Anterior Cruciate Ligament Reconstruction with Tibial Attachment Preserving Hamstring Graft without Implant on Tibial Side

Sinha, S.M.; Naik, Amruta; Maheshwari, Mridul; Sandanshiv, Sumedh; Meena, Durgashankar; Arya, R.R.

doi:10.4103/ortho.ijortho_85_17

Cited by 9 publications

(3 citation statements)

References 20 publications

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“…After screening the title and abstract of these articles, 25 articles were retained, and the full text read to evaluate their eligibility. In the end, 12 articles met the inclusion criteria: 3 studies reported the results of NDHT [ 30 – 32 ], 6 studies compared the results of NDHT and DHT [ 33 – 38 ], 3 studies compared the results of NDHT and other ACL reconstruction techniques (2 used the ST4 technique [ 37 , 39 ] and 1 used a bone-patellar tendon-bone graft [ 40 ]). (Fig.…”

Section: Resultsmentioning

confidence: 99%

Outcomes of hamstring graft with preserved tibial insertion for ACL reconstruction: systematic review and meta-analysis

Vari,

Cavaignac,

Cavaignac

et al. 2023

Eur J Orthop Surg Traumatol

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Purpose Evaluate the outcomes of ACL (Anterior Cruciate Ligament) reconstruction techniques that use a hamstring graft with a preserved tibial insertion and compare them to standard techniques. Methods A systematic literature review and meta-analysis was done of the PubMed, MEDLINE, Cochrane and Ovid databases to identify published clinical studies on ACL reconstruction in which a non-detached hamstring tendon (NDHT) was used as a graft and to compare them to studies in which a detached hamstring tendon (DHT) or other techniques were used. The eligible studies were analyzed for the knee laxity, Lachman test, pivot shift test, joint range of motion, anterior drawer, pain, re-tear, revision surgery, Lysholm score, Tegner score, ACL-RSI scale, KOOS, IKDC, SNQ and Howell scale. Results Twelve articles in which NDHT was used for ACL reconstruction were analyzed. There was no significant difference between NDHT and DHT in the Lachman > 1 (p = .07), pivot shift test > 1 (p = .40), re-tears (p = .62), pain (p = .85) and the Tegner score (p = .95). However, the outcomes were somewhat better with the NDHT technique for the Lachman (RR = 0.30; 95% CI 0.08–1.12), pivot shift test (RR = 0.50; 95% CI 0.10–2.49) and re-tears (RR = 0.66; 95% CI 0.13–3.42). The other criteria were not included in the meta-analysis because of lack of data or because specific outcome scores were used in each article. Conclusion NDHT techniques provide similar results to DHT for ACL reconstruction and tend to produce better stability and a lower re-tear rate.

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Section: Resultsmentioning

confidence: 99%

Outcomes of hamstring graft with preserved tibial insertion for ACL reconstruction: systematic review and meta-analysis

Vari,

Cavaignac,

Cavaignac

et al. 2023

Eur J Orthop Surg Traumatol

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“…These could be explained by the fact that the pes anserinus insertion supplies vascularization to the hamstring tendons through the inferior-medial geniculate artery [42]; and an early blood supply might improve and speed up the healing and remodeling phases of the graft [33]. Despite these interesting speculations, there are only a few ACL reconstruction techniques described in the literature which preserves the biological hamstring attachment [2,6,27,37,40,43]. According to a recently published systematic review [39], MRI images have already been used to analyze maturation processes after ACL reconstruction, [9,11,21,25,38]; nevertheless only 2 studies have compared detached vs preserved hamstring tendons [23,35].…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, some authors proposed surgical techniques that can spare the hamstring distal attachment on the pes anserinus [2,6,27,37,40]; according to histological small animal models, this would maintain the original vascularization and improve graft healing and maturation [24,32,42]. In fact, the graft undergoes a "ligamentization" process which encompasses a profound histological rearrangement; according to the new mechanical and biological environment 1 3 in which the tissue is working [33].…”

Section: Introductionmentioning

confidence: 99%

Hamstring grafts for anterior cruciate ligament reconstruction show better magnetic resonance features when tibial insertion is preserved

