Abstract
In this study, mid to long-term results of anterior cruciate ligament reconstruction with hamstring tendons and Transfix technique were evaluated. Anterior cruciate ligament (ACL) reconstruction with four-strand hamstring tendon was performed with Transfix technique on 271 (198 males, 73 females; mean age 25.7; 17–52) patients with anterior cruciate ligament ruptures. The patients were followed up with clinical examination, Lysholm and Tegner activity scales, IKDC scoring system, KT-1000 test and radiological examination. The mean follow-up period was 82 (48–100) months; 204 (75%) patients had no subjective complaints. According to the KT-1000 test, only 14 (5%) patients had more than 5 mm laxity postoperatively, whereas, 161 (59%) patients had more than 5 mm laxity preoperatively. In addition to this, only 19 (7%) patients had Lysholm scores less than 80 postoperatively, whereas 154 (57%) patients scored less than 80 preoperatively. When compared with Tegner activity scale, 189 (70%) patients scored <6 preoperatively and only 24 (8%) postoperatively; 78 (29%) patients scored D preoperatively and only 5 (2%) patients scored D postoperatively on the basis of the IKDC scoring system. Our functional results were found to be satisfactory in more than 90% of patients. Commonly seen problems in ACL reconstruction such as inaccurate graft placement and tunnel widening were found to be consistent with the values in relevant literature. However, we demonstrated that the functional results and the stability of the knee were not related with tunnel widening. This study concludes that the reconstruction of ACL with hamstring tendons and the Transfix technique is reasonably successful, safe and causes low morbidity. Furthermore, we believe that proper graft preparation, accurate tunnel placement, notch-plasty, fixation and rehabilitation program are all as important as the choice of graft and fixation material.
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References
Aglietti P, Giron F, Buzzi R et al (2004) Anterior cruciate ligament reconstruction: bone–patellar tendon–bone compared with double semitendinosus and gracilis tendon grafts. J Bone Joint Surg 86(10):2143–2155
Ahlback S (1968) Osteoarthrosis of the knee: a radiographic investigation. Acta Radiol Diagn (Stockh) 277(Supll):7–72
Ahmad CS, Gardner TR, Groh M et al (2004) Mechanical properties of soft tissue femoral fixation devices for anterior cruciate ligament reconstruction. Am J Sports Med 32(3):635–640
Anderson JL, Lamb SE, Barker KL et al (2002) Changes in muscle torque following anterior cruciate ligament reconstruction. Acta Orthop Scand 73(5):546–552
Aune AK, Holm I, Risberg MA et al (2001) Four-strand hamstring tendon autograft compared with patellar tendon–bone autograft for anterior cruciate ligament reconstruction. Am J Sports Med 29(6):722–728
Beynnon BD, Johnson RJ, Fleming BC et al (2002) Anterior cruciate ligament replacement: comparison of bone–patellar tendon–bone grafts with two strand hamstring grafts. J Bone Joint Surg 84(9):1503–1513
Buelow JV, Siebold R, Ellermann A (2002) A prospective evaluation of tunnel enlargement in anterior cruciate ligament reconstruction with hamstrings: extracortical versus anatomical fixation. Knee Surg Sports Traumatol Arthrosc 10:80–85
Clark R, Olsen RE, Larson BJ et al (1998) Cross-pin femoral fixation: a new technique for hamstring anterior cruciate ligament reconstruction of the bone. Arthroscopy 14(3):258–267
Fabbriciani C, Milano C, Mulas PD et al (2005) Anterior cruciate ligament reconstruction with doubled semitendinosus and gracilis tendon graft in rugby players. Knee Surg Sports Traumatol Arthrosc 13:2–7
Fauno P, Kaolund S (2005) Tunnel widening after hamstring anterior cruciate ligament reconstruction is influenced by the type of graft fixation used: a prospective randomized study. Arthroscopy 21(11):1337–1341
Freedman KB, D’Amato MY, Nedeff DD et al (2003) Arthroscopic anterior cruciate ligament reconstruction: a meta-analysis comparing patellar tendon and hamstring tendon autografts. Am J Sports Med 31(1):2–7
Fu FH, Bennett CH, Lattermann C et al (1999) Current trends in anterior cruciate ligament reconstruction. Part 1: Biology and biomechanics of reconstruction. Am J Sports Med 27(6):821–830
Galla M, Uffmann J, Lobenhoffer P (2004) Femoral fixation of hamstring tendon autografts using the Transfix device with additional bone grafting in an anteromedial portal technique. Arch Orthop Traumatol Surgery 124:281–284
Giron F, Aglietti P, Cuoma P et al (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
Gobbi A, Mahajan S, Zanazzo M et al (2003) Patellar tendon versus quadrupled bone–semitendinosus anterior cruciate ligament reconstruction: a prospective clinical investigation in athletes. Arthroscopy 19(6):592–601
Goradia VK, Grana WA, Pearson SE (2006) Factors associated with decreased muscle strength after anterior cruciate ligament reconstruction with hamstring tendon grafts. Arthroscopy 22(1):80–86
Hantes ME, Dailiana Z, Zachos VC et al (2006) Anterior cruciate ligament reconstruction using the Bio-Transfix femoral fixation device and anteromedial portal technique. Knee Surg Sports Traumatol Arthrosc 14:497–501
