• Journal of Korean Orthopaedic Sports Medicine
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• v.10 no.1
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• pp.18-26
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• 2011

Purpose: This study is to compare the clinical results of ACL reconstruction between three groups using hamstring tendon autograft, mixed and tibialis tendon allograft. Materials and Methods: Between August 2003 and August 2008, we analyzed 169 cases of ACL reconstruction, 66 cases used hamstring tendon autograft, 42 cases used mixed graft and 61 cases used tibialis tendon allograft, with a minimum follow-up of 12 months. For the clinical evaluation, we evaluated the Lysholm score, Telos stress test device and IKDC score. Results: The average side to side difference in Telos stress test decreased from $7.5{\pm}1.0$ mm to $1.6{\pm}1.0$ mm in autograft group, from $7.6{\pm}1.1$ mm to $1.4{\pm}1.1$ mm in mixed graft group and from $7.4{\pm}1.3$ mm to $2.5{\pm}1.3$ mm in allograft group. The average Lysholm knee score improved from 58.6 to 92.3 in autograft group, from 60.6 to 92.6 in mixed graft group and from 55.3 to 91.5 in allograft group. There was no significant difference between three groups in clinical results. At second look arthroscopy, tension of ligament and synovial coverage were good result in autograft and mixed graft than allograft group. Conclusion: All hamstring tendon autograft, mixed graft and tibialis tendon allograft groups showed satisfactory clinical results, with no significant difference in outcomes between the groups. Both hamstring tendon autograft and mixed graft showed good synovial coverage in second look arthroscopy. So mixed graft will be considered as good alternative in case of shorter or thin harvested hamstring tendon.

• Journal of the Korean Arthroscopy Society
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• v.9 no.2
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• pp.143-147
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• 2005

Purpose: In case of anterior cruciate ligament (ACL) reconstruction, graft tendon is generally fixed in tibial tunnel with knee extended. When reconstructing ACL using hamstring tendon, the authors aim to find out the effect of knee joint position during graft fixation on postoperative knee joint stability and range of motion. Materials and Methods: Prospective study was done on patients who have undergone ACL reconstruction using hamstring tendon from May 2002 to January 2003 We used Rigifix system (Mitek Product, Johnson and Johnson, USA) and Intrafix system for fixation. Thirty nine patients received ACL reconstruction during this period. Excluding 2 patients lost in the follow-up, 37 patients were analyzed. The mean follow-up period was 14 months $(13{\sim}25months)$. Knee position was decided alternatively without any bias. Clinical evaluation was based on Lachman test, pivot shift test, Lysholm score, IKDC(international knee documentation committee) assessment and side to side KT-1000 maximal manual arthrometer difference. Results: After the last follow-up, average postoperative Lysholm score was 93.1 poins(65-98points). According to IKDC score, 26 cases were normal, 10 cases were nearly normal, 1 case was abnormal and we had no case of severe abnormality. The mean difference from the normal side was 2.5 mm under maximal manual loading KT-1000 arthrometer. According to postoperative Lachman test, 32 cases were normal,2 cases were grade I and 1 case was grade II. There were 34 cases of normal, 2 cases of grade I and 1 case of grade II. When using maximal manual KT-1000 arthrometer side to side difference, the difference from the normal side while fixing the tibia at 20'knee flexion was 2.3 mm and at full extention the difference was 2.7 mm. The range of motion at postoperative 1 year showed 5 degree flexion contracture in 1 case at 20 degrees knee flexion and 10 degrees of flexion limitation was observed in 2 cases at full extension. Conclusion: When ACL reconstruction using autogenous hamstring tendon, anterior laxity showed no difference in its stability between two groups. Tibial side fixation at full extension may be helpful in preventing flexion contracture due to overconstrained graft tendon.

• Journal of the Korean Arthroscopy Society
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• v.11 no.2
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• pp.85-91
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• 2007

Purpose: To analyze the clinical results and second look arthroscopic findings of anterior cruciate ligament(ACL) reconstruction with a tibialis anterior tendon allograft and a hamstring tendon autograft. Materials and Methods: We reviewed the cases of athroscopic ACL reconstructions using allogenous tibialis anterior(TA) tendon and autogenous hamstring tendon done from March, 2002 to August, 2005 and followed-up more than 1 year. The 250 cases were included in this study and allogenous TA tendon was used in 150 cases and autogenous hamstring tendon in 100 cases. The mean follow-up period was 15 months and 14 months, respectively. The clinical evaluation was done by Lachman test, Pivot shift test, KT-1000 arthrometer and International Knee Documentation Committee(IKDC) knee score. Graft tension, synovial coverage were observed in cases of second look arthroscopy. Results: At final follow-up, there was no significance between the two groups in clinical examination. On second look arthroscopy, synovial coverage was better in autogenous hamstring tendon group than allogenous TA tendon group(p=0.005). But no difference was found in graft tension(p>0.05). Conclusion: There were no significant differences between the two groups in the clinical results. But autogenous hamstring tendon group had better synovial coverage than allogenous TA tendon group in second look arthroscopy.