Grassi

Casali

Macchiarola

et al. 2020

Knee Surg Sports Traumatol Arthrosc

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PurposeComparing the MRI features of the grafts between a group of patients treated with an over‐the‐top anterior cruciate ligament reconstruction technique that preserves the hamstring attachment and a control group with a classical reconstruction technique. MethodsPatients were assigned to a standard reconstruction technique or an Over‐the‐top plus lateral plasty technique. All patients underwent preoperative, 4‐months and 18‐months MRI; together with a clinical evaluation with KOOS and KT1000 laxity assessment. MRI study involved different parameters: the “Graft” was evaluated with the continuity, Howell Grading system, presence of liquid and signal noise quotient. The “Tibial Tunnel” was evaluated with the signal noise quotient, presence of edema or liquid and tunnel widening. All points assigned to each parameter formed a composite score ranging from 0–10. Tunnel and graft positioning were evaluated. ResultsAt 18‐month 20 MRIs (10 each group) were available, demographics were not significantly different between groups. The non‐detached group showed significantly less liquid within the graft at 4‐months (p = 0.008) and 18‐months (p = 0.028), the tunnel was significantly smaller (p < 0.05) and less enlarged at both follow‐ups (p < 0.05), signal noise quotient of the intra‐tunnel graft was lower at 18‐months (p < 0.05). The total score of the non‐detached group saw a significant improvement at 4‐months (p = 0.006) that remained stable at 18‐months (n.s.). ConclusionsHamstring grafts, which tibial insertions were preserved, showed better MRI features at 4‐and 18‐months follow‐up, especially in terms of liquid effusion, tunnel enlargement and signal noise quotient. Level of evidenceIV.

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Is in-vivo 80 N tensioned quadrupled hamstring graft better than conventional unmeasured pull for arthroscopic ACL reconstruction

Naik

Jain

Goyal

et al. 2020

Journal of Clinical Orthopaedics and Trauma

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To find clinical outcome of in-vivo standard 80 N tensioning of quadrupled hamstring graft during arthroscopic single bundle ACL reconstruction in comparison to traditional graft tensioning. Methods: Sixty cases of isolated ACL tears were included in this study. All cases underwent Arthroscopic ACL reconstruction with Tibial attachment sparing quadrupled hamstring graft. Cases were divided into group I and group II (30 cases each). Graft Tensioning in group 1 was conventional one-handed unmeasured pull and in group II it was measured tension of 80 N with tensionometer during graft fixation. Pre-operative and post-operative (12 months) Anterior tibial translation (ATT) was measured with KT-1000 arthrometer. Clinical outcome was measured using Lysholm knee scoring system at 6weeks, 3months, 6months, 12 months and compared statistically among both groups. Results: The mean pre-op ATT of 10.6 ± 2.04 mm (group I) & 10.83 ± 2 mm (group II) improved to 3.63 ± 1.16 mm (group I) & 3.63 ± 0.92 (group II) respectively at one year without significant difference (p value 1). The mean pre-op Lysholm score was 46.73 ± 6.77 (group I) and 45.97 ± 8.68 (group II). The mean Lysholm score at 6 weeks was 91.5 ± 2.78 (group I) and 93.43 ± 3.02 (group II) with significant difference (p value 0.014). At 3 months it was 95.4 ± 2.99 (group I) and 97.07 ± 2.07 (group II) with significant difference (p value 0.025). At 6 months it was 95.53 ± 2.46 (group I) and 97.5 ± 1.2 (group II) with significant difference (p value 0.0002). At 1 year it was 95.73 ± 2.22 (group I) and 97.8 ± 0.979 (group II) with significance (p value 0.0001). Conclusion:The clinical score of ACL reconstruction is better when in-vivo 80 N tension is applied using tensionometer during graft fixation in comparison to conventional manual tensioning but there is no difference in ATT.

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Anterior Cruciate Ligament Reconstruction with Tibial Attachment Preserving Hamstring Graft without Implant on Tibial Side

Cited by 9 publications

References 20 publications

Outcomes of hamstring graft with preserved tibial insertion for ACL reconstruction: systematic review and meta-analysis

Outcomes of hamstring graft with preserved tibial insertion for ACL reconstruction: systematic review and meta-analysis

Hamstring grafts for anterior cruciate ligament reconstruction show better magnetic resonance features when tibial insertion is preserved

Is in-vivo 80 N tensioned quadrupled hamstring graft better than conventional unmeasured pull for arthroscopic ACL reconstruction

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