Establishment of anterior cruciate ligament reconstruction model in cynomolgus monkey with autogenous hamstring tendon transplantation / 中国修复重建外科杂志

OBJECTIVE@#To investigate the feasibility of establishing an anterior cruciate ligament (ACL) reconstruction model using hamstring tendon autograft in cynomolgus monkeys.@*METHODS@#Twelve healthy adult male cynomolgus monkeys, weighing 8-13 kg, were randomly divided into two groups ( n=6). In the experimental group, the ACL reconstruction model of the right lower limb was prepared by using a single bundle of hamstring tendon, and the ACL of the right lower limb was only cut off in the control group. The survival of animals in the two groups was observed after operation. Before operation and at 3, 6, and 12 months after operation, the knee range of motion, thigh circumference, and calf circumference of the two groups were measured; the anterior tibial translation D-value (ATTD) was measured by Ligs joint ligament digital body examination instrument under the loads of 13-20 N, respectively. At the same time, the experimental group underwent MRI examination to observe the graft morphology and the signal/ noise quotient (SNQ) was caculated.@*RESULTS@#All animals survived to the end of the experiment. In the experimental group, the knee range of motion, thigh circumference, and calf circumference decreased first and then gradually increased after operation; the above indexes were significantly lower at 3 and 6 months after operation than before operation ( P<0.05), and no significant difference was found between pre-operation and 12 months after operation ( P>0.05). In the control group, there was no significant change in knee range of motion after operation, showing no significant difference between pre- and post-operation ( P>0.05), but the thigh circumference and calf circumference gradually significantly decreased with time ( P<0.05), and the difference was significant when compared with those before operation ( P<0.05). At 6 and 12 months after operation, the thigh circumference and calf circumference were significantly larger in the experimental group than in the control group ( P<0.05). At 3 and 6 months after operation, the knee range of motion was significantly smaller in the experimental group than in the control group ( P<0.05). Under the loading condition of 13-20 N, the ATTD in the experimental group increased first and then decreased after operation; and the ATTD significantly increased at 3, 6 months after operation when compared with the value before operation ( P<0.05). But there was no significant difference between the pre-operation and 12 months after operation ( P>0.05). There was no significant change in ATTD in the control group at 3, 6, and 12 months after operation ( P>0.05), and which were significantly higher than those before operation ( P<0.05). At each time point after operation, the ATTD was significantly smaller in the experimental group than in the control group under the same load ( P<0.05). The MRI examination of the experimental group showed that the ACL boundary gradually became clear after reconstruction and was covered by the synovial membrane. The SNQ at each time point after operation was significantly higher than that before operation, but gradually decreased with time, and the differences between time points were significant ( P<0.05).@*CONCLUSION@#The ACL reconstruction model in cynomolgus monkey with autogenous hamstring tendon transplantation was successfully established.

Preliminary study of preoperative MRI measurement of hamstring tendon cross-sectional area to predict graft diameter during anterior cruciate ligament reconstruction / 中华放射学杂志

Objective:To investigate the value of preoperative MRI measurements of hamstring (semitendinosus+gracilis) tendon cross-sectional area in predicting intraoperative graft diameter for anterior cruciate ligament reconstruction (ACLR).Methods:A total of 265 preoperative MRI were retrospectively collected in the Third Affiliated Hospital of Southern Medical University from January 2013 to August 2020 for patients who underwent single-bundle ACLR of hamstring tendon. Patients were divided into a graft diameter≥8 mm group (129 patients) and a graft diameter<8 mm group (136 patients) according to intraoperative graft diameter. The cross-sectional areas of the semitendinosus and gracilis tendons were measured at the largest level of the femoral condyle on preoperative MRI cross-sectional images, and the two were summed to obtain the cross-sectional area of the hamstring tendon. The independent samples t-test was used to compare the differences in the cross-sectional area of each tendon between the graft diameter≥8 mm group and the graft diameter<8 mm group. The Spearman correlation analysis was used to assess the correlation between tendon cross-sectional area and intraoperative graft diameter. Multi-factor logistic regression analysis was used to screen the influence of tendon cross-sectional area on intraoperative graft diameter. The effectiveness of intraoperative graft diameter≥8 mm was assessed by plotting the receiver operating characteristic curves. Results:Intraoperative measurement of graft diameter was 7.5 (7.5, 8.0) mm. The cross-sectional area of the popliteal tendon was (21.4±4.6) mm 2 in the graft diameter≥8 mm group and (15.6±3.7) mm 2 in the graft diameter<8 mm group. Statistically significant differences were found in the cross-sectional areas of the semitendinosus, soleus and hamstring tendons between the graft diameter≥8 mm group and graft diameter<8 mm group ( t=-10.26, -10.29, -11.47, P<0.001). Intraoperative graft diameter was positively correlated with the cross-sectional area of the semitendinosus, gracilis, and hamstring, with correlation coefficients of 0.57 ( P<0.001), 0.58 ( P<0.001), and 0.62 ( P<0.001), respectively. Multi-factor logistic regression showed that popliteal tendon cross-sectional area was a predictor of intraoperative graft diameter (OR=1.45, 95%CI 1.32-1.59, P<0.001). The area under the curve for popliteal tendon cross-sectional area to predict intraoperative graft diameter≥8 mm was 0.838 (95%CI 0.792-0.885), with a critical value of 20.0 mm 2, a sensitivity of 0.581, and a specificity of 0.941. Conclusion:The measurement of the cross-sectional area of the hamstring muscle on preoperative MRI can predict the diameter of the autologous hamstring graft of ACLR.

