik – 422003, Maharashtra ,IN
  • Former PG Resident, Department of Orthopedics, Dr. Vasantrao Pawar Medical College, Nashik – 422003, Maharashtra ,IN
  • Former PG Resident, Department of Orthopedics, Dr. Vasantrao Pawar Medical College, Nashik – 422003, Maharashtra ,IN

DOI:

https://doi.org/10.18311/mvpjms/2020/v7i1/18572

Keywords:

ACL, Autograft, Graft Diameter, 5 Strand

Abstract

Background: Most commonly reconstructed ligament of knee is Anterior Cruciate Ligament that aims to halt or minimise the number of instability episodes 1. Testing with biomechanical parameters has shown that there is correlation between graft cross-sectional area and maximum load to failure 2. This study attempts to analyse the functional outcome of ACL reconstruction with 5 strands of hamstring autograft. Aims and Objectives: This study is based on hypothesis that larger graft will be stronger, stiffer providing better functional outcome. Materials & Methods: 35 Patients having ACL injury were treated at a tertiary care hospital; using a 5-strand hamstring graft, fixed with suspensory fixation at femoral side and aperture fixation at the tibial side. Cases were diagnosed with ACL on clinical examination & MRI. Tegner-lyshom score and International Knee Documentation Committee - Orthopaedic Scores (IKDC) is used post-operatively to grade the functional outcome of an ACL reconstruction. Results: Male predominance was observed in study subjects than female with left side slightly more commonly involved than right. Laterality didn't influenced outcome. Graft diameter observed is 9mm in 68.6%, 8 mm and 10 mm was observed in 11.4% and 20% respectively. Lysholm score at baseline was 41.63 which increased progressively to 93.45 at the end of 9 months. The IKDC score at baseline was 32.5 which increased progressively to 83.45 at the end of 12 months. Superficial infections was seen in 8.6% while complaint of knee pain was given by 2.9% cases. Lachman test was positive in 2 (5.7%) cases. Conclusion: Five-strand graft offers very high strength and more length than the 4ST. It is useful in patients with ligamentous laxity, small tendons, or other stability risk factors.

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Published

2021-03-10

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Section

Original Research Article

 

References

Shelbourne KD, Gray T. Minimum 10-year results after anterior cruciate ligament reconstruction: How the loss of normal knee motion compounds other factors related to the development of osteoarthritis after surgery. Am J Sports Med 2009; 37: 471–80. https://doi.org/10.1177/0363546508326709

Hamner D.L., Brown C.H., Jr., Steiner M.E., Hecker A.T., Hayes W.C. Hamstring tendon grafts for reconstruction of the anterior cruciate ligament: Biomechanical evaluation of the use of multiple strands and tensioning techniques. J Bone Joint Surg Am. 1999; 81: 549–557. https://doi.org/10.2106/00004623-199904000-00013

Wilson T.W., Zafuta M.P., Zobitz M. A biomechanical analysis of matched bone-patellar tendon-bone and double-looped semitendinosus and gracilis tendon grafts. Am J Sports Med. 1999; 27: 202–207. https://doi.org/10.1177/03635465990270021501

Sajovic M., Strahovnik A., Dernovsek M.Z., Skaza K. Quality of life and clinical outcome comparison of semitendinosus and gracilis tendon versus patellar tendon autografts for anterior cruciate ligament reconstruction: An 11-year follow-up of a randomized controlled trial. Am J Sports Med. 2011; 39: 2161–2169. https://doi.org/10.1177/0363546511411702

Prodromos CC, Joyce B. 5-Strand Hamstring ACL Reconstruction: A New Technique with Better Long-Term Stability Versus 4-Strand (SS-13). Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2006 Jun 30; 22(6): e7. https://doi.org/10.1016/j.arthro.2006.04.015

Lavery KP, Rasmussen JF, Dhawan A. Five-Strand Hamstring Autograft for Anterior Cruciate Ligament Reconstruction. Arthroscopy Techniques. 2014; 3(4): e423–e426. doi:10.1016/j.eats.2014.01.013.

Mei Y, Ao YF, Wang JQ, Ma Y, Zhang X, Wang JN, Zhu JX. Clinical characteristics of 4355 patients with anterior cruciate ligament injury. Chin Med J. Dec 2013; 126(23): 4487–92.

Kim MK, Lee BC, Park JH. Anatomic single bundle anterior cruciate ligament reconstruction by the two anteromedial portal method: the comparison of transportal and transtibial techniques. Knee surgery & related research. 1 Dec 2011; 23(4): 213–9. https://doi.org/10.5792/ksrr.2011.23.4.213

Haitao Z. The investigation on students sports tastes and their choices of events. Sports Sci 1999; 20: 63–64.

Wagh N et al. Functional outcome of Arthroscopic reconstruction of single bundle anterior cruciate ligament using 5 strand hamstring graft. IOSR Journal of Dental and Medical Sciences (IOSR-JDMS). 2015; 14(12): 59–62

Figueroa F, Calvo R, Figueroa D, Vaisman A, Arellano S. Five-Strand Hamstrings Autograft Versus Quadruple Hamstrings Autograft, with Graft Diameters 8.0 Millimeters or More, in Anterior Cruciate Ligament Reconstruction: Clinical Outcomes with a Minimum Two-Year Follow-Up. Arthroscopy. 1 Oct 2017; 33(10): e142. https://doi.org/10.1016/j.arthro.2017.08.175

Lee RJ, Ganley TJ. The 5-strand hamstring graft in anterior cruciate ligament reconstruction. Arthroscopy techniques. 31Oct 2014; 3(5): e627–31. https://doi.org/10.1016/j.eats.2014.07.002

Sideris, A., Hamze, A., Bertollo, N., Broe, D. and Walsh, W. (2017) Five Strand Hamstring Tendon Autograft for Anterior Cruciate Ligament Reconstruction Provides No Benefit over the Gold Standard Four Strand Repair for Anterior Stability of the Knee: A Prospective Cohort Study. Open J Orthop., 7, 156–172. https://doi.org/10.4236/ojo.2017.76018