2015 ISAKOS Biennial Congress ePoster #1223
Comparison of ACL Reconstruction With Tripled Semitendinosus Tendon Vs. Quadruple Semitendinosus/Gracilis Grafts
Rafael Arriaza-Loureda, MD, PhD, Perillo, Oleiros, La Coruña SPAIN
Javier Nicolas Nicolás Zepeda De Alba, MD, Mazatlan, Sinaloa MEXICO
Saúl Reán León Hernández, MD, PhD, Mexic, Df MEXICO
César Fernández Rodríguez, La Coruña, La Coruña SPAIN
Alvaro Arriaza Cantos, MD, Madrid SPAIN
Jesús Aizpurúa Prada, La Coruña, La Coruña SPAIN
Instituto Médico Arriaza y Asociados. Hospital HM Modelo, La Coruña, SPAIN
FDA Status Cleared
Summary: A series of 95 patients operated on by using the ST tripled tendon (STT) with standard fixation devices, was compared to a group of patients operated using doubled ST and GR (ST/GR) to form a four-strand graft. There was no correlation between the graft thickness and the rate of graft ruptures or complications. After 12 months, all the patients in the STT group had returned to their sports preinju
ACL reconstruction with hamstring (ST/GR) tendons is a very popular technique that gives excellent functional results. The use of a quadruple ST/GR tendons usually builds a 7-9 mm graft, but generally, graft length exceeds that required for the reconstruction and healthy tissue is severed and discarded at the end of the procedure. Although some authors have showed good results using only the ST tendon, either in tripled or quadrupled by using special fixation devices, there is a very limited bibliography on the subject.
The purpose of the study is to compare the clinical and functional results, as well as the complication rate, of a series of 95 patients operated on by using only the ST tripled tendon (STT) with standard fixation devices, versus a group of patients operated using doubled ST and GR (ST/GR) to form a four-strand graft.
Materials And Methods
There were 64 cases in the STT group, and 31 cases in the ST/GR group. In both groups femoral fixation was achieved with the ACL-TightRope (Arthrex) device, and tibial fixation waqs done with a resorbable interference screw (Megafix, Storz). Graft diameter was measured intraoperatively. Lachman's and pivot shift tests, as well as active range of motion in flexion were measured at 3, 6 and 12 months postop. Tegner and Lysholm activity scales, as well as time to return to sports were measured at a minimum of 12 months postop. Complications (specially flexion or extension limitations, re-tears or reinterventions) were recorded.
Statistical Analysis: Data normality was verified with the Saphiro-Wilk test for quantitative data, and with the Mann-Whitney U-test for non-parametric data. Square-Chi test was applied for proportion comparison, with the level of statistical significance set at p<0.05.
There were a total of 95 patients. Out of those, 64 were in the STT group and 31 in the ST/GR group. 77 were males and 18 females. There was no difference in associated meniscal or chondral injuries found at arthroscopy (p= 0.30). Grafts equal or thicker than 9 mm were 83.9% of the ST/GR group, but only 4.7% of the STT group (p=0.0001). Active flexion in prone was greater in the STT group: 131.7 +/- 5.6 degrees vs. 124.4 +/- 5.1 degrees: p= 0.0001. There was no correlation between the graft thickness and the rate of graft ruptures or complications (2 cases in the STT group and 2 cases in the ST/GR group). All the patients in the STT group had returned to their sports preinjury level by 12 months after surgery, but only 71% of the patients in the ST/GR group had done so (p_ 0.0002)
The use of a STT graft with standard fixation devices offers a safe alternative to the conventional ST/GR graft, sparing a knee flexor and internal rotator, which allows for a safe return to sports with better knee active flexion strength.