Anterior Cruciate Ligament Reconstruction with Tibial Attachment Preserving Hamstring Graft without Implant on Tibial Side
Background Tibial attachment preserving hamstring graft could prevent potential problems of free graft in anterior cruciate ligament (ACL) reconstruction such as pull out before graft-tunnel healing or rupture before ligamentization. Different implants have been reportedly used for tibial side fixat...
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| Veröffentlicht in: | Indian journal of orthopaedics 2018-03, Vol.52 (2), p.170-176 |
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| creator | Sinha, Skand Naik, Ananta Kumar Maheshwari, Mridul Sandanshiv, Sumedh Meena, Durgashankar Arya, Rajendra K. |
| description | Background
Tibial attachment preserving hamstring graft could prevent potential problems of free graft in anterior cruciate ligament (ACL) reconstruction such as pull out before graft-tunnel healing or rupture before ligamentization. Different implants have been reportedly used for tibial side fixation with this technique. We investigated short-term outcome of ACL reconstruction (ACLR) with tibial attachment sparing hamstring graft without implant on the tibial side by outside in technique.
Materials and Methods
Seventy nine consecutive cases of ACL tear having age of 25.7 ± 6.8 years were included after Institutional Board Approval. All subjects were male. The mean time interval from injury to surgery was of 7.5 ± 6.4 months. Hamstring tendons were harvested with open tendon stripper leaving the tibial insertion intact. The free ends of the tendons were whip stitched, quadrupled, and whip stitched again over the insertion site of hamstring with fiber wire (Arthrex). Single bundle ACLR was done by outside in technique and the femoral tunnel was created with cannulated reamer. The graft was pulled up to the external aperture of femoral tunnel and fixed with interference screw (Arthrex). The scoring was done by Lysholm, Tegner, and KT 1000 by independent observers. All cases were followed up for 2 years.
Results
The mean length of quadrupled graft attached to tibia was 127.65 ± 7.5 mm, and the mean width was 7.52 ± 0.78 mm. The mean preoperative Lysholm score of 47.15 ± 9.6, improved to 96.8 ± 2.4 at 1 year. All cases except two returned to the previous level of activity after ACLR. There was no significant difference statistically between preinjury (5.89 ± 0.68) and postoperative (5.87 ± 0.67) Tegner score. The anterior tibial translation (ATT) (KT 1000) improved from 11.44 ± 1.93 mm to 3.59 ± 0.89 mm. The ATT of operated knee returned to nearly the similar value as of the opposite knee (3.47 ± 1.16 mm). The Pivot shift test was negative in all cases. None had a failure of graft till final followup.
Conclusion
Attachment sparing hamstring graft without a tibial implant is a simple, cost-effective technique that provides a consistently satisfactory outcome. |
| doi_str_mv | 10.4103/ortho.IJOrtho_85_17 |
| format | Article |
