Lack of stability at more than 12 months of follow-up after anterior cruciate ligament reconstruction using all-inside quadruple-stranded semitendinosus graft with adjustable cortical button fixation in both femoral and tibial sides

Bressy, G.; Brun, V.; Ferrier, Antoine; Dujardin, D.; Oubaya, Nadia; Morel, Nicolas; Fontanin, N.; Ohl, Xavier

doi:10.1016/j.otsr.2016.08.011

Cited by 36 publications

(37 citation statements)

References 29 publications

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“…Our results confirm the hypothesis that the outcomes of the novel adjustable CSF device compare favorably with those reported in the literature for fixed-length CSF devices § and with those of other adjustable CSF devices 8,10,11,15,23,57,68 (Table 6). While most published studies reported anteroposterior laxity measured using different techniques and forces, our series was measured using one of the most reproducible systems (GNRB), 9,31,53 which applied a constant calibrated force of 150 N. Our postoperative anterior laxity was considerably lower than most values reported in the literature, including series that measured laxity at lower forces.…”

Section: Discussionsupporting

confidence: 88%

Clinical and Functional Outcomes of Anterior Cruciate Ligament Reconstruction at a Minimum of 2 Years Using Adjustable Suspensory Fixation in Both the Femur and Tibia: A Prospective Study

Colombet

Saffarini

Bouguennec

2018

Orthopaedic Journal of Sports Medicine

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Background:The success of anterior cruciate ligament (ACL) reconstruction requires reliable and rigid graft fixation. Cortical suspensory fixation (CSF) devices have become an acceptable alternative to interference screws for soft tissue ACL grafts. However, CSF devices have been reported to be associated with tunnel widening and increased postoperative anterior laxity compared with interference screw fixation. Adjustable CSF devices were introduced to avoid these problems but have been associated with graft lengthening and inconsistent outcomes.Purpose:To (1) report the side-to-side difference (SSD) in anterior laxity at 150 N, clinical scores, and failure rates 2 years after ACL reconstruction with 4-strand semitendinosus autografts using an adjustable CSF device and (2) determine the preoperative factors associated with clinical outcomes.Study Design:Case-control study; Level of evidence, 3.Methods:A total of 131 patients who had undergone primary ACL reconstruction, performed with 4-strand semitendinosus grafts that were secured using Pullup adjustable-length CSF devices with femoral and tibial fixation techniques, were prospectively enrolled in this study; 34 patients were excluded because of contralateral instability or ipsilateral knee injuries that required additional surgery. This left a cohort of 97 patients who were evaluated preoperatively and at 6, 12, and 24 months. The evaluation consisted of measuring the SSD in anterior laxity and patient-reported outcome scores (International Knee Documentation Committee [IKDC] and Lysholm scores). Regression analyses were performed to determine associations between these outcomes and 9 preoperative variables.Results:Only 2 patients could not be reached, 2 could not be evaluated because of contralateral ACL tears, and 2 had graft failure. At 2-year follow-up, the remaining 91 patients had a mean SSD in anterior laxity of 0.8 ± 1.8 mm (range, –4.2 to 5.3 mm), mean IKDC score of 87.6 ± 10.6 (range, 43.7-100.0), and mean Lysholm score of 90.8 ± 9.3 (range, 56.0-100.0). At final follow-up, compared with knees with partial ruptures, those with complete ruptures had equivalent laxity (P = .266) and Lysholm scores (P = .352) but lower IKDC scores (P = .009). Multivariable regression revealed that the IKDC score decreased with increased preoperative laxity (β = –1.35 [95% CI, –2.48 to –0.23]; P = .019).Conclusion:The novel adjustable-length CSF device produced satisfactory anterior laxity and clinical outcomes, with a failure rate of 2.1%, which compare favorably with those reported for nonadjustable CSF devices.

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Section: Discussionsupporting

confidence: 88%

Clinical and Functional Outcomes of Anterior Cruciate Ligament Reconstruction at a Minimum of 2 Years Using Adjustable Suspensory Fixation in Both the Femur and Tibia: A Prospective Study

Colombet

Saffarini

Bouguennec

2018

Orthopaedic Journal of Sports Medicine

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“…Careful interpretation of the many published studies shows that the limit of 3 mm has also been exceeded in some of their patients. 7,22,27,32 In a recent large randomized clinical trial, Mohtadi et al 32 compared the results of ACLR by using single-bundle and double-bundle hamstring autografts and patellar tendon autografts. In all cases, a fixed-loop Endobutton was used for femoral fixation.…”