Correlation between preoperative MRI measurement of cross-sectional area of hamstring tendon and graft in anterior cruciate ligament reconstruction / 中国骨伤

OBJECTIVE@#To study the corretation between the cross-sectional area of hamstring tenden measured by MRI and gragt in anterior cruciate ligament rexonstruction.@*METHODS@#MRI data of 50 patients who planned to undergo anterior cruciate ligament reconstruction from November 2021 to March 2022 were collected, including 32 males and 18 females, aged from 19 to 48 years old with an average of(31.1±8.7) years. Before the operation, the semitendinosus and gracilis tendons were measured and recorded by MRI, and then the anterior cruciate ligament was reconstructed under arthroscope. During the operation, gracilis and semitendinosus tendons were taken to prepare the final tendon to be transplanted, and the diameter of the prepared final graft was measured during the operation. Finally, the data were analyzed by statistical software.@*RESULTS@#The cross sectional areas of semitendinosus tendon, gracilis tendon, semitendinosus tendon and gracilis tendon measured by MRI were significantly and positively correlated with the diameter of grafts required in anterior cruciate ligament surgery, the r values were 0.858, 0.728, 0.842(P<0.001), respectively. The area under curre (AUC), sensitivity, and specificity of the sum of the cross sectional areas of semitendinosus tendon and gracilis tendon were 0.925, 90.48%, and 85.71%, respectively.@*CONCLUSION@#In patients undergoing anterior cruciate ligament reconstruction, preoperative MRI measurement has a strong statistical correlation with the diameter of hamstring muscle transplantation during operation. The sum of the cross sectional areas of semitendinosus tendon and gracilis tendon has a high predictive value for the diameter of grafts during anterior cruciate ligament reconstruction, and can predict the size of grafts during operation.

Comparative study on posterior cruciate ligament reconstruction with autologous hamstring tendon and LARS artificial ligament in the treatment of KD-Ⅲ-M knee dislocation / 中国骨伤

OBJECTIVE@#To observe the curative effect of one-stage reconstruction of anterior cruciate ligament(ACL), posterior cruciate ligament (PCL) and medial collateral ligament (MCL) in patients with KD-Ⅲ-M knee injury, and to compare the operation time, hospitalization cost and curative effect after arthroscopic reconstruction of PCL with LARS artificial ligament and autogenous hamstring tendon, ACL reconstruction with autogenous hamstring tendon and MCL repair combined with limited incision.@*METHODS@#From March 2016 to January 2019, a total of 36 patients met the criteria of this study. Twenty patients in group A were treated with autogenous hamstring tendon reconstruction of ACL and PCL and repair of MCL, including 17 males and 3 females, with an average age of (34.7±9.2) years old. Sixteen patients in group B with LARS artificial ligament reconstruction of PCL, with an autogenous hamstring tendon reconstruction of PCL and MCL repair as before as group B, including 15 males and 1 female, with an average age of (36.8±8.6) years old. The operation time, hospitalization time and total hospitalization cost were compared between the two groups. The preoperative and postoperative functions of the two groups were evaluated by Hospital for Sepcial Surgery (HSS) score and Lysholm score respectively, and the curative effects were compared within and between groups.@*RESULTS@#All the patients in the two groups were followed up for at least 1 year. There were no complications such as infection and poor wound healing in both groups. There was significant difference in operation time between (120.25±9.55) min in group A and (106.63±8.85) min in group B (@*CONCLUSION@#There was no significant difference in the average hospitalization days between the two groups, but the operation time in group A was longerthan that in group B, and the hospitalization cost in group B was higher than that in group A. There was no difference in HSS score and Lysholm score before and follow-up for a certain period of time after operation.

