Abstract
This paper reports the results of our approach to ACL tears and knee laxity, based on 30 years of experience in ACL reconstruction with hamstrings and founded on the following cornerstones: the use of doubled semitendinosus and gracilis as a free graft; the use of an out-in technique for femoral drilling and of very strong and stiff fixation devices; the careful examination and repair or reconstruction of the lateral compartment in selected patients; and the use of unaggressive rehabilitation. We prospectively evaluated a series of 100 consecutive patients who underwent ACL reconstruction between 2001 and 2002. A clinical and radiological follow-up was performed at a minimum of 6 years. After 6 years, the International Knee Documentation Committee score demonstrated good-to-excellent results (A and B) in 98% of patients. However, arthrometric results using the KT-1000 demonstrated that 6/80 patients (7.5%) had >5 mm manual maximum side-to-side difference. The median Tegner activity score was 5 (range 1–9); the median Lysholm score was 96 (range 81–100); and the median subjective IKDC score was 94 (range 66–100). We reported 6/80 failures as revealed by a 2+ or 3+ pivot-shift test result and/or KT-1000 side-to-side difference of more than 5 mm. The IKDC score revealed excellent results in all women who underwent extra-articular tenodesis. Radiographic evaluation demonstrated early signs of osteoarthritis in 9% of patients.
Similar content being viewed by others
References
Aglietti P, Buzzi R, D’Andria S, Zaccherotti G (1992) Long-term study of anterior cruciate ligament reconstruction for chronic instability using the central one-third patellar tendon and a lateral extraarticular tenodesis. Am J Sports Med 20:38–45
Asik M, Sen C, Tuncay I, Erdil M, Avci C, Taser OF (2007) The mid- to long-term results of the anterior cruciate ligament reconstruction with hamstring tendons using Transfix technique. Knee Surg Sports Traumatol Arthrosc 15:965–972
Barrett GR, Noojin FK, Hartzog CW, Nash CR (2002) Reconstruction of the anterior cruciate ligament in females: a comparison of hamstring versus patellar tendon autograft. Arthroscopy 18:46–54
Bunchner M, Schmeer T, Schmitt H (2007) Anterior cruciate ligament reconstruction with quadrupled semitendinosus tendon—minimum 6 year clinical and radiological follow-up. Knee 14:321–327
Cinar BM, Akpinar S, Hersekli MA, Uysal M, Cesur N, Pourbagher A, Derincek A (2009) The effects of two different fixation methods on femoral bone tunnel enlargement and clinical results in anterior cruciate ligament reconstruction with hamstring tendon graft. Acta Orthop Traumatol Turc 43:515–521
Clatworthy MG, Annear P, Bulow J-U, Bartlett RJ (1999) Tunnel widening in anterior cruciate ligament reconstruction: a prospective evaluation of hamstring and patella tendon graft. Knee Surg Sports Traumatol Arthrosc 7:138–145
Draganich LF, Reider B, Ling M, Samuelson M (1990) An in vitro study of an intraarticular and extraarticular reconstruction in the anterior cruciate ligament deficient knee. Am J Sports Med 18:262–266
Engebretsen L, Lew WD, Lewis JL, Hunter RE (1990) The effect of an iliotibial tenodesis on intraarticular graft forces and knee joint motion. Am J Sports Med 18:169–176
Fairbank TJ (1948) Knee joint changes after meniscectomy. J Bone Joint Surg 30B:664–670
Ferretti A, Conteduca F, La Bianca L, Monaco E, De Carli A (2005) Evolgate fixation of doubled flexor graft in ACL reconstruction: biomechanical evaluation with cyclic loading. Am J Sports Med 33:574–582
Ferretti A, Conteduca F, Morelli F, Ticca L, Monaco E (2003) The Evolgate: a method to improve the pullout strength of interference screws in tibial fixation of anterior cruciate ligament reconstruction with doubled gracilis and semitendinosus tendons. Arthroscopy 19:936–940
Ferretti A, Monaco E, Labianca L, D’Angelo F, De Carli A, Conteduca F (2006) How four and twelve weeks of implantation affect the strength and stiffness of a tendon graft securely fixed in a bone tunnel: a study of Evolgate fixation in an extra-articular model bovine model. J Orthop Traumatol 7:136–141
Ferretti A, Vadalà A, De Carli A, Argento G, Conteduca F, Severini G (2008) Minimizing internal rotation strength deficit after use of semitendinosus for anterior cruciate ligament reconstruction: a modified harvesting technique. Arthroscopy 24:786–795
