Long-term outcome of anterior cruciate ligament reconstruction with an autologous four-strand semitendinosus tendon autograft

Abstract

Purpose Although the short-and mid-term outcomes of ACL reconstruction with a hamstring graft are promising, clinical investigations reporting the long-term results after ten years or longer are rare. Therefore we performed a retrospective single-blinded evaluation of ACL reconstruction using a four-stranded single-bundle reconstruction with a semitendinosus tendon graft with extracortical fixation. Methods/Results At follow-up patients obtained at least the same level in the clinical outcome scores (Lysholm, IKDC, Tegner) compared to previous studies with a similar followup time using a STG graft. Furthermore there was no detectable difference in the incidence of osteoarthritis. Patients having a negative pivot shift test showed significantly fewer signs of radiographic osteoarthritis and better functional assessment scores. Conclusion On the basis of our investigation, we conclude that the reconstruction of the ACL by a quadrupled semitendinosus tendon graft with extracortical anchorage can achieve excellent clinical and subjective results after a follow-up of ten years.

Anterior cruciate ligament reconstruction best practice: A review of graft choice

“…Shorter term studies but with larger study group sizes are available. Streich et al [26] reported a single blinded evaluation of 40 patients with 4 strand HS grafts at 10 year follow-up. They report 8% re-rupture rate and an IKDC score of 90.3 and all joints were either grade A or B (normal or nearly-normal).…”

Electromagnetic tracking of the pivot-shift

“…In addition, according to the report from Jonsson et al [7], patients with positive pivot-shift findings demonstrated increased scintigraphic activity in the subchondral bone of the knee joint [7]. Furthermore, negative pivot shift test demonstrated fewer signs of radiographic osteoarthritis [8]. Ayeni et al demonstrated by a systematic review that the result of the pivot-shift test was correlated to the functional outcomes, such as the IKDC, Lysholm score, and tegner activity level, in most of clinical randomized control studies [3].…”

Semitendinosus tendon regeneration after anterior cruciate ligament reconstruction: can we use it twice?

“…There are many advantages of using the hamstrings tendons, including the ease of harvesting, suitable morphology for use as a graft, lower donor site morbidity, early rehabilitation, and patient satisfaction [2][3][4].…”

“…Although some researchers have demonstrated a loss of hamstring muscle strength in such patients, most investigators have found only slight differences between the operated and the controlateral side in the postoperative period. Recovery of the muscle strength after division of the ST and G tendons can be explained by a process of functional regeneration of the tendons or by compensatory hypertrophy of other knee flexors [4,6,[8][9][10]. Morphological changes including atrophy and shortening of the ST have been confirmed in patients with ACL reconstruction using the ST tendon [11,12].…”