Clinical study on reconstruction of posterior cruciate ligament with platelet rich plasma combined with 3-strand peroneus longus tendons / 中国修复重建外科杂志

Objective: To investigate the effectiveness of the reconstruction of posterior cruciate ligament (PCL) with platelet rich plasma (PRP) and 3-strand peroneal longus tendons under arthroscope. Methods: Between June 2014 and December 2017, 58 patients with PCL rupture were randomly divided into two groups: the trial group (PRP assisted reconstruction of 3-strand peroneal longus tendons) and the control group (4-strand hamstring tendon reconstruction alone), 29 cases in each group. There was no significant difference in gender, age, injury side, Kellgren-Lawrence grade, time from injury to operation, and preoperative American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, International Knee Documentation Committee (IKDC) score, Lysholm score between the two groups ( P>0.05). Before operation, at 3 months and 12 months after operation, the IKDC score and Lysholm score of the two groups were recorded to evaluate the knee joint function, AOFAS ankle-hindfoot score was used to evaluate ankle function; KT-2000 examination (knee flexion of 90°, 30 lbs) was used to evaluate the difference of bilateral knee joint posterior relaxation at 12 months after operation, and MRI was used to evaluate ligament reconstruction; CT was used to evaluate the bone tunnel expansion of femur and tibia at 3 months and 12 months after operation. Results: The operation was completed successfully in both groups, there was no complication in the donor tendon area. All the incisions healed by first intention. All the patients were followed up for more than 1 year. The follow-up time of the trial group was 13-17 months, with an average of 15.0 months; that of the control group was 15-20 months, with an average of 15.4 months. At 3 and 12 months after operation, there was no significant difference in AOFAS ankle-hindfoot score when compared with preoperative score and between the two groups ( P>0.05). At 3 and 12 months after operation, the IKDC score and Lysholm score of the two groups were significantly improved, and further improvement was found at 12 months when compared with at 3 months ( P10 mm in 3 cases; the difference between the two groups was not significant ( Z=0.606, P=0.544). At 12 months after operation, MRI of knee joint showed that all patients had good PCL graft. The MRI score of the trial group was better than that of the control group ( t=2.425, P=0.019). CT examination at 3 and 12 months after operation showed that the bone tunnel expansion of femur and tibia in the trial group were significantly better than those in the control group ( P<0.05). Conclusion: PRP combined with 3-stand peroneal longus tendons can significantly improve the function and stability of knee joint, effectively promote graft remodeling, and promote tendon bone healing, reduce the expansion of bone tunnel. The effectiveness is satisfactory.

Systematic evaluation of anterior cruciate ligament reconstruction with peroneus longus tendon and hamstring tendon / 中国组织工程研究

BACKGROUND: In recent years, it has been reported that peroneus longus tendon can be used as a new graft material for anterior cruciate ligament reconstruction and can achieve the same effect as hamstring tendon. Therefore, it is necessary to systematically evaluate the two graft materials for anterior cruciate ligament reconstruction. OBJECTIVE: To evaluate the clinical effect of reconstruction of anterior cruciate ligament with peroneus longus tendon and hamstring tendon by meta-analysis. METHODS: We retrieved controlled clinical trials which compared the long peroneal tendons and hamstring tendons in reconstructing anterior cruciate ligament respectively in Chinese database (WanFang, CNKI, VIP, Chinese biological medicine) and English database (Ovid, PubMed, Web of Science, Embase, the Cochrane library). The retrieval time was from database creation to March 2019. Literature screening and evaluation and data extraction were performed by two evaluators. Meta-analysis was evaluated using Revman5. 3 software. RESULTS AND CONCLUSION: (1) A total of 413 Chinese or English literatures were retrieved and 10 of them were included in the final analysis. Among 647 patients receiving anterior cruciate ligament reconstruction, 271 patients used peroneus longus tendon reconstruction and 376 patients used hamstring tendon reconstruction. (2) Meta-analysis results: Postoperative functional score: There was significant difference in Lysholm score at postoperative 12 months (MD=1. 23, 95%C/[0. 31, 2. 51], P=0. 000 9) and IKDC score at postoperative 6 months (MD=3. 19, 95%C/[0. 07, 6. 31], P=0. 02) between peroneus longus tendon reconstruction and hamstring tendon groups. The occurrence of postoperative complications in the peroneus longus tendon group was significantly lower than that in the hamstring tendon group (OR=0. 15, 95%C/[0. 03, 0. 69], P=0. 01). However, there were no significant differences in Tegner scores, degree of joint motion, degree of joint relaxation at postoperative 6 and 12 months between peroneus longus tendon reconstruction and hamstring tendon groups. No significant difference was found in Lysholm score at postoperative 6 months and in IKDC score at postoperative 12 months between these two groups. The results showed that the clinical effect of peroneus longus tendon in reconstruction of anterior cruciate ligament was comparable to that of hamstring tendon; in the peroneus longus tendon reconstruction group, the Lysholm score at postoperative 12 months and IKDC score at postoperative 6 months were significantly superior to those in the hamstring tendon group. The incidence of postoperative complications in the peroneus longus tendon reconstruction group was lower than that in the hamstring tendon group. The peroneus longus tendon can be clinically recommended to substitute hamstring tendon in the reconstruction of the anterior cruciate ligament. However, the quality of included literatures is limited; therefore higher quality of evidence is required to validate this conclusion.

