Cenk CANKUŞ, Gökhan Bülent SEVER

Providing Graft Tension in ACL Reconstruction with Preservation of the Hamstring Tibial Attachment Site: A Report on the Technique and Clinical Results

Objective: Hamstring autograft is the most commonly used graft in the surgical technique for anterior cruciate ligament recon-struction. Different femoral fixation materials can be used in this surgery. This study aimed to share the surgical technique for an-atomic single-band anterior cruciate ligament reconstruction, preserving hamstring tibial attachment site and the clinical results. Methods: Total 42 consecutive patients who were operated for anterior cruciate ligament rupture were included in the study. An-atomic single-band anterior cruciate ligament reconstruction was performed for patients without disjointing the hamstring distal attachment site. Patients were evaluated in terms of age, sex, four-arm tendon length, total tunnel length from the hamstring attachment site, femoral tunnel length, length of the graft in the femoral tunnel, and the average tendon length calculated as per the tunnel length. The mean follow-up duration was 17 months. The patients were evaluated clinically using the Tegner activity score, Lysholm score, and International Knee Documentation Scale (IKDC). The anterior translation of the tibia was evaluated with a KT 1000 device.Results: The preoperative and postoperative mean Tegner, IKDC, and Lysholm scores were improved significantly.Conclusion: The surgical method for anatomic single-band anterior cruciate ligament reconstruction with preservation of the hamstring attachment site is a useful technique. Moreover, this technique is cost-effective and did not increase patient morbidity.

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1. Buda R, Ruffili A, Vannini F, Parma A, Giannini S. Anatomic anterior cruciate ligament reconstruction using distally inserted doubled hamstring tendons. Orthopaedics 2013; 36: 449-53.[CrossRef ]
2. Marcacci M, Zaffagnini S, Giordano G, Iacono F, Presti ML. Anterior cruciate ligament reconstruction associated with extraarticular teno-desis: a prospective clinical and radiographic evaluation with 10 to 13 year follow up. Am J Sports Med 2009; 37: 707-14. [CrossRef ]
3. Sinha S, Naik AN, Maneshwari M, Sandansniv S, Meena D, Arya RK. Anterior cruciate ligament reconstruction with tibial attachment preserving hamstring graft without implant on tibial side. Indian J Orthop 2018; 53: 170-6.
4. Janssen RP, Scheffler SU. Intraarticular remodelling of hamstring tendon grafts after anterior cruciate ligament reconstruction. Knee Surg Sports Traumato Arthrosc 2014; 22: 2102-8. [CrossRef ]
5. Löcherbach C, Zayni R, Champat P, Sonnery-Cotet B. Biologically en-hanced ACL reconstruction. Orthop Traumatol Surg Res 2010; 96: 810-5. [CrossRef ]
6. Wagih AM. Anatomic double bundle anterior cruciate ligament re-construction using in situ hamstring graft with 4 tunnels. Arthrosc Tech 2014; 3: e49-56. [CrossRef ]
7. Ruffili A, Pagliazzi G, Ferranti E, Busacca M, Capanelli D, Buda R. Ham-string graft tibial insertion preservation versus detachment in an-terior cruciate ligament reconstruction: a prospective randomized comparative study. Eur J Orthop Surg Traumatol 2016; 26: 657-64. [CrossRef ]
8. Ali MS, Kumar A, Adnaan Ali S, Hislop T. Anterior cruciate ligament reconstruction using hamstring tendon graft without detachment of the tibial insertion. Arch Orthop Trauma Surg 2006; 126: 644-8. [CrossRef ]
9. Sacramento SN, Magalhaes E, Christel P, Ingham S, Fukuda TY. A new technique in double bundle anterior cruciate ligament reconstruc-tion with implant free tibial fixation. Knee Surg Sports Traumatol Arthrosc 2016; 24: 2831-7.[CrossRef ]
10. Kim YK, Yoo JD, Kim SW, Park SH, Cho JH, Lim HM. Intraoperative graft isometry in anatomic single-bundle anterior cruciate ligament reconstruction. Knee Surg Relat Res 2018; 30: 115-20. [CrossRef ]
11. Lane JG, McFadden P, Bowden K, Amiel D. The ligamentization pro-cess: A 4 year case study following ACL reconstruction with a semi-tendinosis graft. Arthroscopy 1993; 9: 149-53.[CrossRef ]
12. Goradia VK, Rochat MC, Kida M, Grana WA. Natural history of a hamstring tendon autograft used for anterior cruciate ligament reconstruction in a sheep model. Am J Sports Med 2000; 28: 40-6. [CrossRef ]
13. Deehan DJ, Cawston TE. The biology of integration of the an-terior cruciate ligament. J Bone Joint Surg Br 2005; 87: 889-95. [CrossRef ]
14. Doschak MR, Zenicke RF. Structure, function and adaptation of bone-tendon and bone-ligament complexes. J Musculoskelet Neu-ronal Interact 2005; 5: 35-40.
15. Zaffagnini S, Golanio P, Farinas O, Depasquale V, Strocchi R, Cortec-chia S, et al. Vascularity and neuroreceptors of the pes anserinus: anatomic study. Clin Anat 2003; 16: 19-24. [CrossRef ]
16. Papachristou G, Nikolau V, Efstathopoulos N, Sourlas J, Lazarettos J, Frangia K, et al. ACL reconstruction with semitendinosus tendon autograft without detachment of its tibial insertion: a histologic study in a rabbit model. Knee Surg Sports Traumato Arthrosc 2007; 15: 1175-80.[CrossRef