Comparative Analysis of Arthroscopic Tight Rope ACL Reconstruction Using four Strand Isolated Semitendinosus Graft and Quadrupled Combined Hamstring Graft

Document Type : RESEARCH PAPER

Authors

1 Department of Orthopaedics, Vardhman Mahavir Medical College, New Delhi

2 Department of Orthopedics, Lady Hardinge Medical College, New Delhi

3 Department of Orthopedics, All India Institute of Medical Sciences, Raipur

Abstract

Background: Arthroscopic ACL reconstruction using hamstring autograft is a quite a popular surgical procedure. 
But there is a conflict regarding the use of isolated semitendinosus graft or a combined hamstring graft. We did a 
comparative analysis of the functional outcome after ACL reconstruction performed with four strand semitendinosus 
graft and a combined hamstring graft over tightrope.
Methods: Two groups of 30 patients each with similar demographic profiles, presenting with symptoms of instability 
after chronic ACL tear were included. A standard single bundle arthroscopic ACL reconstruction was performed by using 
four-strand semitendinosus graft in Group A and combined hamstring graft in Group B patients. Clinical and functional 
outcome analysis was done using quantitative anterior tibial translation measurement and Lysholm score. 
Results: The mean age of subjects in group A was 29 years and in Group B was 28 years. The semitendinosus 
graft length was insufficient in 13.33% cases in group A. The improvement in Lysholm score and the decrease in the 
tibial translation were comparable in both the groups at one year of follow-up. No added comorbidities were noted in 
additional removal of gracilis tendon in group B patients.
Conclusion: Isolated semitendinosus four-strand autograft can be used for arthroscopic single bundle ACL 
reconstruction when adequate graft length is obtained. However, one should not be hesitant in additional removal of 
gracilis tendon when needed. In terms of functional outcome and patient satisfaction, both the graft configurations stand 
the same.
Level of evidence: I

