Bob's ACL WWWBoard On-Line Knee Library |
------
Document Title: Toritsuka-AJARS-May04.shtml
Article Title: Second-look arthroscopy of anterior cruciate ligament grafts with multistranded hamstring tendons
Authors: Yukiyoshi Toritsuka M.D., Ph.D., Konsei Shino M.D., Ph.D., Shuji Horibe M.D., Ph.D., Tomoki Mitsuoka M.D., Ph.D., Masayuki Hamada M.D., Ph.D., Ken Nakata M.D., Ph.D., Norimasa Nakamura M.D., Ph.D. and Hideki Yoshikawa M.D., Ph.D.
Publication: Arthroscopy: The Journal of Arthroscopic & Related Surgery
Date: May 2004
Volume 20, Issue 3, March 2004, Pages 287-293
Keywords: ACL reconstruction, Second-look arthroscopy, Multistranded hamstring tendon graft
(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 set out to compare single-bundle with double-bundle ACL reconstruction techniques. They were unable to find any advantages of the latter, but note that more study is required to show that the theoretical advantages (i.e. better biomechanics because a double-bundle graft would better mimic the movement of a natural ACL) translate into immediately tangible benefits in the everyday clinical realm. The follow-up period ranged from 5 to 51 months (just over 4 years). Given that knee-ligament injuries bring lifelong consequences, it would be nice to see follow-up periods of 10 years, 20 years, or even longer...because these are the time-frames in which the standard ACL-injury-history sequelae (e.g. degenerative changes in the knee) tend to become increasingly apparent. And, it is over these time frames that the theoretical benefits of double-bundle ACL reconstruction are more likely to translate into improved knee longevity. (Of course, the theoretical benefits of double-bundle ACL grafting are only able to exert themselves if the surgeon is capable of handling the increased technical complexity that double-bundle grafting methods bring. Many surgeons today have a lot of problems correctly performing traditional single-bundle ACL grafts. Proof of this can be found in the fact that the single major cause of ACL-graft failure is still surgeon error.)
Abstract
Purpose: The purpose of this study was to clarify the fate of intra-articularly transplanted multistranded hamstring tendon grafts used for anterior cruciate ligament (ACL) reconstruction.
Type of study: Consecutive samples.
Methods
The subjects were 153 patients (156 knees) with a mean age of 24 years, who had been evaluated as experiencing clinical success. The patients consented to undergo second-look arthroscopy after ACL reconstruction with multistranded autogenous hamstring tendon grafts at 5 to 51 months previously. Ninety-six knees were surgically treated with the single-socket procedure, and the remaining 60 were treated with the bisocket procedure. None of the patients complained of instability of the index knee. The mean side-to-side difference at manual-maximum force in anterior displacement by KT-1000 on 107 patients was 1.2 ± 1.1 mm (-1 to 4 mm). Arthroscopic evaluation was performed focusing on tension and thickness dividing into 3 groups based on the postoperative period. The Chi-square and Mann-Whitney U tests were used for statistical analysis.
Results
A total of 139 grafts (89%) were evaluated as taut and 17 (11%) as mildly lax or lax. Fifty-three (34%) showed some partial tear, and the other 103 (66%) appeared thick without partial tear. The percentage of mildly lax or lax grafts in the group of patients older than 2 years was higher than that in patients younger than 1 year, and no significant difference was found among the groups in the percentage of partially torn grafts. The patients with mildly lax or lax grafts showed statistically higher KT values, while those with partially torn grafts did not. No statistically significant difference was seen in any of these findings between the 2 procedures, although the bisocket procedure tended to show better tension or thickness.
Conclusions: Arthroscopically, 11% of the hamstring ACL grafts showed looseness and 34% had partial tear in the clinically successful knees.
Level of evidence: Level IV in therapeutic studies investigating the results of treatment.
To access the full text of this article, please click here.
There is no charge for viewing articles. However, a password is required.
If you do not already have a password, please e-mail Michael Frind at frind@execulink.com for one.
Prior to requesting a password, please make certain you have read the
Site Terms of Use
pertaining to this site.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Copyright Arthroscopy: The Journal of Arthroscopic & Related Surgery, Arthroscopy Association of North America, Published by Elsevier of Holland, April 2005. For details regarding copyright as it applies to this page, please visit the page entitled Site Terms of Use and Aspects of Copyright on this site.
Copyright American Journal of Sports Medicine, American Orthopaedic Society for Sports Medicine, November/December 1999. For details regarding copyright as it applies to this page, please visit the page entitled Site Terms of Use and Aspects of Copyright on this site.
This website was created for the benefit of the world's largest knee-injury community, Bob's ACL WWWBoard (also known as the Kneeboard), accessible to everyone at http://factotem.org.
Documents posted on this site serve merely as a virtual library, and are intended solely for purposes of making access to high-quality peer-reviewed medical-journal articles convenient for all users of the Kneeboard. Knee-injury patients are hereby encouraged to discuss this material with their respective medical teams.
Click here to return to the Main Entrance Page of the Knee Library.
Looking for the Main Index Page of Bob's ACL WWWBoard? Click here!
To find recent postings on Bob's ACL WWWBoard, use the Search Engine.
To find older postings on Bob's ACL WWWBoard, use the On-Line Archive.
Site Terms of Use and Aspects of Copyright