The Effect of Hamstring Tendon Autograft Harvest on the Restoration of Knee Stability in the Setting of Concurrent Anterior Cruciate Ligament and Medial Collateral Ligament Injuries

Abstract

A concurrent ACL and MCL injury is a commonly encountered clinical problem. Knowledge regarding the implications of hamstring autograft harvest techniques on joint kinematics may help guide management decisions.

Graft Choice for Anterior Cruciate Ligament Reconstruction With a Concomitant Non-surgically Treated Medial Collateral Ligament Injury Does Not Influence the Risk of Revision

“…gracilis loading. 12 Although the lack of details about the MCL injuries in the present study aggravates comparison with previous cadaveric studies, this study contradicts such studies, since no indications for inferior outcome after HT harvest were found. This finding might illustrate that laxity determined in cadaveric models may not always be clinically relevant.…”

“…Although this does not exclude the possibility of valgus laxity still being present, it should probably be distinguished from the state of a complete MCL injury, which Herbort et al 11 tested biomechanically and reported that the medial hamstrings were crucial for valgus stability in this setting. In contrast, Kremen et al 12 cut only the superficial MCL to mimic a partial MCL injury and reported that an ACL reconstruction in this setting was still not sufficient to restore valgus rotational stability in the absence of ST and The proportion of patients with exact 95% confidence intervals achieving the 1-year patient acceptable symptom state in the Knee Injury and Osteoarthritis Outcome Score subscales for each study group respectively. No significant differences were found between the groups.…”

“…The rationale for this study was based on findings in cadaveric studies suggesting that harvesting the medial hamstrings in the MCL-injured knee would result in an inferior outcome due to a further compromised ability to resist valgus forces. 11,12 Although a registry study per se cannot provide causality and that specific characteristics such as location and severity of the MCL injuries are not included in the SNKLR, this study adds clinical data regarding graft choice for ACL reconstruction with a concomitant MCL injury. However, the long time from injury to surgery (mean 314 days) in this study should be considered when interpreting the results.…”

“…[7][8][9][10] Recent biomechanical studies have shown that the medial hamstrings are important to resist valgus forces in the MCL-deficient knee. 11,12 This becomes especially relevant when considering that a hamstring tendon (HT) autograft is one of the most frequently used graft choices for ACL reconstruction worldwide 13,14 and questions whether an alternative graft should be selected when performing ACL reconstruction in the MCL-injured knee not to further compromise medial side laxity and ACL graft survival.…”

“…11 Another cadaveric study evaluated valgus stability after ACL reconstruction with a concomitant superficial MCL tear and found that rotational valgus stability was only restored when the ST and gracilis muscles were activated. 12 From cadaveric studies, it therefore appears plausible that HT harvest for ACL reconstruction in the MCL-deficient knee may further compromise valgus laxity, which may increase the forces on the newly reconstructed ACL. [7][8][9][10] Current theories regarding the effect of graft choice in the ACL-ruptured and MCL-deficient knee are derived from human cadaveric models, and studies assessing the clinical impact of graft choice are lacking.…”