Clinical Evaluation of Anterior Cruciate Ligament Reconstruction with Remnant-preserving Technique - Method Using Single Four-strand Semitendinosus Tendon -

Hee-Soo Kyung; Chang-Wug Oh; Hyun-Ju Lee

doi:10.4055/jkoa.2011.46.1.60

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Kyung, Oh, and Lee: Clinical Evaluation of Anterior Cruciate Ligament Reconstruction with Remnant-preserving Technique - Method Using Single Four-strand Semitendinosus Tendon -

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2011; 46(1): 60-67.

Published online: 22 February 2011

DOI: https://doi.org/10.4055/jkoa.2011.46.1.60

Clinical Evaluation of Anterior Cruciate Ligament Reconstruction with Remnant-preserving Technique - Method Using Single Four-strand Semitendinosus Tendon -

Hee-Soo Kyung, M.D., Ph.D., Chang-Wug Oh, M.D., Ph.D., Hyun-Ju Lee, M.D.

Department of Orthopedic Surgery, School of Medicine, Kyungpook National University, Daegu, Korea.

Correspondence to: Hee-Soo Kyung, M.D., Ph.D. Department of Orthopaedic Surgery, Kyungpook National University Hospital, 50, Samduk-2ga, Jung-gu, Daegu 700-721, Korea. TEL: +82-53-420-5636, FAX: +82-53-422-6605, hskyung@knu.ac.kr

Received 2 March 2010 Accepted 20 September 2010

(open-access):

"This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited."

Abstract

Purpose

We evaluated the functional and clinical results of anterior cruciate ligament (ACL) reconstruction with remnant-preserving technique using an autologous single four-strand semitendinosus tendon.

Materials and Methods

We evaluated 70 patients who had undergone ACL reconstruction using autologous single four-strand semitendinosus tendon. Group I (n=34) were cases in which more than half of the ACL remnant remained. Group II (n=36) included cases in which the ACL was nearly absent. The mean follow-up period was 18.7 months for group I cases, and 20.7 months in group II cases. We performed clinical evaluation using the following tests: Lachman test, pivot shift test, Lysholm score, Tegner activity score, and IKDC score; functional evaluation was performed using the single limb standing test and ability to return to pre-injury sports activity.

Results

Lachman test, pivot-shift test, measurement of side-to-side difference using KT-2000 arthrometer and Tegner activity scores were much improved over preoperative evaluations, and there were no statistically significant differences between the 2 groups. The objective IKDC (International Knee Documentation Committee) score and return to pre-injury sports activity showed no statistical difference between the 2 groups, but the subjective IKDC score (p=0.007) and Lysholm score (p=0.001) were better in group I than in group II. There was no difference in the single limb standing test and there was no difference between the 2 groups, but there was a tendency to have improved over the preoperative evaluation.

Conclusion

We obtained good results after ACL reconstruction using the autologous single four-strand semitendinosus tendon. ACL remnant preserving group had better Lysholm score and IKDC subjective score.

Keywords: anterior cruciate ligament reconstruction, remnant preserving method, single four strand semitendinosus tendon

Figures and Tables

Figure 1

This photograph shows semitendinosus tendon harvesting technique with periosteum attachment.

Figure 2

This drawing shows sufficient length for the ACL reconstruction: 2 cm for femoral side, 3 cm for intra-articular portion, and 2 cm for tibial side.

Table 1

Stability Results in Group I and II

SD, standard deviation.

Table 2

Clinical Evaluation Results in Group I and II

SD, standard deviation; IKDC, international knee documentation committee; SLS, single limb standing.

^*IKDC grade A+B.

References

1. Lewis PB, Parameswaran AD, Rue JP, Bach BR Jr. Systematic review of single-bundle anterior cruciate ligament reconstruction outcomes: a baseline assessment for consideration of double-bundle techniques. Am J Sports Med. 2008. 36:2028–2036.

2. Barrett DS. Proprioception and function after anterior cruciate reconstruction. J Bone Joint Surg Br. 1991. 73:833–837.

3. Fremerey RW, Lobenhoffer P, Zeichen J, Skutek M, Bosch U, Tscherne H. Proprioception after rehabilitation and reconstruction in knees with deficiency of the anterior cruciate ligament: a prospective, longitudinal study. J Bone Joint Surg Br. 2000. 82:801–806.