Section: Discussionmentioning

confidence: 99%

Anterior Laxity at 2 Years After Anterior Cruciate Ligament Reconstruction Is Comparable When Using Adjustable-Loop Suspensory Fixation and Interference Screw Fixation

et al. 2018

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“…Our study had much better mean Lysholm score (92.96 ± 6.00) with no patient showing poor outcome. This may be the result of using interference screw fixation on tibial side which is a stronger fixation modality as compared to extracortical tibial fixation [23,24] . Nakamura et al studied active knee flexion and hamstring strength after ACL reconstruction and observed significant difference in knee flexion torques at deeper flexion angles between ST4 and STG groups [18] .…”

Section: Discussionmentioning

confidence: 99%

Functional outcomes of quadrupled semitendinosus vs. four strand semitendinosus / Gracilis graft for arthroscopic ACL reconstruction

Aggarwal¹,

Mahapatra²,

Awasthi³

et al. 2020

Int. J. Orthop. Sci.

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Introduction: Anterior cruciate ligament is a commonly disrupted ligament causing anterior instability of knee. Arthroscopic ACL reconstruction is the treatment of choice. Many graft options are available most common being the four-strand hamstring autograft. Four strand hamstring graft can be made either by doubling both Semitendinosus and Gracilis tendon (STG) or by quadrupling Semitendinosus tendon (ST4). Aim: To compare functional outcomes following ACL reconstruction with STG graft vs ST4 graft using femoral adjustable loop button and tibial bio-screw fixation. Material and Methods: This was a prospective cohort study in which 68 patients with isolated ACL tear with knee instability were enrolled during 2017-2018. Patients with multi-ligamentous injury, associated meniscal tears, chondral lesions, juxta-articular fractures and previous surgery on same knee were excluded. Patients were randomly allocated into two groups in which Group one patient underwent Arthroscopic ACL reconstruction by autologous four strand STG graft and Group two patients using quadrupled ST4 graft. Functional evaluation was done using Lysholm scoring system preoperatively and postoperatively at 1 year. Knee flexion strength was measured post-operatively at 1 year as maximum standing knee flexion angle. The side to side ratio of knee flexion angle was used for comparison. Appropriate statistical analysis of the data was done. Results: 68 patients were enrolled for the study in which, 38 patients underwent Arthroscopic ACL reconstruction by Autologous four strand STG graft and 30 patients using quadrupled ST4 graft. Out of 68 patients 52(76.47%) were male and 16 (23.53%) were female. 50 (73.5%) patients had right sided involvement and 18 (26.4%) had left side involvement. Mean age of patients was 29 years ranging from 19-45 years. Mean follow-up duration was 20 months (14-32 months). Average duration since injury was 6.22 ± 4.68 months (2-24 months). Mean Pre-operative Lysholm score in STG and ST4 groups were 69.78 ± 8.46 and 68.6 ± 10.41 respectively. Mean post-operative Lysholm scores at 1 year in STG and ST groups were 91.5 ± 6.13 and 92.96 ± 6.00 respectively. Lysholm score was reported as excellent in 49 patients (72%), good in 12 patients (17.6%) and fair in 7 patients (10.2%) with none of the patients reporting poor outcome. Mean maximum standing knee flexion angle ratio of operated knee compared to non -operated knee at 1 year was 90.51±6.37% and 94.45 ±2.89% in STG and ST4 groups respectively. There were no major complications reported with the procedure. Conclusion: Quadrupled Semitendinosus graft is a viable alternative to Semitendinosus/Gracilis graft for ACL reconstruction. Preserving Gracilis tendon results in better knee flexion. Hence Gracilis tendon harvest must be avoided whenever possible.

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Lack of stability at more than 12 months of follow-up after anterior cruciate ligament reconstruction using all-inside quadruple-stranded semitendinosus graft with adjustable cortical button fixation in both femoral and tibial sides

Abstract: Prospective study - Level IV.

Cited by 36 publications

References 29 publications

Clinical and Functional Outcomes of Anterior Cruciate Ligament Reconstruction at a Minimum of 2 Years Using Adjustable Suspensory Fixation in Both the Femur and Tibia: A Prospective Study

Clinical and Functional Outcomes of Anterior Cruciate Ligament Reconstruction at a Minimum of 2 Years Using Adjustable Suspensory Fixation in Both the Femur and Tibia: A Prospective Study

Anterior Laxity at 2 Years After Anterior Cruciate Ligament Reconstruction Is Comparable When Using Adjustable-Loop Suspensory Fixation and Interference Screw Fixation

Functional outcomes of quadrupled semitendinosus vs. four strand semitendinosus / Gracilis graft for arthroscopic ACL reconstruction

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