Giron F, Aglietti P, Cuomo P, Mondanelli N, Ciardullo A (2005) Anterior cruciate ligament reconstruction with double-looped semitendinosus and gracilis tendon graft directly fixed to cortical bone: 5-year results. Knee Surg Sports Traumatol Arthrosc 13:81–91
Goertzen M, Schulitz KP (1993) Comparison of combined extra- and intra-articular stabilization versus isolated arthroscopic semitendinosus repair after rupture of the anterior cruciate ligament. Sportverletz Sportschaden 7:7–12
Hefti F, Muller W, Jakob RP, Staubli HU (1993) Evaluation of knee ligament injuries with the IKDC form. Knee Surg Sports Traumatol Arthrosc 1:226–234
Hertel P, Behrend H, Cierpinski T, Musahl V, Widjaja G (2005) ACL reconstruction using bone-patellar tendon-bone press-fit fixation: 10-year clinical results. Knee Surg Sports Traumatol Arthrosc 13:248–255
Horer J, Moller HD, Fu FH (1998) Bone enlargement after anterior cruciate ligament reconstruction: fact or fiction? Knee Surg Sports Traumatol Arthrosc 6:231–240
Iorio R, Vadalà A, Argento G, Di Sanzo V, Ferretti A (2007) Bone tunnel enlargement after ACL reconstruction using autologous hamstring tendons: a CT study. Int Orthop 31:49–55
Jonsson H, Riklund-Ahlstrom K, Lind J (2004) Positive pivot shift after ACL reconstruction predicts later osteoarthrosis. Acta Orthop Scand 75:594–599
Kellgren JH, Lawrence JS (1957) Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16:494–502
Kessler MA, Behrend H, Henz S, Stutz G, Rukavina A, Kuster MS (2008) Function, osteoarthritis and activity after ACL-rupture: 11 year follow-up results of conservative versus reconstructive treatment. Knee Surg Sports Traumatol Arthrosc 16:442–448
L’Insalata JC, Klatt B, Fu FH et al (1997) Tunnel expansion following anterior cruciate ligament reconstruction: a comparison of hamstring and patellar tendon autografts. Knee Surg Sports Traumatol Arthrosc 5:234–238
Labianca L, Monaco E, Speranza A, Camillieri G, Ferretti A (2006) A biomechanical evaluation of six femur-graft-tibia complex in ACL reconstruction. J Orthop Traumatol 7:131–135
Lerat JL, Chotel F, Besse JL et al (1998) The results after 10–16 years of the treatment of chronic anterior laxity of the knee using reconstruction of the anterior cruciate ligament with a patellar tendon graft combined with an external extra-articular reconstruction. Rev Chir Orthop Reparatrice Appar Mot 84:712–727
MacIntosh DL, Darby JA (1976) Lateral substitution reconstruction. In: Proceedings of the Canadian Orthopaedic Association. J Bone Joint Surg Br 58:142
Marcacci M, Zaffagnini S, Giordano G, Iacono F, Presti ML (2009) Anterior cruciate ligament reconstruction associated with extra-articular tenodesis: a prospective clinical and radiographic evaluation with 10–13-year follow-up. Am J Sports Med 37:707–714
Monaco E, Labianca L, Conteduca F, De Carli A, Ferretti A (2007) Double bundle or single bundle plus extraarticular tenodesis in ACL reconstruction? A CAOS study. Knee Surg Sports Traumatol Arthrosc 15:1168–1174
Outerbridge RE (1961) The etiology of chondromalacia patellae. J Bone Joint Surg 43-B:752–757
Pearl AJ, Bergfeld JA (eds) (1992) Extraarticular reconstruction in the anterior cruciate ligament deficient knee. Human Kinetics, Champaign
Sommer CH, Friederich NF, Muller W (2000) Improperly placed anterior cruciate ligament grafts: correlation between radiological parameters and clinical results. Knee Surg Sports Traumatol Arthrosc 8:207–213
Tegner Y, Lysholm J (1985) Rating systems in evaluation of knee ligament injuries. Clin Orthop Relat Res 198:43–48
Vadalà A, Iorio R, De Carli A, Argento G, Di Sanzo V, Conteduca F, Ferretti A (2007) The effect of accelerated, brace free, rehabilitation on bone tunnel enlargement after ACL reconstruction using hamstring tendons: a CT study. Knee Surg Sports Traumatol Arthrosc 15:365–371
Zaffagnini F, Marcacci M, Lo Presti M et al (2006) Prospective and randomized evaluation of ACL reconstruction with three techniques: a clinical and radiographic evaluation at 5 year follow-up. Knee Surg Sports Traumatol Arthrosc 14:1060–1069
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Ferretti, A., Monaco, E., Giannetti, S. et al. A medium to long-term follow-up of ACL reconstruction using double gracilis and semitendinosus grafts. Knee Surg Sports Traumatol Arthrosc 19, 473–478 (2011). https://doi.org/10.1007/s00167-010-1206-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00167-010-1206-1