Mid-Term Results after Anterior Cruciate Ligament Reconstruction Using Four-Strand Single Semitendinosus Tendon

Ho-Won Park; Hee-June Kim; Hee-Soo Kyung; Jung-Won Han

doi:10.4055/jkoa.2015.50.5.387

Journal List > J Korean Orthop Assoc > v.50(5) > 1013399

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Park, Kim, Kyung, and Han: Mid-Term Results after Anterior Cruciate Ligament Reconstruction Using Four-Strand Single Semitendinosus Tendon

Original Article

Journal of the Korean Orthopaedic Association 2015; 50(5): 387-393.

Published online: 23 October 2015

DOI: https://doi.org/10.4055/jkoa.2015.50.5.387

Mid-Term Results after Anterior Cruciate Ligament Reconstruction Using Four-Strand Single Semitendinosus Tendon

Ho-Won Park, M.D., Hee-June Kim, M.D., Hee-Soo Kyung, M.D., Ph.D., Jung-Won Han, M.D.

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

Correspondence to: Hee-Soo Kyung, M.D., Ph.D. Department of Orthopaedic Surgery, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu 41944, Korea. TEL: +82-53-200-5636, FAX: +82-53-422-6605, hskyung@knu.ac.kr

Received 23 March 2015 Revised 21 May 2015 Accepted 22 June 2015

(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/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study was to evaluate the mid-term results after anterior cruciate ligament (ACL) reconstruction using a single four-strand semitendinosus tendon.

Materials and Methods

We evaluated 81 patients (84 cases) who had undergone ACL reconstruction using an autologous single four-strand semitendinosus tendon. The patients consisted of 77 men and 4 women with a mean age of 28.8 years (15-59 years) years. Most injuries were sports related, and the largest number of cases occurred during a soccer game (38 cases). Combined injuries were meniscus injuries in 43 cases, cartilage injuries in 6 cases and medial collateral ligament injuries in 8 cases. Femoral fixation device was PINN-ACL CrossPin in 44 cases and extracortical suspension device in 40 cases. Suture tie around a screw post and an additional bioabsorbable screw were used for tibial fixation. The mean time from injury to surgery was 9±16 months (7 days-10 years) and the mean follow-up period was 72.0±8.3 months (53-95 months). Clinical evaluation was performed using Lachman test, pivot-shift test, KT-2000 arthrometer, Lysholm score, Tegner activity score, International Knee Documentation Committee (IKDC) score and return to pre-injury sports activity. Radiologic evaluation was performed using plain radiographs to evaluate joint space narrowing.

Results

All patients showed normal range of motion at the final follow-up. The Lachman test was positive in 4 cases, and pivot-shift test was positive in 3 cases. Lysholm score improved from 76.7 to 92.2, Tegner activity score improved from 5.1 to 6, IKDC score improved from 72.0 to 86.5, and mean anterior translation by KT-2000 improved from 7.4 mm to 2.3 mm, and 80.2µ of patients returned to pre-injury sports activity. No significant differences in joint space narrowing were observed in plain radiographs.

Conclusion

In this study, good results were obtained after ACL reconstructions using the autologous four-strand single semitendinosus tendon with maintaining the joint stability at mid-term follow-up.

Keywords: anterior cruciate ligament reconstruction, semitendinosus tendon

Figures and Tables

Figure 1

(A) This figure shows the semitendinosus tendon harvesting technique with periosteum attachment. (B) Additional 2 cm periosteum was harvested.

Figure 2

(A) The semitendinosus tendon was harvested with 2 cm periosteum. (B) This figure shows the 4-strand semitendinosus tendon graft with suspension device.

Table 1

Clinical Outcomes after ACL Reconstruction Using Four-strand Single Semitendinosus Tendon

Values are presented as number only or mean±standard deviation. ^*Side-to-side difference. ACL, anterior cruciate ligament; F/U, follow-up; IKDC, International Knee Documentation Committee.

Notes

^{CONFLICTS OF INTEREST} The authors have nothing to disclose.

References

1. Sherman OH, Banffy MB. Anterior cruciate ligament reconstruction: which graft is best. Arthroscopy. 2004; 20:974–980.

2. Corry IS, Webb JM, Clingeleffer AJ, Pinczewski LA. Arthroscopic reconstruction of the anterior cruciate ligament. A comparison of patellar tendon autograft and four-strand hamstring tendon autograft. Am J Sports Med. 1999; 27:444–454.