4. Reider B, Arcand MA, Diehl LH, et al. Proprioception of the knee before and after anterior cruciate ligament reconstruction. Arthroscopy. 2003. 19:2–12.

5. Shimizu T, Takahashi T, Wada Y, Tanaka M, Morisawa Y, Yamamoto H. Regeneration process of mechanoreceptors in the reconstructed anterior cruciate ligament. Arch Orthop Trauma Surg. 1999. 119:405–409.

6. Aune AK, Hukkanen M, Madsen JE, Polak JM, Nordsletten L. Nerve regeneration during patellar tendon autograft remodelling after anterior cruciate ligament reconstruction: an experimental and clinical study. J Orthop Res. 1996. 14:193–199.

7. Coombs R, Cochrane T. Knee flexor strength following anterior cruciate ligament reconstruction with the semitendinosus and gracilis tendons. Int J Sports Med. 2001. 22:618–622.

8. Nakamura N, Horibe S, Sasaki S, et al. Evaluation of active knee flexion and hamstring strength after anterior cruciate ligament reconstruction using hamstring tendons. Arthroscopy. 2002. 18:598–602.

9. Tashiro T, Kurosawa H, Kawakami A, Hikita A, Fukui N. Influence of medial hamstring tendon harvest on knee flexor strength after anterior cruciate ligament reconstruction. A detailed evaluation with comparison of single- and double-tendon harvest. Am J Sports Med. 2003. 31:522–529.

10. Kyung HS, Kim TG, Oh CW, Yoon SH. Anterior cruciate ligament reconstruction with a four-strand single semitendinosus tendon autograft. J Korean Arthrosc Soc. 2009. 13:138–142.

11. Kyung HS, Oh CW, Kim PT, Lee BW. Arthroscopic ACL reconstruction using quadrupled hamstring tendon with tibial remnant-preservingtechnique. J Korean Orthop Sports Med. 2007. 6:92–98.

12. Shelbourne KD, Whitaker HJ, McCarroll JR, Rettig AC, Hirschman LD. Anterior cruciate ligament injury: evaluation of intraarticular reconstruction of acute tears without repair. Two to seven year followup of 155 athletes. Am J Sports Med. 1990. 18:484–488.

13. Barrack RL, Skinner HB, Buckley SL. Proprioception in the anterior cruciate deficient knee. Am J Sports Med. 1989. 17:1–6.

14. Schultz RA, Miller DC, Kerr CS, Micheli L. Mechanoreceptors in human cruciate ligaments. A histological study. J Bone Joint Surg Am. 1984. 66:1072–1076.

15. Schutte MJ, Dabezies EJ, Zimny ML, Happel LT. Neural anatomy of the human anterior cruciate ligament. J Bone Joint Surg Am. 1987. 69:243–247.

16. Solomonow M, Baratta R, Zhou BH, et al. The synergistic action of the anterior cruciate ligament and thigh muscles in maintaining joint stability. Am J Sports Med. 1987. 15:207–213.

17. Tibone JE, Antich TJ, Fanton GS, Moynes DR, Perry J. Functional analysis of anterior cruciate ligament instability. Am J Sports Med. 1986. 14:276–284.

18. Crain EH, Fithian DC, Paxton EW, Luetzow WF. Variation in anterior cruciate ligament scar pattern: does the scar pattern affect anterior laxity in anterior cruciate ligament-deficient knees? Arthroscopy. 2005. 21:19–24.

19. Georgoulis AD, Pappa L, Moebius U, et al. The presence of proprioceptive mechanoreceptors in the remnants of the ruptured ACL as a possible source of re-innervation of the ACL autograft. Knee Surg Sports Traumatol Arthrosc. 2001. 9:364–368.

20. Adachi N, Ochi M, Uchio Y, Iwasa J, Ryoke K, Kuriwaka M. Mechanoreceptors in the anterior cruciate ligament contribute to the joint position sense. Acta Orthop Scand. 2002. 73:330–334.

21. MacDonald PB, Hedden D, Pacin O, Sutherland K. Proprioception in anterior cruciate ligament-deficient and reconstructed knees. Am J Sports Med. 1996. 24:774–778.

22. Valeriani M, Restuccia D, Di Lazzaro V, Franceschi F, Fabbriciani C, Tonali P. Clinical and neurophysiological abnormalities before and after reconstruction of the anterior cruciate ligament of the knee. Acta Neurol Scand. 1999. 99:303–307.