| fullrecord | <record><control><sourceid>gale_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_5858211</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A530060302</galeid><sourcerecordid>A530060302</sourcerecordid><originalsourceid>FETCH-LOGICAL-c593r-77d90614f001e8970326d8591e1e7d0ea4ece9e4d1d1188c6b0d103e7abf412b3</originalsourceid><addsrcrecordid>eNp9klFr2zAUhc3YWNNuv2AwDIOxF2eSLVvWyyCErs0IdGzds5Dt61itbaWS3LD--l0nadaMUSyQkL9zpHt1guAdJVNGSfLZWN-Y6eLb1TjLPJWUvwgmVIg8SnjMXwYTQqiIUkaTk-DUuRtC0pjH2evgJBYpzzKWToKHWe_BamPDuR1KrTyES71SHfQ-_AGl6Z3Hfa9NH260b8JrXWjVhjPvVdlsqe8WHNh73a_CS9UhPq4urKr9VmEGHy66dasQRZO9_qeu4E3wqlatg7f7-Sz49fX8en4ZLa8uFvPZMipTkdiI80qQjLIaq4FccJLEWZWnggIFXhFQDEoQwCpaUZrnZVaQCtsDXBU1o3GRnAVfdr7roeigKvHSVrVybXWn7G9plJbHf3rdyJW5l2me5jGlaPBpb2DN3QDOy067ElqsCczgZExonmUZZzGiH_5Bb8xgeyxvpNCLiUT8pVaqBan72uC55WgqZ2lCSEYSMnpN_0PhV0Gn8WWg1rh_JPj4RNCAan3jTDuMr-eOwWQHltY4Z6E-NIMSOWZLbrMlj7KFqvdP-3jQPIYJgfMdsDEthsrdtsMGrET2tjeb57xxEPmYRPRhOx-3HsOEFocmPne_PxdQ-Vc</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2011134939</pqid></control><display><type>article</type><title>Anterior Cruciate Ligament Reconstruction with Tibial Attachment Preserving Hamstring Graft without Implant on Tibial Side</title><source>PubMed Central</source><source>EZB Electronic Journals Library</source><source>SpringerLink Journals - AutoHoldings</source><creator>Sinha, Skand ; Naik, Ananta Kumar ; Maheshwari, Mridul ; Sandanshiv, Sumedh ; Meena, Durgashankar ; Arya, Rajendra K.</creator><creatorcontrib>Sinha, Skand ; Naik, Ananta Kumar ; Maheshwari, Mridul ; Sandanshiv, Sumedh ; Meena, Durgashankar ; Arya, Rajendra K.</creatorcontrib><description>Background
Tibial attachment preserving hamstring graft could prevent potential problems of free graft in anterior cruciate ligament (ACL) reconstruction such as pull out before graft-tunnel healing or rupture before ligamentization. Different implants have been reportedly used for tibial side fixation with this technique. We investigated short-term outcome of ACL reconstruction (ACLR) with tibial attachment sparing hamstring graft without implant on the tibial side by outside in technique.
Materials and Methods
Seventy nine consecutive cases of ACL tear having age of 25.7 ± 6.8 years were included after Institutional Board Approval. All subjects were male. The mean time interval from injury to surgery was of 7.5 ± 6.4 months. Hamstring tendons were harvested with open tendon stripper leaving the tibial insertion intact. The free ends of the tendons were whip stitched, quadrupled, and whip stitched again over the insertion site of hamstring with fiber wire (Arthrex). Single bundle ACLR was done by outside in technique and the femoral tunnel was created with cannulated reamer. The graft was pulled up to the external aperture of femoral tunnel and fixed with interference screw (Arthrex). The scoring was done by Lysholm, Tegner, and KT 1000 by independent observers. All cases were followed up for 2 years.
Results
The mean length of quadrupled graft attached to tibia was 127.65 ± 7.5 mm, and the mean width was 7.52 ± 0.78 mm. The mean preoperative Lysholm score of 47.15 ± 9.6, improved to 96.8 ± 2.4 at 1 year. All cases except two returned to the previous level of activity after ACLR. There was no significant difference statistically between preinjury (5.89 ± 0.68) and postoperative (5.87 ± 0.67) Tegner score. The anterior tibial translation (ATT) (KT 1000) improved from 11.44 ± 1.93 mm to 3.59 ± 0.89 mm. The ATT of operated knee returned to nearly the similar value as of the opposite knee (3.47 ± 1.16 mm). The Pivot shift test was negative in all cases. None had a failure of graft till final followup.