• Journal of the Korean Arthroscopy Society
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• v.10 no.2
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• pp.148-152
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• 2006

Purpose: The purpose of this study was to investigate the distribution of the diameter of four strand autologous hamstring tendon and to identify the factors related to the diameter. Materials and Methods: Between December 2004 and July 2006, 66 patients underwent anterior cruciate ligament reconstruction using autologous hamstring tendon. Sixty one patients were male and the other 5 patients were female. Both semitendinosus and gracilis tendon were harvested in every case. Harvested two tendons were folded once together to create a four strand double loop graft and were passed through cylindrical sizer to measure their diameter. Parameters such as sex, age, height and weight were analyzed for their correlation with the diameter of the graft. Results: The diameter of the graft ranged from 6 mm to 10 mm. The graft with the diameter of 8 mm was most common and the average diameter of all the grafts was $7.85{\pm}0.92mm$. Seven patients (10.6%) had a graft with the diameter of 6 mm, which is considered too thin to be ideal one. No statistically significant correlation was found between age of the patient and the diameter of the graft. However, the diameter of the graft was significantly correlated with sex, height and weight of the patient. Female patients had a significant tendency to have thinner hamstring tendons. Both small height and light weight of the patients were correlated with thinner hamstring tendons significantly. Conclusion: Sex, height and weight of the patients were the factors that had a statistically significant correlation with the diameter of the graft. Being aware of the risk factors related with harvesting exceedingly thin hamstring tendon prior to anterior cruciate ligament reconstruction, one can utilize wide range of options in selecting an optimal graft.

• Journal of the Korean Arthroscopy Society
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• v.6 no.2
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• pp.188-191
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• 2002

The complication caused by a bioabsorbable interference screw composed of Poly-L-Lactic-Acid is rare after anterior cruciate ligament (ACL) reconstruction. We reported a case of a pretibial ganglion at the orifice of the tibial tunnel where the graft tendon had been fixed with a bioabsorbable interference screw $(Bioscrew^{\circledR})$ for ACL reconstruction using autogenous hamstring tendon. The patient was underwent ganglion excision and interference screw removal.

• Journal of Korean Orthopaedic Sports Medicine
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• v.8 no.2
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• pp.109-114
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• 2009

Purpose: The purpose of this study is to compare the clinical results of ACL reconstruction between two groups using hamstring tendon autograft and tibialis anterior tendon allograft. Materials and Methods: Between January 2006 and June 2007, we analyzed 68 cases of ACL reconstruction, 32 cases using hamstring tendon autograft and 36 cases using tibialis anterior tendon allograft, with a minimum follow-up of 24 months. For the clinical evaluation, we evaluated the Lysholm score, anterior laxity by Telos device and KT-2000 arthrometer. Results: The mean diameter of graft were 8.0 mm (7.0~9.0 mm) in autograft group and 9.1 mm (8.0~10.0 mm) in allograft group. In all cases, the range of motion was above 135 degrees. The average side to side difference in Telos stress test decreased from $7.3{\pm}1.0$ mm to $2.4{\pm}1.1$ mm in autograft group and from $7.4{\pm}1.2$ mm to $2.3{\pm}1.3$ mm in allograft group. The average Lysholm knee score improved from $72.6{\pm}3.4$ to $92.3{\pm}3.5$ in autograft group and from $72.3{\pm}3.5$ to $91.6{\pm}3.3$ in allograft group. There was no significant difference between two groups in clinical results. Conclusion: Both hamstring tendon autograft and tibialis anterior tendon allograft groups showed satisfactory clinical results, with no significant difference in outcomes between the groups. We suggest that both hamstring tendon autograft and tibialis anterior tendon allograft will be considered as acceptable graft for anterior cruciate ligament reconstruction.

