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

Document Type : RESEARCH PAPER


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


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


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Pages 426-431
  • Receive Date: 15 June 2020
  • Revise Date: 27 November 2020
  • Accept Date: 31 July 2021
  • First Publish Date: 30 August 2021