Conclusion
Attachment sparing hamstring graft without a tibial implant is a simple, cost-effective technique that provides a consistently satisfactory outcome.</description><identifier>ISSN: 0019-5413</identifier><identifier>EISSN: 1998-3727</identifier><identifier>DOI: 10.4103/ortho.IJOrtho_85_17</identifier><identifier>PMID: 29576645</identifier><language>eng</language><publisher>New Delhi: Springer India</publisher><subject>Biomechanics ; Clinical outcomes ; Conservative Orthopedics ; Gangrene ; Knee ; Ligaments ; Medicine & Public Health ; Original ; Original Article ; Orthopedic surgery ; Orthopedics ; Political corruption ; Skin & tissue grafts ; Surgery ; Surgical Orthopedics ; Tendons ; Transplants & implants</subject><ispartof>Indian journal of orthopaedics, 2018-03, Vol.52 (2), p.170-176</ispartof><rights>Indian Orthopaedics Association 2018</rights><rights>COPYRIGHT 2018 Medknow Publications and Media Pvt. Ltd.</rights><rights>Copyright Medknow Publications & Media Pvt. Ltd. Mar/Apr 2018</rights><rights>Copyright: © 2018 Indian Journal of Orthopaedics 2018</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c593r-77d90614f001e8970326d8591e1e7d0ea4ece9e4d1d1188c6b0d103e7abf412b3</citedby><cites>FETCH-LOGICAL-c593r-77d90614f001e8970326d8591e1e7d0ea4ece9e4d1d1188c6b0d103e7abf412b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5858211/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5858211/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,881,27903,27904,41467,42536,51297,53769,53771</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29576645$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sinha, Skand</creatorcontrib><creatorcontrib>Naik, Ananta Kumar</creatorcontrib><creatorcontrib>Maheshwari, Mridul</creatorcontrib><creatorcontrib>Sandanshiv, Sumedh</creatorcontrib><creatorcontrib>Meena, Durgashankar</creatorcontrib><creatorcontrib>Arya, Rajendra K.</creatorcontrib><title>Anterior Cruciate Ligament Reconstruction with Tibial Attachment Preserving Hamstring Graft without Implant on Tibial Side</title><title>Indian journal of orthopaedics</title><addtitle>IJOO</addtitle><addtitle>Indian J Orthop</addtitle><description>Background
Tibial attachment preserving hamstring graft could prevent potential problems of free graft in anterior cruciate ligament (ACL) reconstruction such as pull out before graft-tunnel healing or rupture before ligamentization. Different implants have been reportedly used for tibial side fixation with this technique. We investigated short-term outcome of ACL reconstruction (ACLR) with tibial attachment sparing hamstring graft without implant on the tibial side by outside in technique.
Materials and Methods
Seventy nine consecutive cases of ACL tear having age of 25.7 ± 6.8 years were included after Institutional Board Approval. All subjects were male. The mean time interval from injury to surgery was of 7.5 ± 6.4 months. Hamstring tendons were harvested with open tendon stripper leaving the tibial insertion intact. The free ends of the tendons were whip stitched, quadrupled, and whip stitched again over the insertion site of hamstring with fiber wire (Arthrex). Single bundle ACLR was done by outside in technique and the femoral tunnel was created with cannulated reamer. The graft was pulled up to the external aperture of femoral tunnel and fixed with interference screw (Arthrex). The scoring was done by Lysholm, Tegner, and KT 1000 by independent observers. All cases were followed up for 2 years.
Results
The mean length of quadrupled graft attached to tibia was 127.65 ± 7.5 mm, and the mean width was 7.52 ± 0.78 mm. The mean preoperative Lysholm score of 47.15 ± 9.6, improved to 96.8 ± 2.4 at 1 year. All cases except two returned to the previous level of activity after ACLR. There was no significant difference statistically between preinjury (5.89 ± 0.68) and postoperative (5.87 ± 0.67) Tegner score. The anterior tibial translation (ATT) (KT 1000) improved from 11.44 ± 1.93 mm to 3.59 ± 0.89 mm. The ATT of operated knee returned to nearly the similar value as of the opposite knee (3.47 ± 1.16 mm). The Pivot shift test was negative in all cases. None had a failure of graft till final followup.
