Low re-rupture rate with BPTB autograft and semitendinosus gracilis autograft with preserved insertions in ACL reconstruction surgery in sports persons

Gupta, Ravi; Sood, Munish; Malhotra, Anubhav; Masih, Gladson David; Kapoor, Anil; Raghav, Mukta; Dhillon, Mehar

doi:10.1007/s00167-017-4790-5

Cited by 20 publications

(19 citation statements)

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“…This finding is in contrast to that of various other recent studies, which show an average improvement of 25–30 points in Lysholm score after ACLR. 3 15 16) Further, this difference in scores between other studies and the present study were statistically significant ( Table 3 ). 3 6 16 17 18) Also, based on the Tegner activity scale, the majority of patients were not able to return to the preinjury level.…”

Section: Discussionsupporting

confidence: 43%

“…1) Arthroscopic ACL reconstruction (ACLR) is considered the standard of care for patients with ACL tears with instability. 2 3 4) The aim of ACLR is to restore the preinjury level of function, which is a challenging task. 5 6) The good functional outcome after ACLR depends upon multiple factors, which can be divided into extrinsic and intrinsic factors.…”

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confidence: 99%

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Poor Functional Outcome in Patients with Voluntary Knee Instability after Anterior Cruciate Ligament Reconstruction

et al. 2020

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Anterior cruciate ligament (ACL) tears are commonly seen injuries in sports traumatology. 1) Arthroscopic ACL reconstruction (ACLR) is considered the standard of care for patients with ACL tears with instability. 2-4) The aim of ACLR is to restore the preinjury level of function, which is a challenging task. 5,6) The good functional outcome after ACLR depends upon multiple factors, which can be divided into extrinsic and intrinsic factors. 7) The extrinsic factors include the type of graft used, surgical technique, and preoperative and postoperative rehabilitation. The intrinsic factors are various, including the genetic and biological factors, type of tear, associated injuries, motivation, and psychological attitude. 7-10) Pain and swelling of the knee joint are the initial symptoms of an acute ACL injury, whereas instability of

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Section: Discussionsupporting

confidence: 43%

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confidence: 99%

Poor Functional Outcome in Patients with Voluntary Knee Instability after Anterior Cruciate Ligament Reconstruction

et al. 2020

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“…Among the studies included in the current review, various types of tendon grafts were used: namely, the BPTB autograft and allograft, 3 the doubled hamstring tendon autograft, 17 and the quadrupled hamstring tendon autograft. 20 According to previous studies, 11,33,42 both the BPTB and GST grafts can lead to satisfactory clinical outcomes. However, considering the reduced donor site morbidity and potentially fewer problems encountered with the extensor mechanism in ACLR with hamstring tendon autograft or allograft, several authors have suggested these procedures in older patients with relatively low functional demands.…”

Section: Discussionmentioning

confidence: 93%

Anterior Cruciate Ligament Reconstruction in Patients Older Than 50 Years: A Systematic Review and Meta-analysis

Tan

Hsu

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: There is no consensus regarding the best treatment approach for middle-aged patients with anterior cruciate ligament (ACL) injuries. Chronic ACL-deficient knees are often associated with instability as well as secondary meniscal and cartilage lesions. ACL reconstruction (ACLR) has achieved satisfactory outcomes in younger patients; however, the effectiveness and safety of ACLR in middle-aged patients remain uncertain. Purpose: To compare the patient-reported functional scores, arthrometric outcomes, and complications of primary ACLR between older (≥50 years) and younger (<50 years) patients. Study Design: Systematic review; Level of evidence, 3. Methods: We conducted a systematic review of cohort studies that compared the clinical outcomes of ACLR between patients aged ≥50 years and those aged <50 years. The Cochrane Central Register of Controlled Trials, Embase, and MEDLINE databases were searched for relevant studies. The Methodological Index for Non-randomized Studies (MINORS) criteria was used to assess the risk of bias and conducted a random-effects meta-analysis to combine the data, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to evaluate the overall quality of the body of retrieved evidence. The primary outcome was knee functional outcomes, and secondary outcomes were arthrometric outcomes of ACLR and complications. Results: This study included 4 retrospective cohort studies with a total of 287 participants (129 in the older group and 158 in the younger group). All included studies reported significant improvements in clinical outcomes in both groups after ACLR. No significant differences were noted in the improvement of International Knee Documentation Committee (IKDC) scores (mean difference [MD], 0.20 [95% CI, −2.65 to 3.05]; P = .89) and Lysholm scores (MD, −1.98 [95% CI, −6.93 to 2.98]; P = .43) between the 2 groups. No significant differences were observed in anteroposterior stability or risk of complications between the groups. Conclusion: ACLR may be performed in middle-aged patients (≥50 years) without concern for inferior clinical and arthrometric results compared with younger patients (<50 years).

