This Article Full Text Full Text (PDF) CME: Take the activities for this article: Sports Test 3: Knee CME 1: January, February, March 2004 [Supplementary Material] Letters to the Editor: Submit a response Alert me when this article is cited Alert me when Letters to the Editor are posted Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Rights and Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Williams, R. J. Articles by Wickiewicz, T. L. Search for Related Content PubMed PubMed Citation Articles by Williams, R. J., III Articles by Wickiewicz, T. L. Related Collections Sports Social Bookmarking                   What's this?

Anterior Cruciate Ligament Reconstruction with a Four-Strand Hamstring Tendon Autograft

¹ The Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021
² 5671 Peachtree-Dunwoody N.E., Suite 700, Atlanta, GA 30342
³ University of Pennsylvania Health System, 3400 Spruce Street, Philadelphia, 19104

Investigation performed at the Sports Medicine and Shoulder Service, The Hospital for Special Surgery, New York, NY

In support of their research or preparation of this manuscript, one or more of the authors received grants or outside funding from the Institute for Sports Medicine Research, New York, NY. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

A commentary is available with the electronic versions of this article, on our web site (www.jbjs.org) and on our quarterly CD-ROM (call our subscription department, at 781-449-9780, to order the CD-ROM).

Methods: One hundred and twenty-two consecutive patients who had an isolated, symptomatic anterior tibial subluxation associated with rupture of the anterior cruciate ligament were treated with reconstruction of the anterior cruciate ligament with a four-strand autologous semitendinosus-gracilis tendon graft. One surgeon performed all of the operations. Prior to surgery and at the follow-up examination, physical findings and functional scores were recorded and knee radiographs were analyzed. Following surgery, a six-month rehabilitation regimen was implemented.

Results: Eighty-five patients (70%) were available for follow-up, which included physical examination, scoring of function, KT-1000 arthrometric testing, and radiographs, at a mean of twenty-eight months. Seventy-six (89%) of the patients had negative Lachman and pivot shift tests. The mean Lysholm score improved from 55 points preoperatively to 91 points at the time of follow-up (p < 0.01). The mean Tegner score improved from 5 to 6 points (p < 0.01). Sixty-five patients had <3 mm of knee translation on arthrometric testing, but six patients with marked laxity were not tested. Three patients (4%) had a positive pivot shift test but had no history of additional trauma to the knee. Six patients (7%) had a traumatic rupture of the graft, occurring at a mean of 10.7 months postoperatively. Assessment of the follow-up radiographs demonstrated no evidence of progressive degenerative change compared with the appearance on the preoperative radiographs. However, tunnel expansion was noted in all patients. The tibial tunnel expanded a mean of 17% (range, 0% to 32%), and the femoral tunnel expanded a mean of 29% (range, 0% to 40%).

Conclusions: Reconstruction of the anterior cruciate ligament with use of a four-strand hamstring tendon autograft eliminated anterior tibial subluxation in 89% of patients who were examined at a minimum of two years postoperatively. The overall rate of failure was 11%. The functional knee scores were significantly increased at the time of follow-up, but these results did not correlate with the results of knee arthrometric testing.

Level of Evidence: Therapeutic study, Level IV (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence.

CiteULike    Connotea    Del.icio.us    Facebook    Technorati    Twitter    What's this?

This article has been cited by other articles:

				T. Zantop, M. Wellmann, F. H. Fu, and W. Petersen Tunnel Positioning of Anteromedial and Posterolateral Bundles in Anatomic Anterior Cruciate Ligament Reconstruction: Anatomic and Radiographic Findings Am. J. Sports Med., January 1, 2008; 36(1): 65 - 72. [Abstract] [Full Text] [PDF]

				M. Kobayashi, N. Watanabe, Y. Oshima, Y. Kajikawa, M. Kawata, and T. Kubo The Fate of Host and Graft Cells in Early Healing of Bone Tunnel After Tendon Graft Am. J. Sports Med., December 1, 2005; 33(12): 1892 - 1897. [Abstract] [Full Text] [PDF]

				K. P. Spindler, T. A. Warren, J. C. Callison Jr., M. Secic, S. B. Fleisch, and R. W. Wright Clinical Outcome at a Minimum of Five Years After Reconstruction of the Anterior Cruciate Ligament J. Bone Joint Surg. Am., August 1, 2005; 87(8): 1673 - 1679. [Abstract] [Full Text] [PDF]

				S. C. Montgomery and M. D. Miller What's New in Sports Medicine J. Bone Joint Surg. Am., March 1, 2005; 87(3): 686 - 694. [Full Text] [PDF]

Stanford University Libraries' HighWire Press (TM) assists in the publication of JBJS Online.
Copyright © 2004 by The Journal of Bone and Joint Surgery, Inc. Online ISSN: 1535-1386.
The Journal of Bone and Joint Surgery®, JBJS®, JB&JS®, and eJBJS® are registered in the U.S. Patent and Trademark Office.