Anterior Cruciate Ligament Reconstruction Using the Semitendinosus and Gracilis Tendons Augmented by the Losee Iliotibial Band Tenodesis

Abstract

Seventy patients were evaluated after combined intra- and extraarticular reconstruction of the anterior cruciate ligament. Semitendinosus and gracilis tendons were used for the intraarticular reconstruction and Losee iliotibial band tenodesis for the extraarticular procedure. Minimum followup was 5 years (average, 7). Clinical examination and instrumented ligament examination with the KT-1000 arthrometer and the Cybex II dynamometer were used to evaluate results. Subjectively, patients had no complaints of instability with daily activities; 93% had no complaints of instability with athletic participation. Clinical examination demonstrated that 81% had less than a 1 + Lachman test; 98% had a negative pivot shift. Instrumented examination of the anteroposterior limits of motion revealed that only 57% had less than 3-mm side-to-side difference; 30% had 3- to 5-mm; and 13% had 6- to 9-mm. Mean hamstring muscle strength measured with the Cybex II dynamometer was 94% at 60 and 96% at 100 deg/sec. When evaluated with the Zarins scale, 90% were rated good or excellent, 6% fair, and 4% poor. This reconstructive procedure restores functional, but not necessarily normal, stability in most anterior cruciate ligament-deficient knees. It allows patients to increase activity levels without significant risk of additional injuries.

Fixation strength of biocomposite wedge interference screw in ACL reconstruction: effect of screw length and tunnel/screw ratio. A controlled laboratory study

“…In this study, experimental testing of a screw tibial fixation for hamstrings tendons has been performed. This device is designed for four-strand grafts; this surgical technique has being gaining ground on bone-tendon-bone procedures because of its low morbidity and good results [2-4], although two-bundle grafts have demonstrated to achieve enough stability [16]. Bio-absorbable screws have evident advantages [8]: they provide similar or even better fixation than metallic screws [17-20], causing less damage to the graft [21] and without interfering with the graft incorporation process [19].…”

“…In the last decade, the use of double looped hamstrings has been growing in popularity among arthroscopists. Excellent results have been reported with this technique [2,3], without significant differences between the outcomes of both procedures [4]. …”

Clinical Outcome at a Minimum of Five Years After Reconstruction of the Anterior Cruciate Ligament

“…Randomized, controlled trials have previously demonstrated the superiority of reconstruction compared with primary repair [1][2][3] . Additional randomized, controlled trials have shown no clinical differences in outcome between the use of patellar tendon autograft and the use of hamstring tendon graft [4][5][6][7][8][9][10][11] or between one and two-incision arthroscopic operative techniques 10,[12][13][14] . Thus, reconstructions of the anterior cruciate ligament have been performed to allow patients to resume activities, especially in sports requiring cutting and pivoting, and studies have shown overall good short-term function 15,16 .…”

Sports Injuries and Prevention

“…Despite these advantages, a considerable decrease in knee fl exion strength during deep knee fl exion has been reported after harvesting the ST tendon for ACL reconstruction (Nakajima et al 1996 ;Ohkoshi et al 1998 ;Tadokoro et al 2004 ;Tashiro et al 2003 ), although the peak knee fl exion torque of the ST tendon-harvested limb can eventually recover to at least 90 % of normal (Aglietti et al , 1997Anderson et al 1994Anderson et al , 2001Cooley et al 2001 ;Cross et al 1992 ;Ferretti et al 2002 ;Gobbi et al 2003 ;Irie and Tomatsu 2002 ;Karlson et al 1994 ;Lipscomb et al 1982 ;Lipscomb and Anderson 1986 ;Maeda et al 1996 ;Siegel and Barber-Westin 1998 ;Simonian et al 1997 ;Yasuda et al 1995 ). There are many advantages of using the ST tendon, including ease of harvest during ACL reconstructive surgery, suitable morphology for use as an ACL graft, and lower donor-site morbidity .…”