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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. E-mail address for R.J. Williams III: williamsr{at}hss.edu
² 5671 Peachtree-Dunwoody N.E., Suite 700, Atlanta, GA 30342
³ Department of Orthopaedic Surgery, University of California at Los Angeles Medical Center, 10833 Le Conte Avenue, Los Angeles, CA 90095
⁴ University of Pennsylvania Health System, 3400 Spruce Street, Philadelphia, PA 19104

Investigation performed by the Sports Medicine and Shoulder Service at The Hospital for Special Surgery, Weill Cornell Medical College, New York, NY

The original scientific article in which the surgical technique was presented was published in JBJS Vol. 86-A, pp. 225-232, February 2004

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.

The line drawings in this article are the work of Jennifer Fairman (jfairman{at}fairmanstudios.com).

In this study, we analyzed the clinical outcomes at a minimum of two years following reconstruction of the anterior cruciate ligament with use of a four-strand hamstring tendon autograft in patients who had presented with a symptomatic torn anterior cruciate ligament.

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.

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