Outcome of Hamstring Autograft With Preserved Insertions Compared With Free Hamstring Autograft in Anterior Cruciate Ligament Surgery at 2-Year Follow-up

Gupta, Ravi; Bahadur, Raj; Malhotra, Anubhav; Masih, Gladson David; Sood, Munish; Gupta, Prabha Nini; Mathur, Vivek Kumar

doi:10.1016/j.arthro.2017.06.040

Cited by 16 publications

(7 citation statements)

References 28 publications

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“…These findings are also in contrast to those of other studies, which showed as many as 35%−60% of patients were able to return to the preinjury level. 19,20) The marginal improvement in Lachman test and Pivot shift test was not found to be significant. Although manual examination to check the stability of the joint cannot be considered as foolproof, it has a definite role as an examination performed by a single person.…”

Section: Discussionmentioning

confidence: 82%

Poor Functional Outcome in Patients with Voluntary Knee Instability after Anterior Cruciate Ligament Reconstruction

et al. 2020

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Anterior cruciate ligament (ACL) tears are commonly seen injuries in sports traumatology. 1) Arthroscopic ACL reconstruction (ACLR) is considered the standard of care for patients with ACL tears with instability. 2-4) The aim of ACLR is to restore the preinjury level of function, which is a challenging task. 5,6) The good functional outcome after ACLR depends upon multiple factors, which can be divided into extrinsic and intrinsic factors. 7) The extrinsic factors include the type of graft used, surgical technique, and preoperative and postoperative rehabilitation. The intrinsic factors are various, including the genetic and biological factors, type of tear, associated injuries, motivation, and psychological attitude. 7-10) Pain and swelling of the knee joint are the initial symptoms of an acute ACL injury, whereas instability of

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Section: Discussionmentioning

confidence: 82%

Poor Functional Outcome in Patients with Voluntary Knee Instability after Anterior Cruciate Ligament Reconstruction

et al. 2020

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“…Tibial side xation has been observed to be a weak link post ACL reconstruction as the vector of forces acts in the line of tibial tunnel [37,38]. Further, tendon to bone healing at insertion site is superior to tendon xation inside tunnel with screw as observed by various studies inpast [15,16,[18][19][20]. As, the biological insertion at tibial side maintains the inherent strength, that is resistant to cyclical forces [15], we propose, hamstring graft with preserved insertion provides less chances of graft pull-out from tunnel.…”

Section: Discussionmentioning

confidence: 99%

“…With the problems related to the vascularisation of graft, less effective proprioception postoperatively, and weak tibial side xation, there remains risk of graft pull-out from the tunnel [15][16][17]. Recent literature reports, preservation of insertion on tibial side led to better mechanical stability and proprioception, though not established conclusively [15,[17][18][19][20]. Also, Sacramento et al in a study on double bundle ACL reconstruction with preserved tibial side insertion reported better clinical outcome and stability [20].…”

Section: Introductionmentioning

confidence: 99%

Outcome of hamstring graft with preserved insertion: Prospective Study with 5 year Follow-up

Gupta

Singhal

Mehta

et al. 2020

Preprint

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BackgroundAutologous hamstring graft remains to be a commonly used graft for Anterior Cruciate Ligament (ACL) in sportspersons. With less graft failure rates, better mechanical stability and proprioception with preserved insertion hamstring graft, we investigated long term outcomes of hamstring graft with preserved insertion. Methods: 441 sportspersons were enrolled in the study. They were divided into two groups by computerized randomization. In Group I, ACL reconstruction was done using hamstring free graft (STGF), and in Group II, ACL reconstruction was done using hamstring graft with preserved tibial insertion (STGPI). Postoperatively, patients were assessed for graft rupture, knee stability, Lysholm score, tegner activity and WOMAC score.ResultsThe average age of the patients was 24 ± 2 years in group 1 and 27 ± 8.5 years in group 2. At 5 years, the mean KT-1000 difference was 2.01 in group 1 and 1.96 in group 2 (P = 0.77); the mean Lysholm score was 97.80 and 98.60(p = 0.07), respectively; mean WOMAC score was 3.09 and 3.12(p = 0.89) respectively; mean difference between the pre-injury and post-surgery Tegner level of sports activity was 1.78 and 0.54(P < 0.05), respectively and graft failure rate was 4.1% and 7.7%.(p < 0.05), respectively.ConclusionWe report STGPI to be a more viable option than hamstring free graft in sportspersons for ACL reconstruction due to less graft failure rates and better tegner activity score postoperatively. Further, STGPI is an option with low graft failure rate like that of Bone Patellar Tendon Bone graft,with added advantage of not having significant donor site morbidity.Level of EvidenceLevel 1, Randomized Controlled Trial

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“…Since then, several studies have evaluated the functional and biomechanical outcomes of hamstring insertion-preserving procedures. Gupta et al compared the ACL reconstruction with pedunculated hamstring autograft and the free hamstring autograft after 2 years of follow-up [24]. The results of their single-blinded randomized trial reported significantly higher Cincinnati knee scores, greater improvement in the Tegner activity scale and lower side-to-side difference in KT-1000 testing in favor of the pedunculated hamstring group.…”

Section: Preservation Of Hamstrings Tibial Insertionmentioning

confidence: 99%

Maturation of Anterior Cruciate Ligament Graft—Possibilities of Surgical Enhancement: What Do We Know So Far?

Ebisz¹,

Góralczyk

Mostowy

et al. 2021

Applied Sciences

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The purpose of this study is to review the surgical methods of enhancing anterior cruciate ligament (ACL) graft maturation. Several methods of ACL maturation enhancement were identified through research of the literature available in the PubMed database. ACL remnant preservation was the most extensively investigated technique. ACL reconstruction with a pedunculated hamstring graft provides superior revascularization of the graft along with higher mechanical strength. The usage of a graft enveloped with a periosteum was proposed to enhance the tendon-bone unit formation, and consequently, to prevent the bone tunnel widening. The muscle tissue on the graft is a potential source of stem cells. However, an excessive amount may weaken whole graft strength despite its enhanced remodeling. Similarly, amniotic tissue may augment the ACL reconstruction with stem cells and growth factors. Despite the existence of several surgical techniques that utilize amnion, the outcomes of these augmentation methods are lacking. Lastly, the intra-articular transplantation of the synovium on the surface of an ACL was proposed to augment the graft with synovial tissue and blood vessels. In conclusion, diverse approaches are being developed in order to enhance the maturation of an ACL reconstruction graft. Although these approaches have their foundation in on well-established scientific research, their outcomes are still equivocal. Clinical trials of high quality are needed to evaluate their utility in clinical practice.

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Outcome of Hamstring Autograft With Preserved Insertions Compared With Free Hamstring Autograft in Anterior Cruciate Ligament Surgery at 2-Year Follow-up

Cited by 16 publications

References 28 publications

Poor Functional Outcome in Patients with Voluntary Knee Instability after Anterior Cruciate Ligament Reconstruction

Poor Functional Outcome in Patients with Voluntary Knee Instability after Anterior Cruciate Ligament Reconstruction

Outcome of hamstring graft with preserved insertion: Prospective Study with 5 year Follow-up

Maturation of Anterior Cruciate Ligament Graft—Possibilities of Surgical Enhancement: What Do We Know So Far?

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