A clinical comparative study on the reconstruction of posterior cruciate ligament with single tendon autograft plus high-strength braid or not / 中国综合临床

Objective@#To observe the difference of the clinical effect of using high-strength woven suture or not in the reconstruction of posterior cruciate ligament (PCL) with single tendon autograft under arthroscope.@*Methods@#The clinical data of 40 patients with posterior cruciate ligament rupture and ligament reconstruction admitted to Shengjing Hospital Affiliated to China Medical University from 2017 to 2018 were analyzed retrospectively.According to whether or not to add Arthrex ar-7200 (Arthrex, Naples, FL, USA) braided suture in the autogenous hamstring graft, the patients were divided into test group (17 cases) and control group (23 cases). The posterior drawer test (PDT) was used as the knee joint stability test to evaluate the knee function, IKDC score, Lysholm score and Tegner score were used as the evaluation criteria.The evaluation results of the knee joint in the experimental group and the control group were compared before and one year after the operation, and the evaluation results of the knee joint in the two groups were compared one year after the operation and one year before the operation@*Results@#Functional aspects of knee joint: The Lysholm score of the experimental group was expressed by median (quartile) 1 year before and after operation.Lysholm scores of the trail group were 64 (40, 81) and 84 (73, 87) preoperative and postoperative, respectively, the control group were 68 (48, 78) and 80 (70, 90) respectively, there was statistically difference before and after surgery (Z value was -2.535 and -3.576, P value was 0.011 and<0.001, respectively). There was no statistically significant difference between groups (all P>0.05). The Tegner score of the experimental group before and 1 year after operation was expressed as the median [quartile], which was 2.0 (1.0, 2.5), 6.0 (5.0, 7.5) respectively, and that of the control group was 2.0 (1.0, 3.0), 6.0 (4.0, 7.0) respectively.There was statistically significant difference between the two groups before and after operation (Z value was -3.397, -4.122, all P<0.001), but there was no statistically significant difference between the two groups (all P>0.05). One year after operation, the IKDC scores of the two groups were significantly improved (Z values were -3.750, -4.234, all P<0.001), but there was no significant difference between the two groups (P>0.05). There was no significant difference between the two groups in the postoperative drawer test (P>0.05); one year after the operation, the stability of the two groups was significantly improved (Z values were -3.674, -4.083, all P<0.01), and the stability of the experimental group was significantly better than that of the control group(Z=0.156, P=0.039).@*Conclusion@#Posterior cruciate ligament reconstruction with autologous hamstring muscle can achieve satisfactory clinical results, and placing high-strength braided sutures in the graft is more conducive to the recovery of knee joint stability.

A comparative study on the effect of reconstruction of posterior cruciate ligament with Autogenous hamstring tendon plus Peroneus longus tendon anterior bundle and LARS ligament / 实用医学杂志

Objective To investigate the effect of the use of autologous hamstring tendon plus peroneal longus tendon and the application of LARS artificial ligament reconstruction of posterior cruciate ligament (PCL) knee function and recovery of mechanical stability. Methods Forty-three patients with posterior cruciate ligament rupture were divided into two groups according to the type of graft used during the operation : the LARS artificial ligament group (22 cases) and the autologous hamstring tendon plus peroneal longus tendon group (21 cases). The postoperative follow-up time was at least two years. The knee joint function was evaluated using the knee joint Lysholm score, IKDC score, and Tegner score. The post-drawer test evaluated mechanical stability. Results After 43 cases were followed up completely, the knee joint stability and function indexes of the two groups were significantly improved compared with preoperative ones. The differences were statistically significant (P < 0.05).At the same time, for all postoperative scores, two There was no significant difference between groups (P> 0.05).Conclusion The application of autologous hamstring tendons plus peroneal longus tendon anterior bundle and LARS artificial ligament reconstruction posterior cruciate ligament can achieve satisfactory clinical curative effect.