23. Ochi M, Iwasa J, Uchio Y, Adachi N, Sumen Y. The regeneration of sensory neurones in the reconstruction of the anterior cruciate ligament. J Bone Joint Surg Br. 1999. 81:902–906.

24. Ochi M, Adachi N, Deie M, Kanaya A. Anterior cruciate ligament augmentation procedure with a 1-incision technique: anteromedial bundle or posterolateral bundle reconstruction. Arthroscopy. 2006. 22:463.e1–463.e5.

25. Choi JW, Oh CW, Sohn YH, Lee HJ, Kyung HS. Return to pre-injury activity after ACL reconstruction on athletes: remnant preserving technique. Korean J Sports Med. 2008. 26:1–6.

26. al-Othman A, Moussa M, Eraky MZ. A simple outpatient test for proprioception in the anterior cruciate ligament-deficient knee. Orthopedics. 1998. 21:677–679.

27. Lee BI, Kim JB, Min KD, Choi HS, Eom JP. Comparison of clinical results according to amount of preserved remnant in arthroscopic ACL reconstruction using quadrupled hamstring graft. J Korean Orthop Assoc. 2005. 40:284–292.

28. Spindler KP, Kuhn JE, Freedman KB, Matthews CE, Dittus RS, Harrell FE Jr. Anterior cruciate ligament reconstruction autograft choice: bone-tendon-bone versus hamstring: does it really matter? A systematic review. Am J Sports Med. 2004. 32:1986–1995.

29. Williams GN, Snyder-Mackler L, Barrance PJ, Axe MJ, Buchanan TS. Muscle and tendon morphology after reconstruction of the anterior cruciate ligament with autologous semitendinosus-gracilis graft. J Bone Joint Surg Am. 2004. 86-A:1936–1946.

30. Greis PE, Burks RT, Bachus K, Luker MG. The influence of tendon length and fit on the strength of a tendon-bone tunnel complex. A biomechanical and histologic study in the dog. Am J Sports Med. 2001. 29:493–497.

31. Yamazaki S, Yasuda K, Tomita F, Minami A, Tohyama H. The effect of intraosseous graft length on tendon-bone healing in anterior cruciate ligament reconstruction using flexor tendon. Knee Surg Sports Traumatol Arthrosc. 2006. 14:1086–1093.

32. Zantop T, Ferretti M, Bell KM, Brucker PU, Gilbertson L, Fu FH. Effect of tunnel-graft length on the biomechanics of anterior cruciate ligament-reconstructed knees: intra-articular study in a goat model. Am J Sports Med. 2008. 36:2158–2166.

33. Chen CH, Chen WJ, Shih CH, Yang CY, Liu SJ, Lin PY. Enveloping the tendon graft with periosteum to enhance tendon-bone healing in a bone tunnel: a biomechanical and histologic study in rabbits. Arthroscopy. 2003. 19:290–296.

34. Kyung HS, Kim SY, Oh CW, Kim SJ. Tendon-to-bone tunnel healing in a rabbit model: the effect of periosteum augmentation at the tendon-to-bone interface. Knee Surg Sports Traumatol Arthrosc. 2003. 11:9–15.

35. Ohtera K, Yamada Y, Aoki M, Sasaki T, Yamakoshi K. Effects of periosteum wrapped around tendon in a bone tunnel: a biomechanical and histological study in rabbits. Crit Rev Biomed Eng. 2000. 28:115–118.

36. Harilainen A, Linko E, Sandelin J. Randomized prospective study of ACL reconstruction with interference screw fixation in patellar tendon autografts versus femoral metal plate suspension and tibial post fixation in hamstring tendon autografts: 5-year clinical and radiological follow-up results. Knee Surg Sports Traumatol Arthrosc. 2006. 14:517–528.

37. Laxdal G, Sernert N, Ejerhed L, Karlsson J, Kartus JT. A prospective comparison of bone-patellar tendon-bone and hamstring tendon grafts for anterior cruciate ligament reconstruction in male patients. Knee Surg Sports Traumatol Arthrosc. 2007. 15:115–125.

38. Streich NA, Friedrich K, Gotterbarm T, Schmitt H. Reconstruction of the ACL with a semitendinosus tendon graft: a prospective randomized single blinded comparison of double-bundle versus single-bundle technique in male athletes. Knee Surg Sports Traumatol Arthrosc. 2008. 16:232–238.

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