Conclusion
Attachment sparing hamstring graft without a tibial implant is a simple, cost-effective technique that provides a consistently satisfactory outcome.</description><subject>Biomechanics</subject><subject>Clinical outcomes</subject><subject>Conservative Orthopedics</subject><subject>Gangrene</subject><subject>Knee</subject><subject>Ligaments</subject><subject>Medicine & Public Health</subject><subject>Original</subject><subject>Original Article</subject><subject>Orthopedic surgery</subject><subject>Orthopedics</subject><subject>Political corruption</subject><subject>Skin & tissue grafts</subject><subject>Surgery</subject><subject>Surgical Orthopedics</subject><subject>Tendons</subject><subject>Transplants & implants</subject><issn>0019-5413</issn><issn>1998-3727</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp9klFr2zAUhc3YWNNuv2AwDIOxF2eSLVvWyyCErs0IdGzds5Dt61itbaWS3LD--l0nadaMUSyQkL9zpHt1guAdJVNGSfLZWN-Y6eLb1TjLPJWUvwgmVIg8SnjMXwYTQqiIUkaTk-DUuRtC0pjH2evgJBYpzzKWToKHWe_BamPDuR1KrTyES71SHfQ-_AGl6Z3Hfa9NH260b8JrXWjVhjPvVdlsqe8WHNh73a_CS9UhPq4urKr9VmEGHy66dasQRZO9_qeu4E3wqlatg7f7-Sz49fX8en4ZLa8uFvPZMipTkdiI80qQjLIaq4FccJLEWZWnggIFXhFQDEoQwCpaUZrnZVaQCtsDXBU1o3GRnAVfdr7roeigKvHSVrVybXWn7G9plJbHf3rdyJW5l2me5jGlaPBpb2DN3QDOy067ElqsCczgZExonmUZZzGiH_5Bb8xgeyxvpNCLiUT8pVaqBan72uC55WgqZ2lCSEYSMnpN_0PhV0Gn8WWg1rh_JPj4RNCAan3jTDuMr-eOwWQHltY4Z6E-NIMSOWZLbrMlj7KFqvdP-3jQPIYJgfMdsDEthsrdtsMGrET2tjeb57xxEPmYRPRhOx-3HsOEFocmPne_PxdQ-Vc</recordid><startdate>20180301</startdate><enddate>20180301</enddate><creator>Sinha, Skand</creator><creator>Naik, Ananta Kumar</creator><creator>Maheshwari, Mridul</creator><creator>Sandanshiv, Sumedh</creator><creator>Meena, Durgashankar</creator><creator>Arya, Rajendra K.</creator><general>Springer India</general><general>Wolters Kluwer India Pvt. 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Tibial attachment preserving hamstring graft could prevent potential problems of free graft in anterior cruciate ligament (ACL) reconstruction such as pull out before graft-tunnel healing or rupture before ligamentization. Different implants have been reportedly used for tibial side fixation with this technique. We investigated short-term outcome of ACL reconstruction (ACLR) with tibial attachment sparing hamstring graft without implant on the tibial side by outside in technique.
Materials and Methods
Seventy nine consecutive cases of ACL tear having age of 25.7 ± 6.8 years were included after Institutional Board Approval. All subjects were male. The mean time interval from injury to surgery was of 7.5 ± 6.4 months. Hamstring tendons were harvested with open tendon stripper leaving the tibial insertion intact. The free ends of the tendons were whip stitched, quadrupled, and whip stitched again over the insertion site of hamstring with fiber wire (Arthrex). Single bundle ACLR was done by outside in technique and the femoral tunnel was created with cannulated reamer. The graft was pulled up to the external aperture of femoral tunnel and fixed with interference screw (Arthrex). The scoring was done by Lysholm, Tegner, and KT 1000 by independent observers. All cases were followed up for 2 years.
Results
The mean length of quadrupled graft attached to tibia was 127.65 ± 7.5 mm, and the mean width was 7.52 ± 0.78 mm. The mean preoperative Lysholm score of 47.15 ± 9.6, improved to 96.8 ± 2.4 at 1 year. All cases except two returned to the previous level of activity after ACLR. There was no significant difference statistically between preinjury (5.89 ± 0.68) and postoperative (5.87 ± 0.67) Tegner score. The anterior tibial translation (ATT) (KT 1000) improved from 11.44 ± 1.93 mm to 3.59 ± 0.89 mm. The ATT of operated knee returned to nearly the similar value as of the opposite knee (3.47 ± 1.16 mm). The Pivot shift test was negative in all cases. None had a failure of graft till final followup.
Conclusion
Attachment sparing hamstring graft without a tibial implant is a simple, cost-effective technique that provides a consistently satisfactory outcome.</abstract><cop>New Delhi</cop><pub>Springer India</pub><pmid>29576645</pmid><doi>10.4103/ortho.IJOrtho_85_17</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Indian journal of orthopaedics, 2018-03, Vol.52 (2), p.170-176 |
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| source | PubMed Central; EZB Electronic Journals Library; SpringerLink Journals - AutoHoldings |
| subjects | Biomechanics Clinical outcomes Conservative Orthopedics Gangrene Knee Ligaments Medicine & Public Health Original Original Article Orthopedic surgery Orthopedics Political corruption Skin & tissue grafts Surgery Surgical Orthopedics Tendons Transplants & implants |
| title | Anterior Cruciate Ligament Reconstruction with Tibial Attachment Preserving Hamstring Graft without Implant on Tibial Side |
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