Keywords


1. Lawhorn KW, Howell SM. Scientific justification
and technique for anterior cruciate ligament
reconstruction using autogenous and allogeneic softtissue grafts. The Orthopedic Clinics of North America.
2003; 34(1):19-30.
2. Muramatsu K, Hachiya Y, Izawa H. Serial evaluation of
human anterior cruciate ligament grafts by contrastenhanced magnetic resonance imaging: comparison of
allografts and autografts. Arthroscopy: The Journal of
Arthroscopic & Related Surgery. 2008; 24(9):1038-44.
3. Jost PW, Dy CJ, Robertson CM, Kelly AM. Allograft use
in anterior cruciate ligament reconstruction. HSS
Journal®. 2011; 7(3):251-6.
4. Steiner ME, Hecker AT, Brown Jr CH, Hayes WC.
Anterior cruciate ligament graft fixation: comparison
of hamstring and patellar tendon grafts. The American
journal of sports medicine. 1994; 22(2):240-7.
5. Gobbi A, Domzalski M, Pascual J, Zanazzo M.
Hamstring anterior cruciate ligament reconstruction:
is it necessary to sacrifice the gracilis? Arthroscopy:
The Journal of Arthroscopic & Related Surgery. 2005;
21(3):275-80.
6. Makihara Y, Nishino A, Fukubayashi T, Kanamori A.
Decrease of knee flexion torque in patients with ACL
reconstruction: combined analysis of the architecture
and function of the knee flexor muscles. Knee Surgery,
Sports Traumatology, Arthroscopy. 2006; 14(4):310-7.
7. Gobbi A, Francisco R. Quadruple semitendinosus
tendon for anterior cruciate ligament reconstruction.
Techniques in Orthopaedics. 2005; 20(3):203-6.
8. Henry BM, Tomaszewski KA, Pękala PA, Graves MJ,
Pękala JR, Sanna B, et al. Oblique incisions in hamstring
tendon harvesting reduce iatrogenic injuries to the
infrapatellar branch of the saphenous nerve. Knee
Surgery, Sports Traumatology, Arthroscopy. 2018;
26(4):1197-203.
9. Lanternier H, de Cussac JB, Collet T. Short medial
approach harvesting of hamstring tendons.
Orthopaedics & Traumatology: Surgery & Research.
2016; 102(2):269-72.
10.Vinagre G, Kennedy NI, Chahla J, Cinque ME,
Hussain ZB, Olesen ML, et al. Hamstring graft
preparation techniques for anterior cruciate ligament
reconstruction. Arthroscopy techniques. 2017;
6(6):e2079-84.
11.Carmont MR, Scheffler S, Spalding T, Brown J,  Sutton PM. Anatomical single bundle anterior
cruciate ligament reconstruction. Current reviews in
musculoskeletal medicine. 2011; 4(2):65-72.
12.Ganko A, Engebretsen L, Ozer H. The rolimeter: a
new arthrometer compared with the KT-1000. Knee
Surgery, Sports Traumatology, Arthroscopy. 2000;
8(1):36-9.
13.Yu B, Garrett WE. Mechanisms of non-contact ACL
injuries. British journal of sports medicine. 2007;
41(suppl 1):i47-51.
14.Millett PJ, Willis AA, Warren RF. Associated injuries
in pediatric and adolescent anterior cruciate
ligament tears: does a delay in treatment increase
the risk of meniscal tear? Arthroscopy: The Journal of
Arthroscopic & Related Surgery. 2002; 18(9):955-9.
15.Chaudhari AM, Briant PL, Bevill SL, Koo S, Andriacchi
TP. Knee kinematics, cartilage morphology, and
osteoarthritis after ACL injury. Medicine and science
in sports and exercise. 2008; 40(2):215-22.
16.Aglietti P, Buzzi R, Zaccherotti G, De Biase P. Patellar
tendon versus doubled semitendinosus and gracilis
tendons for anterior cruciate ligament reconstruction.
The American journal of sports medicine. 1994;
22(2):211-8.
17.Sinha S, Naik AK, Maheshwari M, Sandanshiv S, Meena
D, Arya RK. Anterior cruciate ligament reconstruction
with tibial attachment preserving hamstring graft
without implant on tibial side. Indian journal of
orthopaedics. 2018; 52:170-6.
18. Stergios PG, Georgios KA, Konstantinos N, Efthymia P,
Nikolaos K, Alexandros PG. Adequacy of semitendinosus
tendon alone for anterior cruciate ligament
reconstruction graft and prediction of hamstring graft
size by evaluating simple anthropometric parameters.
Anatomy research international. 2012; 2012.
19.Fauno P, Kaalund S. Tunnel widening after hamstring
anterior cruciate ligament reconstruction is
influenced by the type of graft fixation used: a
prospective randomized study. Arthroscopy: The
Journal of Arthroscopic & Related Surgery. 2005;
21(11):1337-41.
20.Papachristou G, Nikolaou 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 Surgery, Sports Traumatology,
Arthroscopy. 2007; 15(10):1175-80.
21.Tetsumura S, Fujita A, Nakajima M, Abe M.
Biomechanical comparison of different fixation
methods on the tibial side in anterior cruciate
ligament reconstruction: a biomechanical study in
porcine tibial bone. Journal of Orthopaedic Science.
2006; 11(3):278-82.
22.Harvey A, Thomas NP, Amis AA. Fixation of the graft
in reconstruction of the anterior cruciate ligament.
The Journal of bone and joint surgery. British volume.
2005; 87(5):593-603.
23.Magen HE, Howell SM, Hull ML. Structural properties
of six tibial fixation methods for anterior cruciate
ligament soft tissue grafts. The American journal of
sports medicine. 1999; 27(1):35-43.
24.Gobbi A. Double bundle ACL reconstruction using
only the semitendinosus. ISAKOS Current concepts,
Winter. 2007, vol 1: 8-9.
Volume 10, Issue 5
May 2022
Pages 426-431
  • Receive Date: 15 June 2020
  • Revise Date: 27 November 2020
  • Accept Date: 31 July 2021
  • First Publish Date: 30 August 2021