Integration of hamstring tendon graft with bone in reconstruction of the anterior cruciate ligament

Pinczewski, Leo A.; Clingeleffer, Amanda J.; Otto, David; Bonar, S. Fiona; Corry, Ian S.

doi:10.1016/s0749-8063(97)90194-8

Cited by 182 publications

(112 citation statements)

References 4 publications

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“…13 Experimental and clinical studies support the fast healing of tendon-to-bone fixation using interference screws. 23,24 In conventional single-bundle PCL reconstruction, it is recommended that femoral graft fixation be placed in the so-called most isometric point. [25][26][27] However, the normal PCL consists of a posteromedial bundle that is tight in extension, and a stronger anterolateral bundle that is mostly taught in flexion.…”

mentioning

confidence: 99%

Anatomic double-bundle posterior cruciate ligament reconstruction using hamstring tendons

Stähelin

Südkamp

Weiler

2001

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Recent biomechanical studies have shown that an anatomic double-bundle posterior cruciate ligament (PCL) reconstruction is superior in restoring normal knee laxity compared with the conventional single-bundle isometric reconstruction. We describe a modification of an endoscopic PCL reconstruction technique using a double-bundle Y-shaped hamstring tendon graft. A double-or triple-bundle semitendinosus-gracilis tendon graft is used and directly fixed with soft threaded biodegradable interference screws. In the medial femoral condyle, 2 femoral tunnels are created inside-out through a low anterolateral arthroscopic portal. First, in 80°of flexion, the double-stranded gracilis graft is fixed with an interference screw inside the lower femoral socket, representing the insertion site of the posteromedial bundle. In full extension the combined semitendinosus-gracilis graft is pretensioned and fixed inside the posterior aspect of the single tibial tunnel. The double-or triple-stranded semitendinosus tendon is inserted in the higher femoral tunnel, presenting the insertion site of the anterolateral bundle. Finally, pretension is applied to the semitendinosus bundle in 70°of flexion and a third screw is inserted. Using this technique, the stronger semitendinosus part of the double-bundle graft, which mimics the anterolateral bundle of the PCL, is fixed in flexion, whereas the smaller gracilis tendon part (posteromedial bundle) is fixed in full extension. Thus, a fully arthroscopic anatomic PCL reconstruction technique is available that may better restore normal knee kinematics as compared to the single-stranded isometric reconstruction. Key Words: Posterior cruciate ligament-Double bundle-Biodegradable interference screw-Hamstring tendon.

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mentioning

confidence: 99%

Anatomic double-bundle posterior cruciate ligament reconstruction using hamstring tendons

Stähelin

Südkamp

Weiler

2001

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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“…There are no analogous sites in humans where a native tendon passes through a bone tunnel, however, and the biology of this unique environment remains incompletely understood. Wide variations in the morphological characteristics of the tendon-bone attachment site have been reported [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23]. Some studies have demonstrated formation of a native, direct type of insertion and an intermediate fibrocartilage zone at the interface.…”

Section: Discussionmentioning

confidence: 99%

Differences in Tendon Graft Healing between the Intra-articular and Extra-articular Ends of a Bone Tunnel

et al. 2009

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The basic biology of healing between a tendon graft and bone tunnel remains incompletely understood. Distinct variability in the morphological characteristics of the healing tendon-bone attachment site has been reported. We hypothesized that spatial and temporal differences in tendon-to-bone healing exist at different regions of a surgically created bone tunnel. Twenty-four male, Sprague-Dawley rats underwent anterior cruciate ligament (ACL) reconstruction in the left knee using a flexor digitorum longus tendon graft secured using suspensory periosteal fixation.

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“…In cases using cross-pins, as the cortical-cancellous suspensory devices, excellent strength and stiffness have been reported [8]; nonetheless, it has the shortcomings of bungee effects and slippage within cancellous bones [14]. Interference screws, as the compression fixation devices, could be fixed close to the normal ACL attachment site [22], and additional incisions are not required. In cases when bioabsorbable screws are used, it has an advantage that it does not distort the results of magnetic resonance imaging; however, in comparison with cases using the BPTB, it showed remarkably low strength and stiffness [2] and it may induce an inflammatory reaction [5,16].…”

Section: Discussionmentioning

confidence: 99%

Comparative biomechanical study of the Ligament Plate® and other fixation devices in ACL reconstruction

Sim

Kwak

Yang

et al. 2008

International Orthopaedics (SICOT)

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The objective of this study was to evaluate and compare the biomechanical properties of the Ligament Plate® with other femoral fixation devices. The Ligament Plate® and three different femoral fixation devices were used in fixation of 60 porcine femora and harvested porcine tendons. For each fixation device, a porcine graft-tendon complex was used for the simple load-to-failure test and the load-to-failure test after a cyclic loading test, and the maximal failure load was measured. The amount of graft elongation and failure pattern after the cyclic loading test and load-to-failure test were evaluated. In the BioScrew® group, the mean maximal failure load in the load-to-failure test and load-to-failure test after a cyclic loading test was significantly lower and significant graft elongation was noted. There were no significant differences between the other groups. The Ligament Plate® provided adequate initial fixation power suitable for early rehabilitation.

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Integration of hamstring tendon graft with bone in reconstruction of the anterior cruciate ligament

Cited by 182 publications

References 4 publications

Anatomic double-bundle posterior cruciate ligament reconstruction using hamstring tendons

Anatomic double-bundle posterior cruciate ligament reconstruction using hamstring tendons

Differences in Tendon Graft Healing between the Intra-articular and Extra-articular Ends of a Bone Tunnel

Comparative biomechanical study of the Ligament Plate® and other fixation devices in ACL reconstruction

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