Harilainen A, Sandelin J, Janssen KA (2005) Cross-pin femoral fixation versus metal interference screw fixation in anterior cruciate ligament reconstruction with hamstring tendons: results of a controlled prospective randomized study with 2-year follow-up. Arthroscopy 21(1):25–33
Howell SM, Clark JA (1992) Tibial tunnel placement in anterior cruciate ligament reconstruction and graft impingement. Clin Orthop 283:187–195
Howell SM, Gittins ME, Gottlieb JE et al (2001) The relationship between the angle of the tibial tunnel in the coronal plane and loss of flexion and anterior laxity after anterior cruciate ligament reconstruction. Am J Sports Med 29(5):567–574
Iorio R, Vadala A, Argento G et al (2006) Bone tunnel enlargement after ACL reconstruction using autologous hamstring tendons: a CT study. Int Orthop doi:10.1007/S 00264–006-0118-7
Irrang JJ, Ho H, Harner CD et al (1998) Use of the International Knee Documentation Committee guidelines to assess outcome following anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 6:107–112
Jansson KA, Linko E, Sandelin J et al (2003) A prospective randomized study of patellar versus hamstring tendon autografts for anterior cruciate ligament reconstruction. Am J Sports Med 31(1):12–18
Klein YP, Lintner DM, Downs D et al (2003) The incidence and significans of femoral tunnel widening after quadrupled hamstring anterior cruciate ligament reconstruction using femoral cross pin fixation. Arthroscopy 19(5):470–476
Kousa P, Jarunen TLN, Vihavainen M et al (2003) The fixation strength of six hamstring tendon graft fixation devices in anterior cruciate ligament reconstruction. Part 1: Femoral site. Am J Sports Med 31(2):174–181
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
Lysholm J, Gillquist J (1986) Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med 14:156–159
Majima T, Yasuda K, Tago H et al (2002) Rehabilitation after hamstring anterior cruciate ligament reconstruction. Clin Orthop 397:370–380
Mısra R, Straver A, El-Shazly M (2006) Intraarticular protrusion of malpositioned Transfix implant following ACL reconstruction. Arthroscopy 22(2):226–229
Milano G, Mulas PD, Pinas S et al (2006) Comparison between different femoral fixation devices for ACL reconstruction with doubled hamstring tendon graft: a biomechanical analysis. Arthroscopy 22(6):660–668
Nakamura N, Horibe S, Sasaki S et al (2002) Evaluation of active knee flexion and hamstring strength after anterior cruciate ligament reconstruction using hamstring tendons. Arthroscopy 18(6):598–602
Nebelung W, Becker R, Merkel M et al (1998) Bone tunnel enlargement after anterior cruciate ligament reconstruction with semitendinosus tendon using endobutton fixation on the femoral side. Arthroscopy 14(8):810–815
Pelfoit X, Monllau JC, Puig LL et al (2006) Iliotibial band friction syndrome after anterior cruciate ligament reconstruction using the Transfix device: report of two cases and rewiev of the literature. Knee Surg Sports Traumatol Arthrosc 14:586–589
Puyol N, David T, Bauer T et al (2005) Transvers femoral fixation in anterior cruciate ligament reconstruction with hamstrings graft: an anatomic study about the relationships between transcondylar device and the posterolateral structures of the knee. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/S00167–005-0024-3
Rose T, Hopp P, Venus J et al (2006) Prospective randomized clinical comparison of femoral transfixation versus bioscrew fixation in hamstring tendon ACL reconstruction: a preliminary report. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/S00167-006-0034-9
Sachs RA, Daniel DM, Stone ML et al (1989) Patellofemoral problems after anterior cruciate ligament reconstruction. Am J Sports Med 17:760–765
Scranton PE, Bagenstose YE, Lantz BA et al (2002) Quadruple hamstring anterior cruciate ligament reconstruction: a multicenter study. Arthroscopy 18(7):715–724
Segawa H, Omori G, Koga Y et al (2002) Rotational muscle strenght of the limb after anterior cruciate ligament reconstruction using semitendinosus and gracilis tendon. Arthroscopy 8(2):177–182
Sommer C, Friederich NK, Müler 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, Lysholm M et al (1986) A performance test to monitor rehabilitation and evaluate anterior cruciate ligament injuries. Am J Sports Med 14:156–159
West RV, Harner CD (2005) Graft selection in anterior cruciate ligament reconstruction. J Am Acad Orthop Surg 13:197–207
Wilcox JF, Gross YA, Sibel R et al (2005) Anterior cruciate ligament reconstruction with hamstring tendons and cross-pin femoral fixation compared with patellar tendon autografts. Arthroscopy 21(10):1186–1192
Wolf EM (1998) Semitendinosus and gracilis anterior cruciate ligament reconstruction using the Transfix technique. Techniques in Orthopedics 13(4):329–336
Webster KE, Chiu JJ, Feller JA (2005) Impact of measurement error in the analysis of bone tunnel enlargement after anterior cruciate ligament reconstruction. Am J Sports Med 33(11):1680–1687
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Asik, M., Sen, C., Tuncay, I. et al. The mid- to long-term results of the anterior cruciate ligament reconstruction with hamstring tendons using Transfix technique. Knee Surg Sports Traumatol Arthr 15, 965–972 (2007). https://doi.org/10.1007/s00167-007-0344-6
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DOI: https://doi.org/10.1007/s00167-007-0344-6