Tibial Rotation is Not Restored after ACL Reconstruction with a Hamstring Graft

Abstract

Recent research suggests ACL reconstruction does not restore tibial rotation to normal levels during high demand activities when a bone-patellar tendon-bone graft is used. We asked if an alternative graft, the semitendinosus-gracilis (ST/G) tendon graft, could restore tibial rotation during a high demand activity. Owing to its anatomic similarity with the normal ACL we hypothesized the ST/G graft could restore excessive tibial rotation to normal healthy levels along with a successful reinstatement of the clinical stability of the knee. We assessed tibial rotation in vivo, using gait analysis. We compared the knees of ACL reconstructed patients with an ST/G graft to their intact contralateral and healthy controls during a pivoting task that followed a stair descent. We also evaluated knee stability after ACL reconstruction with standard clinical tests. ACL reconstruction with the ST/G graft and with current techniques did not restore tibial rotation to previous physiological levels during an activity with increased rotational loading at the knee, although abnormal anteroposterior (AP) tibial translation was restored.

Hamstring tendon anterior cruciate ligament reconstruction: does gracilis tendon harvest matter?

“…A novel aspect of this study was the use of kinematic gait analysis of a dynamic task to compare the two graft types. Residual rotational laxity has been reported after ACL reconstructions with PT and ST/G grafts [13,16]. Contrary to these reports, we found that in our patients, the range of tibial rotation in the ACL reconstructed knee was similar to the contralateral knee.…”

“…Measuring true rotational laxity in a setting similar to the pivoting demands posed in sports is difficult. A number of studies have nonetheless measured tibial rotation during pivoting using gait analysis techniques, and all report comparable values regarding rotational laxity [12,13,20,24]. The use of marker-based gait analysis to measure knee rotation motion may be subject to error from marker misplacement and artefact from skin movement.…”

“…The evaluation of tibial rotation with gait analysis has shown comparable results after PT and ST/G reconstructions [12][13][14][15], but to our knowledge the ST graft reconstruction has not been evaluated with gait analysis with regard to knee rotation. Adding a gait analysis protocol to other more traditional outcome measures may provide further information to evaluate graft choice [14].…”

“…After a series of warm-up trials of walking, rotational laxity of the knee was assessed during a stair descent and pivot activity. This task has been previously described [18] and was essentially the same as the procedure used by Georgoulis et al [13]. Patients were required to descend two steps to the floor with alternating feet on each step.…”

A study on functional outcome of arthroscopic anatomical reconstruction of anterior cruciate ligament using quadrupled hamstring graft

“…7,8 Tashman et al showed similar finding when investigating running in an ACL reconstructed knee. 9 Combination of abnormal knee kinematics, clinical studies indicate a significant proportion of patients exhibiting poor clinical rotational stability and study showing a relationship between ACL injury reconstruction and development of arthritis suggested further investigation was required to reestablish normal knee joint kinematics and hopefully a more optimal physiological knee joint environment.…”