3. 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.

4. 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.

5. 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.

6. 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.

7. 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.

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

9. Kyung HS, Oh CW, Lee HJ. Clinical evaluation of anterior cruciate ligament reconstruction with remnant-preserving technique: method using single four-strand semitendinosus tendon. J Korean Orthop Assoc. 2011; 46:60–67.

10. Kyung HS, Lee HJ, Oh CW, Hong HP. Comparison of results after anterior cruciate ligament reconstruction using a four-strand single semitendinosus or a semitendinosus and gracilis tendon. Knee Surg Sports Traumatol Arthrosc. 2015; 23:3238–3243.

11. Ahn JH, Kim JG, Wang JH, Jung CH, Lim HC. Long-term results of anterior cruciate ligament reconstruction using bone-patellar tendon-bone: an analysis of the factors affecting the development of osteoarthritis. Arthroscopy. 2012; 28:1114–1123.

12. Leys T, Salmon L, Waller A, Linklater J, Pinczewski L. Clinical results and risk factors for reinjury 15 years after anterior cruciate ligament reconstruction: a prospective study of hamstring and patellar tendon grafts. Am J Sports Med. 2012; 40:595–605.

13. Shaerf DA, Pastides PS, Sarraf KM, Willis-Owen CA. Anterior cruciate ligament reconstruction best practice: a review of graft choice. World J Orthop. 2014; 5:23–29.

14. Qi L, Chang C, Jian L, Xin T, Gang Z. Effect of varying the length of soft-tissue grafts in the tibial tunnel in a canine anterior cruciate ligament reconstruction model. Arthroscopy. 2011; 27:825–833.

15. 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.

16. Yang DL, Cheon SH, Oh CW, Kyung HS. A comparison of the fixation strengths provided by different intraosseous tendon lengths during anterior cruciate ligament reconstruction: a biomechanical study in a porcine tibial model. Clin Orthop Surg. 2014; 6:173–179.

17. 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.

18. 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.

19. Choi JY, Ha JK, Kim YW, Shim JC, Yang SJ, Kim JG. Relationships among tendon regeneration on MRI, flexor strength, and functional performance after anterior cruciate ligament reconstruction with hamstring autograft. Am J Sports Med. 2012; 40:152–162.

20. Karimi-Mobarakeh M, Mardani-Kivi M, Mortazavi A, Saheb-Ekhtiari K, Hashemi-Motlagh K. Role of gracilis harvesting in four-strand hamstring tendon anterior cruciate ligament reconstruction: a double-blinded prospective randomized clinical trial. Knee Surg Sports Traumatol Arthrosc. 2015; 23:1086–1091.

21. Eriksson K, Hamberg P, Jansson E, Larsson H, Shalabi A, Wredmark T. Semitendinosus muscle in anterior cruciate ligament surgery: morphology and function. Arthroscopy. 2001; 17:808–817.

22. Eriksson K, Larsson H, Wredmark T, Hamberg P. Semitendinosus tendon regeneration after harvesting for ACL reconstruction. A prospective MRI study. Knee Surg Sports Traumatol Arthrosc. 1999; 7:220–225.

23. Stevanović V, Blagojević Z, Petković A, et al. Semitendinosus tendon regeneration after anterior cruciate ligament reconstruction: can we use it twice? Int Orthop. 2013; 37:2475–2481.

24. Irie K, Tomatsu T. Atrophy of semitzendinosus and gracilis and flexor mechanism function after hamstring tendon harvest for anterior cruciate ligament reconstruction. Orthopedics. 2002; 25:491–495.

25. Hioki S, Fukubayashi T, Ikeda K, Niitsu M, Ochiai N. Effect of harvesting the hamstrings tendon for anterior cruciate ligament reconstruction on the morphology and movement of the hamstrings muscle: a novel MRI technique. Knee Surg Sports Traumatol Arthrosc. 2003; 11:223–227.

26. 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; 86:1936–1946.

27. Nakamae A, Ochi M, Deie M, Adachi N. Unsuccessful regeneration of the semitendinosus tendon harvested for anterior cruciate ligament reconstruction: report of two cases. Orthop Traumatol Surg Res. 2012; 98:932–935.

TOOLS

Similar articles