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Document Title: Hamada-AJARS-Aug05.shtml
Article Title: Changes in Cross-Sectional Area of Hamstring Anterior Cruciate Ligament Grafts as a Function of Time Following Transplantation
Authors: Masayuki Hamada, Konsei Shino, Shuji Horibe, Tomoki Mitsuoka, Yukiyoshi Toritsuka, and Norimasa Nakamura
Publication: Arthroscopy, the Journal of Arthroscopy and Related Surgery
Date: August 2005
Volume Volume 21, Issue 8, August 2005, Pages 917-922
Keywords: hamstring autograft, soft-tissue grafting, graft choice.
(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: The authors found that the hamstring autograft increases encouragingly in cross-sectional area during the year after surgery. This provides tangible evidence that the ACL graft continues to ligamentize long after the typical formal-rehabilitation period of approximately 6 months. This is something to keep in mind when considering returning to knee-demanding sports. It is prudent to wait a year or longer, and to diligently continue physiotherapy and return-to-sports training (including sports-specific exercises and proprioceptive training, including plyometrics) during the latter half of the first postoperative year.
Abstract
Purpose: To measure the cross-sectional area (CSA) of hamstring anterior cruciate ligament (ACL) grafts in humans up to 2 years postoperatively and to estimate the appropriate graft-notch distance (the distance between ACL graft and roof or wall of the notch) at surgery.
Type of Study: Case series.
Methods: Fifty-nine patients, who had consented to have a magnetic resonance imaging (MRI) evaluation postoperatively, underwent endoscopic ACL reconstruction using 3- to 5-strand autogenous hamstring tendons. Intraoperatively, the CSA of the graft was measured using a custom-made area micrometer. Postoperatively, 115 axial MRIs of the grafts (48 at 3 months, 44 at 12 months, and 23 at 24 months) were obtained. They were transmitted to a personal computer and the CSAs of the grafts’ midsubstance were calculated. To evaluate the accuracy of the MRI measurement, another 15 patients who consented to have MRI 2 days after surgery were selected and intraoperative graft CSA measurements and graft axial MRI were performed 2 days after surgery.
Results: The CSAs of the grafts measured by MRI 2 days after surgery were well correlated with those directly measured intraoperatively (? = 0.905). The CSA of the grafts measured intraoperatively was 43 ± 5 mm2, and those estimated by MRI at 3, 12, and 24 months were 50 ± 9 mm2, 54 ± 9 mm2, and 48 ± 12 mm2, respectively. The increase in graft diameter at 3, 12, and 24 months was 9% ± 8%, 13% ± 10%, and 7% ± 12%, respectively.
Conclusions: In humans, the increase in CSA of the ACL graft was smaller compared with previous animal studies. The graft CSA increased up to 29% (13% in diameter) 12 months after surgery. When a 95% confidence interval was used, the percent increase in diameter of the reconstructed graft was estimated to be less than 32% in 95% of the cases. When the graft diameter was 7, 8, or 9 mm, a 1.1-, 1.3-, or 1.4-mm graft-notch distance, respectively, was suitable for impingement-free graft during postoperative periods with 95% of probability. Level of Evidence: Level IIII.
Key Words: Anterior cruciate ligament; Surgery; Notch impingement; Cross-sectional area; Hamstring tendon
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