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Document Title: Chouliaras-AJSM-Feb07.shtml
Article Title: Effectiveness of Reconstruction of the Anterior Cruciate Ligament With Quadrupled Hamstrings and Bone-Patellar Tendon-Bone Autografts -- An In Vivo Study Comparing Tibial Internal-External Rotation
Authors: Vasileios Chouliaras, MD, Stavros Ristanis, MD, Constantina Moraiti, MD, Nicholas Stergiou, PhD and Anastasios D. Georgoulis, MD.
Publication: American Journal of Sports Medicine, Baltimore, Maryland
Date: February 2007
Volume 35, pages 189-196
Keywords: Knee motion, single-bundle ACL graft, compatibility of various graft constructs with double-bundle graft, anterior cruciate ligament reconstruction, gait analysis, tibial rotation, quadrupled hamstrings autograft, DLSTG, bone-patellar tendon-bone autograft.
(Reference-denoting numbers appear in the same font and point size as the document text. As with all Knee Library documents, this article is provided in full-text form, complete with all figures and tables.)
Comments: These authors confirm and amplify a long-standing (see, for example, Furia-AJSM-May97.shtml) biomechanical worry: that the standard single-bundle ACL-graft construct, as has been used for years in hundreds of thousands of patients, unsatisfactorily reproduces the intricate biomechanics and motion of the natural ACL. The biomechanical need for a double-bundle graft construct is abundantly clear. Other good articles dealing with ACL-graft biomechanics, and highlighting the benefits of a double-bundle ACL graft construct, are Petersen-AJSM-Feb07.shtml and Zantop-AJSM-Feb07.shtml. However, there is one practical problem with double-bundle ACL-grafting: such grafting is technically more complicated than single-bundle ACL grafting, and thus makes far greater demands on the surgeon's skill. This means there is greater risk of surgeon error with a double-bundle graft. In the future, widespread implementation of double-bundle ACL grafting might be feasible through the use of technological advancements such as computerized bone-tunnel-drilling guidance systems. Such systems would have to somehow scan the knee bones (remember that each person's knee is unique), accurately map the individual's knee and its motion in three dimensions, and indicate where the bone tunnels should be drilled and what tension should be applied to the grafts upon installation.
ABSTRACT
Background: The 2 most frequently used autografts for anterior cruciate ligament reconstruction are the bone-patellar tendon-bone and the quadrupled hamstrings tendon.
Hypothesis: Hamstring tendon graft is superior to patellar tendon graft in restoring tibial rotation during highly demanding activities because of its superiority in strength and linear stiffness and because it is closer morphologically to the anatomy of the natural anterior cruciate ligament.
Study Design: Case control study; Level of evidence, 3.
Methods: Eleven patients with patellar tendon graft anterior cruciate ligament reconstruction, 11 patients with hamstring tendon graft anterior cruciate ligament reconstruction, and 11 controls were assessed. Kinematic data were collected (50 Hz) with a 6-camera optoelectronic system while the subjects descended stairs and, immediately after, pivoted on their landing leg. The dependent variable examined was the tibial internal-external rotation during pivoting. All patients in both groups were also assessed clinically and with the use of a KT-1000 arthrometer to evaluate anterior tibial translation.
Results: The results demonstrated that reconstructions with either graft successfully restored anterior tibial translation. However, both anterior cruciate ligament reconstruction groups had significantly increased tibial rotation when compared with the controls, whereas no differences were found between the 2 reconstructed groups.
Conclusion: The 2 most frequently used autografts for anterior cruciate ligament reconstruction cannot restore tibial rotation to normal levels.
Clinical Relevance: New surgical techniques are needed that can better approximate the actual anatomy and function of the anterior cruciate ligament.
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