Early clinical outcomes of anterior cruciate ligament reconstruction by LARS artificial ligament versus hamstring tendon autograft / 医学研究生学报

Objective Clinically, the anterior cruciate ligament ( ACL) can be reconstructed by either ligament advanced reinforcement system ( LARS) artificial ligament or hamstring tendon autograft ( HTAG) . This study aims to compare the early clinical outcomes of LARS versus HTAG in the treatment of ACL. Methods This study included 38 cases of ACL injury treated in our de-partment from March 2012 to August 2014, 18 by LARS artificial ligament and the other 20 by HTAG. Before and at 18 months after surgery, we evaluated the clinical outcomes of the tow strategies using the Lysholm knee scoring scale and International Knee Documen-tation Committee ( IKDC) scoring systems, and conducted statistical analysis on the follow-up findings. Results Statistically signifi-cant differences were not observed preoperatively between the LARS and HTAG groups either in the Lyshrolm scores (46.78±1.52 vs 46.80 ±1.89, P>0.05) or in the IKDC scores (42.83±1.47 vs 42.20±1.61, P>0.05), nor at 18 months postoperatively in the Lyshrolm scores (93.52±3.19 vs 94.10±1.37, P>0.05) or the IKDC scores (92.11± 1.45 vs 93.15±1.76, P>0.05). However, both the LARS and HTAG groups showed significant differences in the Lyshrolm and IKDC scores at the baseline as compared with those at 18 months after oper-ation ( P<0.05) . Conclusion Both LARS artificial ligament ham-string tendon autograft can achieve good early clinical outcomes in ACL reconstruction.

The curative effects of autograft and allograft in anterior cruciate ligament reconstruction / 实用医学杂志

Objective To investigate gender differences in the curative effects of allograft and autologous hamstring tendon in anterior cruciate ligament reconstruction. Methods One hundred and forty-eight patients with the anterior cruciate ligament injury received surgical treatment were enrolled from January 2011 to January 2015 and divided into two groups,including group M(Men)and group W(Women). Patients in each group were also divided in the allograft group (Group A) and the autologous hamstring tendon group (Group B). The patient condition was separately assessed with the Lysholm,Tegner,VAS score and the value of KT-1000 before and after surgery. Results All patients received an average of 16(13-18)-month follow-up visit. No severe complication , such as blood-vessel and nerve injury ,infection and rupture of graft ,occurred in patients after operations. Compared with those before operation,the Lysholm,Tegner,VAS score and the value of KT-1000 after operation in four groups were significantly improved (P 0.05). Conclusions The curative effect of ACL reconstruction between allograft ligament and autologous hamstring tendon has no significant difference in gender. The selection of graft should be considered in more aspects.

Curative effect analysis of arthroscopic transtibial single-bundle posterior cruciate ligament residual reconstruction using artificial ligament compared with hamstring tendon autograft / 中国综合临床

Objective To compare the curative effect of arthroscopic transtibial single-bundle posterior cruciate ligament(PCL) reconstruction using LARS artificial ligament and hamstring tendon autograft.Methods Thirty-seven patients who underwent isolated single-bundle PCL reconstruction with remnant preservation technique were evaluated.They were divided into LARS group(n=19) and 4-strand hamstring tendon autograft (4SHG) group (n =18).Minimum follow-up was 2 years.Patients were evaluated preoperatively and postoperatively at the latest follow-up with several parameters,including the international knee documentation committee(IKDC) score,Lysholm knee score,Tegner activity rating and physical examination.Results After operation,in LARS group,Lysholm sorce was 89 (51,100) points,Tegner sorce was 6 (1,9) points,IKDC sorces were normal of 5 cases,nearly normal of 10 cases,abnormal of 3 cases,and obviously abnormal of 1 case,significantly improved compared with before operation (62 (28,98) points,2 (1,5) points,abnormal IKDC score of 8 cases,obviously abnormal of 11 cases;P＜0.001).In 4SHG group,Lysholm sorce was 84(36,100) points,Tegner sorce was 6(1,9) points,IKDC sorces were normal of 5 cases,nearly normal of 9 cases,abnormal of 3 cases,and obviously abnormal of 1 case,better than before operation (64 (28,98) points,2 (1,5) points,IKDC score abnormal of 8 cases,obviously abnormal of 10 cases;P＜0.001).There was significant difference about Lysholm sorce between two groups after operation (P=0.037).The drawer test results show that,after operation,there were 15 case of grade 0,4 cases of grade 1 in LARS group,3 cases of grade 0,11 cases of grade 1,4 cases of grade 2 in 4SHG group,all improved significantly compared with before operation,and the differences were statistically significant(LARS group:x2 =38.000,P＜0.001;4SHG group:x2 =29.143,P＜0.001),and the grade of patients in LARS group were superior to 4SHG group after operation (x2 =15.251,P ＜0.001).Conclusion The clinical effect of using a LARS ligament for PCL reconstruction is more useful than using a 4SHG.