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“…Tibial side xation has been observed to be a weak link post ACL reconstruction as the vector of forces acts in the line of tibial tunnel [37,38]. Further, tendon to bone healing at insertion site is superior to tendon xation inside tunnel with screw as observed by various studies inpast [15,16,[18][19][20]. As, the biological insertion at tibial side maintains the inherent strength, that is resistant to cyclical forces [15], we propose, hamstring graft with preserved insertion provides less chances of graft pull-out from tunnel.…”

Section: Discussionmentioning

confidence: 99%

“…With the problems related to the vascularisation of graft, less effective proprioception postoperatively, and weak tibial side xation, there remains risk of graft pull-out from the tunnel [15][16][17]. Recent literature reports, preservation of insertion on tibial side led to better mechanical stability and proprioception, though not established conclusively [15,[17][18][19][20]. Also, Sacramento et al in a study on double bundle ACL reconstruction with preserved tibial side insertion reported better clinical outcome and stability [20].…”

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confidence: 99%

Outcome of hamstring graft with preserved insertion: Prospective Study with 5 year Follow-up

Gupta

Singhal

Mehta

et al. 2020

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BackgroundAutologous hamstring graft remains to be a commonly used graft for Anterior Cruciate Ligament (ACL) in sportspersons. With less graft failure rates, better mechanical stability and proprioception with preserved insertion hamstring graft, we investigated long term outcomes of hamstring graft with preserved insertion. Methods: 441 sportspersons were enrolled in the study. They were divided into two groups by computerized randomization. In Group I, ACL reconstruction was done using hamstring free graft (STGF), and in Group II, ACL reconstruction was done using hamstring graft with preserved tibial insertion (STGPI). Postoperatively, patients were assessed for graft rupture, knee stability, Lysholm score, tegner activity and WOMAC score.ResultsThe average age of the patients was 24 ± 2 years in group 1 and 27 ± 8.5 years in group 2. At 5 years, the mean KT-1000 difference was 2.01 in group 1 and 1.96 in group 2 (P = 0.77); the mean Lysholm score was 97.80 and 98.60(p = 0.07), respectively; mean WOMAC score was 3.09 and 3.12(p = 0.89) respectively; mean difference between the pre-injury and post-surgery Tegner level of sports activity was 1.78 and 0.54(P < 0.05), respectively and graft failure rate was 4.1% and 7.7%.(p < 0.05), respectively.ConclusionWe report STGPI to be a more viable option than hamstring free graft in sportspersons for ACL reconstruction due to less graft failure rates and better tegner activity score postoperatively. Further, STGPI is an option with low graft failure rate like that of Bone Patellar Tendon Bone graft,with added advantage of not having significant donor site morbidity.Level of EvidenceLevel 1, Randomized Controlled Trial

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Low re-rupture rate with BPTB autograft and semitendinosus gracilis autograft with preserved insertions in ACL reconstruction surgery in sports persons

Abstract: III.

Cited by 20 publications

References 39 publications

Poor Functional Outcome in Patients with Voluntary Knee Instability after Anterior Cruciate Ligament Reconstruction

Poor Functional Outcome in Patients with Voluntary Knee Instability after Anterior Cruciate Ligament Reconstruction

Anterior Cruciate Ligament Reconstruction in Patients Older Than 50 Years: A Systematic Review and Meta-analysis

Outcome of hamstring graft with preserved insertion: Prospective Study with 5 year Follow-up

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