Application value of femoral intercondylar notch plasty in quadruple hamstring tendon reconstructing for old anterior cruciate ligament injury / 中国医师进修杂志

ObjectiveTo investigate clinical efficacy of reconstructing for old anterior cruciate ligament(ACL) injury with quadruple hamstring tendon,and application value of femoral intercondylar notch plasty.Methods Fifty-six cases of old ACL injury were reconstructed arthroscopically with quadruple hamstring tendon.Forty-five cases were used femoral intercondylar notch plasty.Preoperative Lachman test were positive,and ACL injury were confirmed by MRI.The curative effect was evaluated according to Lysholm knee score and KT-1000 measurement results.ResultsAll of the 56 patients were followed up for 6-24 (13.0 ± 4.2) months.Postoperative Lachman test of 53 cases were negative,and 3 cases were weak positive.The Lysholm knee score increased from preoperative (56.0 ± 7.3) scores to postoperative (93.0 ± 3.5 ) scores,comparison of preoperative had significant difference (t =34.20,P ＜ 0.01 ).The postoperative KT-1000 measurement showed ＜ 3.0 mm side difference of anterior laxity,moving average of(2.0 ± 0.6) mm,comparison of preoperative ≥ 3.0 mm,moving average of (3.0 ± 1.2 ) mm had significant difference (t =5.58,P ＜ 0.01 ).ConclusionsArthroscopic reconstruction of ACL with quadruple hamstring tendon have a good effect.The postoperative rehabilitation exercise can practise early.The femoral intercondylar notch plasty which used during operation is benefit of decreasing femoral intercondylar notch impingement syndrome,accurate positioning femur tunnel,and increasing curative effect.

Cross Pins versus Endobutton Femoral Fixation in Hamstring Anterior Cruciate Ligament Reconstruction: Minimum 4-Year Follow-Up

PURPOSE: We aimed to compare cross-pin fixation and Endobutton femoral fixation for hamstring anterior cruciate ligament (ACL) reconstruction with respect to clinical and radiographic results, including tunnel widening and the progression of knee osteoarthritis (OA). MATERIALS AND METHODS: Between August 2002 and August 2005, 126 autogenous hamstring ACL reconstructions were performed using either cross pins or Endobutton for femoral fixation. Fifty-six of 75 patients in the cross-pin group and 35 of 51 patients in the Endobutton group were followed up for a minimum of 4 years. We compared the clinical and radiological results between the groups using the International Knee Documentation Committee (IKDC) evaluation form, the KT-2000 arthrometer side to side difference, the amount of tunnel widening and the advancement of OA on radiographs. RESULTS: There were no significant differences in the IKDC grades between the groups at the 4 year follow-up. There was no significant difference in the side to side difference according to KT-2000 arthrometer testing. Also, there were no significant differences in terms of tunnel widening or advancement of OA on radiographs. CONCLUSIONS: Endobutton femoral fixation showed good results that were comparable to those of cross pins fixation in hamstring ACL reconstruction.

ACL Reconstruction with Autologous Hamstring Tendon: Comparison of Short Term Clinical Results between Rigid-fix and PINN-ACL Cross Pin

PURPOSE: To compare the short term clinical results of anterior cruciate ligament (ACL) reconstruction with autologous hamstring tendon between Rigid-fix and PINN-ACL Cross Pin for femoral side fixation. MATERIALS AND METHODS: 127 patients who underwent arthroscopic ACL reconstruction using autologous hamstring tendon and had been followedup for over than one year were enrolled for the present study. Rigid-fix was used in 71 cases (group 1), and PINN-ACL Cross Pin was used in 56 cases (group 2). Clinical and radiological results, operation time, and perioperative complications were compared amongst the two groups. RESULTS: The International Knee Documentation Committee subjective score and Lysholm score were 94 and 95 in group 1 and 87 and 91 in group 2, with no statistical difference (p=0.892, p=0.833), respectively. However, significant difference was observed in one-leg hop test between the two groups (p=0.032). Five cases in group 1 and 40 cases in group 2 were found to be associated with perioperative complications with statistical difference (p<0.0001). CONCLUSIONS: There was no resultant difference between the employment of PINN-ACL Cross Pin and Rigid-fix as femoral graft fixation for ACL reconstruction with hamstring tendon. However, PINN-ACL Cross Pin led to complications with extensive operation times. Hence, it needs further improvement of tools for minimization of complications.

Short-term Follow-up of Double Bundle ACL Reconstruction using Autogenous Hamstring Tendons Fixed with Ligament Plate(R) / 대한정형외과학회잡지

PURPOSE: We wanted to evaluate the clinical outcomes at a minimum 1-year following anatomic double bundle ACL reconstruction with using autogenous hamstring tendons fixed with Ligament Plate(R). MATERIALS AND METHODS: We evaluated a total of 50 patients. Semitendinosus tendon was used for the reconstruction of the anteromedial bundle and the gracilis tendon was used for the reconstruction of the posterolateral bundle. For femoral fixation, we used an anteromedial bundle that was suspended in Ligament Plate(R) and a posterolateral bundle linked with Mersilene tape(R). For tibial fixation, we used double post-tie. The average follow-up period was 16.5 months. We analyzed the clinical and radiographic results. RESULTS: At the last follow-up, the Lysholm score was 92.4+/-6.8 points. For the IKDC score, there were 35 cases of grade A, 14 cases of grade B and 1 case of grade C. The Lachman test was negative for 40 cases, it was grade 1 for 9 cases and it was grade 2 for 1 case and the pivot shift test was negative for 45 cases and it was grade 1 for 5 cases. The side-to-side differences with the KT-2000 and the anterior drawer radiogram were 1.3+/-1.6 mm and 1.3+/-1.3 mm, respectively. The femoral tunnel enlarged to 1.7+/-0.6 mm in the anteromedial aspect and 1.6+/-0.7 mm in the posterolateral aspect, and the tibial tunnel enlarged to 1.2+/-0.4 mm in the anteromedial aspect and 1.4+/-0.5 mm in the posterolateral aspect. CONCLUSION: Anatomic ACL reconstruction using autogenous hamstring tendons that are fixed with Ligament Plate(R) showed good clinical results due to the strong strength of early fixation and the anatomic restoration of the ACL.

The Clinical Results of ACL Reconstruction with the Bio-Transfix(R) Technique

PURPOSE: We wanted to evaluate the clinical results of ACL reconstructions with using four strands of an auto-hamstring tendon graft and a bioresorbable-Transfix device (Arthrex, Naples, FL) for femoral fixation. MATERIALS AND METHODS: From May 2005 to May 2007, a total of 108 cases that underwent arthroscopic ACL reconstruction with using hamstring tendons and a bioresorbable-Transfix device were followed-up for more than 1 year (Range: 12~32 months) postoperatively. The clinical results were evaluated by the preoperative and postoperative Lysholm knee scores, the International Knee Documentation Committee (IKDC) scoring system and a KT-1000 arthrometer. The radiological results were evaluated by the measurement method described by L'Insalata. RESULTS: Preoperatively, the mean Lysholm knee score was 70.8+/-6.8 (Range: 52.0~81.0) which improved to 94.2+/-4.8 (Range: 76.0~98.0) at the last follow up (p<0.05). According to the IKDC scoring system, 104 cases (96%) were categorized as normal or nearly normal and no case was categorized as severely abnormal at the last follow up (p<0.05). KT-1000 arthrometer instability was statistically improved from 8.8 mm (Range: 3~17 mm) to 2.1 mm (Range: 1~7 mm) (p<0.05). The femoral and tibial tunnels were statistically widened 22.7% and 12.7% on the AP view, respectively, and 17.4% and 8.4% on the lateral view, respectively, at the last follow up (p<0.05). CONCLUSION: ACL reconstruction using auto-hamstring tendons with a bioresorbable-Transfix device showed satisfactory results on the physical examination and functional evaluation.

Arthroscopic reconstruction of the anterior cruciate ligament using multi-strands of hamstring tendons / 中国医师杂志

Objective To investigate the clinical effect of arthroscopic anterior cruciate ligament(ACL) reconstruction using autologous multi-strands of hamstring tendon.Method From May 2002 to Dec.2006,arthroscopic reconstruction of the anterior cruciate ligament using multi-strands of hamstring tendon was performed on 39 patients.Among them,28 cases were followed up for 7 to 48 months(average 13.5±2.3 months).Result The median Lysholm knee score was improved from 47.3±3.6 to 91.3±2.9 after operation.Conclusion Arthruscopic reconstruction of the anterior cruciate ligament using muhi-strands of hamstring tendons is a good alternative method with minimal invasion and convenient tendon harvesting and fewer complication and reliable clinical effect.

Clinical Outcomes after Arthroscopic ACL Reconstruction using Bone-Patellar Tendon-Bone Allografts, Anterior Tibialis Tendon Allografts, and Hamstring Tendon Autografts

PURPOSE: To use physical and quantitative tests and second look arthroscopy to compare knee joint stability, graft remodeling, and healing after arthroscopic anterior cruciate ligament (ACL) reconstruction in patients receiving bone-patellar tendon-bone (BPTB) allografts, tibialis anterior tendon (TA) allografts, and hamstring (HA) autografts. MATERIALS AND METHODS: We analyzed 338 patients who underwent ACL reconstruction between March 2000 and February 2006 and who were followed up for at least 1 year. There were 60 BPTB allografts, 153 TA allografts, and 125 HA autografts. We compared the range of motion (ROM), Lachman test, pivot shift test, KT-1000 arthrometer test, and International Knee Documentation Committee (IKDC) knee examination form among the three groups, as well as the laxity and synovial coverage of the grafts as determined by second look arthroscopy. RESULTS: There was no significant difference among the three groups with regard to preoperative and postoperative clinical and physical findings. Synovial coverage of greater than 50% was found in 60% of patients in the BPTB allograft group, in 69.2% of patients in the TA allograft group, and in 100% of patients in the HA autograft group. The HA autograft group had a higher incidence of synovial coverage greater than 50% (p=0.017, 0.025). Regarding IKDC grade, Grade A or B was found among 93.7% of the cases with synovial coverage greater than 50% and among 72.2% of the cases with synovial coverage less than 50%. There was a significant correlation between the extent of synovial coverage and the IKDC grade (p=0.015). CONCLUSION: The HA autograft group had superior synovial coverage over the other two groups on second look arthroscopy, and there was a significant correlation between the extent of synovial coverage and the IKDC grade.

The Midterm Results of Arthroscopic Anterior Cruciate LigamentReconstruction with Hamstring Tendon and Ligament Anchor Screw / 대한정형외과학회잡지

PURPOSE: To evaluate the clinical and radiological results of an arthroscopic ACL reconstruction with a hamstring tendon and Ligament Anchor (LA) screw. MATERIALS AND METHODS: 48 cases among 47 patients with a minimum 5 year follow up after the ACL reconstruction were examined. The clinical results (Lysholm Knee score, Tegner activity scale, Lachmann test, Pivot-shift test, and complications) were evaluated, and the radiological results (osteoarthritis, bony tunnel enlargement, instrumented anterior laxity test with Telos?) were assessed. RESULTS: The Lysholm Knee score showed significant improvement from 65.8 to 96.7 at the final follow up. The Tegner activity scale also showed significant improvement from 3.5 preoperatively to 6.0 at the final follow-up. The Lachmann test showed that 42 cases had converted to negative. The Pivot-shift test was negative in 39 cases and mild positive in 9 cases. The side to side difference using the instrumented anterior laxity test was 12.5 mm preoperatively and 3.2 mm at the final follow-up. Degenerative osteoarthritis was observed in 9 (19%) knees. The femoral and tibial tunnel were widened by 21.6 and 20.9% in the AP view and 16.3 and 19.0% in the lateral view, respectively (p<0.05). CONCLUSION: An ACL reconstruction with a hamstring tendon and LA screw can restore the knee stability with satisfactory clinical results and few complications.

A Short Term Follow-up of Anterior Cruciate Ligament Reconstruction using Hamstring Tendon Grafts fixed with Ligament Plate(R)

PURPOSE: To evaluate the clinical outcomes at a minimum of 1 year following the ACL reconstruction with use of Liga- ment Plate(R) which was invented for secure fixation of hamstring tendon graft into femoral tunnel. MATERIALS AND METHODS: Seventy-six patients who could followed up for minimum 12 months were treated with the ACL reconstruction fixed with Ligament Plate(R) using a four-stranded autologous hamstring tendon graft. For femoral fixation, we used Ligament Plate(R), and for tibial fixation, we used suture-post strengthened with cortical screw. Average follow up period was 18.6 months. Prior to surgery and at the follow-up examination, we evaluated the clinical results with Lachmann test, pivot shift test, Lysholm score and the difference of mid-thigh circumference, and KT 2000 arth- rometer was perfomed. For radiographic evaluation, we analyzed knee radiographs including anterior drawer radiographs and evaluated the degree of tunnel enlargement. RESULTS: Lysholm score improved from 61.6 points to 93.8 points. Lachman test revealed negative findings for sixty- three cases, and ten cases with grade 1 laxity and another three cases with grade 2 at last follow-up. Pivot shift test showed negative findings except six cases with grade 1 laxity at last follow-up. The results of KT 2000 arthrometer improved from 5.4mm difference compared with normal limb to 2.1mm respectively. The difference of mid-thigh circumference compared with normal limb showed 1.7cm. Radiographic analysis of anterior drawer view revealed 6.5 mm difference compared with normal limb preoperatively and 1.1 mm difference at last follow-up. Femoral and tibial tunnel enlarged to 2.7mm and 1.8 mm compared with immediate postoperative radiographs. CONCLUSION: ACL reconstruction using hamstring tendon grafts fixed with Ligament Plate(R) could provide sufficient strength of early fixation, and then could show good clinical results. However, long term follow-up was necessary.