• Journal of the Korean Arthroscopy Society
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• v.10 no.2
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• pp.165-172
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• 2006

Purpose: The purpose of this study is to evaluate the effects of intratunnel fixation in the tibial side on the arthroscopic ACL reconstruction with quadruple hamstring tendon at the second look arthroscopy. Materials and Method: From Dec 1999 to May 2005, we arthroscopically reexamined 32 cases who had been done arthroscopic ACL reconstruction with quadruple hamstring tendons. Hamstring tendons of all cases were fixed at femoral side with RigidfixTM. At the tibial side hamstring tendons were fixed only Post-tie (Group I) or Post-tie combined with IntrafixTM (Group II). At the time of second look arthroscopy mean age of cases was 30 years and mean duration for second look arthroscopy was 21.3 months. We analyzed the results with IKDC score, KT-1000 arthrometer under anesthesia, Telos stress radiography, tibial tunnel widening on the radiography and second look arthroscopic findings. Results: Group II had more superior than group I at side to side differences with KT-1000 and Telos stress radiograph, IKDC score, but the differences were insignificant. At arthroscopic evaluation, Group ll also had more superior than group I at graft tension and graft appearance, graft synovialization, but the differences were insignificant. Tibial tunnel widening in the knee AP radiograph was 2.3 mm in Group I and 1.7 mm in Group II and the difference was significant. (P=0.042) Conclusions: Additional procedure of tibial intratunnel fixation in arthroscopic ACL reconstruction with autogenous hamstring tendon significantly prohibited from tibial tunnel widening but clinical results, radiologic joint stability, findings in second look arthroscopy were insignificantly different. We concluded that Post-tie itself induced satisfactory clinical results, joint stability and graft maturation and that tibial tunnel widening did not affect the results.

• Journal of the Korean Arthroscopy Society
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• v.3 no.2
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• pp.91-96
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• 1999

Purpose : The purpose of this study is to compare the clinical and radiologic results of the anterior cruciate ligament(ACL) reconstruction using bone-patellar tendon-bone unit with doubled semitendinosus and gracilis tendons. Materias and Methods : Clinical results of ACL reconstructions which were performed in 47 patients using doubled semitendinosus and gracilis were compared with those performed in 45 patients using bone-patellar tendon-bone autograft. There were no differences in preoperative parameters(age, sex, instability). Average follow-up period were 17 months and 19 months each. Results : There were no significant differences between two groups in functional results (Lysholm knee score), degree of laxity and range of motion at final follow-up. However, the parapatellar complication, especially anterior knee pain after long distance walking or exercise and quadriceps weakness less occurred in hamstring tendon group than in bone-patellar tendon-bone group. Conclusion : Although there were no significant differences in clinical results of ACL reconstruction using bone-patellar tendon-bone autograft and doubled semitendinosus and gacilis, parapateller complications occurred more in the bone-patellar tendon-bone autograft group than in the doubled semitendinosus and gracilis group. It is thought that the careful selection of patient, achivement of skillful technique and active rehabilitation are important to prevent the parapatellar complications.

• Journal of the Korean Arthroscopy Society
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• v.8 no.1
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• pp.19-25
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• 2004

Purpose: To compare the results of two different autografts used to reconstruct the anterior cruciate ligament(ACL): bone-patellar tendon-bone and quadruple hamstring tendon. Materials and Methods: Forty one cases (20 bone-patellar tendon-bone cases and 21 quadruple hamstring tendon cases) were followed up more than 2 years postoperatively. Patellar tendons were fixed with interference screws and hamstring tendons were fixed with cross pins and intrafix sheaths and screws. Follow-up results were evaluated with KT-2000 arthrometer, International knee Documentation Committee(IKDC) evaluation form and follow up X-ray Donor site morbidity was analysed. Results: Final IKDC) scores more than B grade and side to side differences of manual maximum test using KT-2000 arthrometer showed insignificant differences(p>) between the two groups. Plain radiographs of hamstring group showed marked widening of the femoral and tibial tunnels at postoperative 2 years. Patellar tendon group showed 30% rate of anterior knee complications. Conclusion: ACL reconstruction using autogenous hamstring graft with new fixation method showed comparable clinical results to using autogenous patellar tendon graft with fewer anterior knee symptoms.

• Journal of the Korean Arthroscopy Society
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• v.12 no.1
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• pp.32-39
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• 2008

Purpose: To evaluate the effectiveness of MRI after ACL reconstruction with femoral tunnel at 10 o'clock position. Materials and Methods: MRI findings of 29 patients after ACL reconstruction using hamstring tendon autograft were evaluated. The mean period from operation to MRI was 18.9 months($7{\sim}40$ months). Signal intensity, morphology and continuity of graft, femoral insertion, graft angle, roof impingement, cross pin breakage and position were evaluated. Those findings were compared with KT-2000, Lysholm knee score and pivot shift test. Results: There was no significant correlation between signal intensity of graft and the duration to MRI. Most common pattern of the morphology was straight, and the continuity was well-preserved. 13 cases of femoral tunnel insertion were zone 4 and 16 were zone 3. There were no roof impingement. 10 cases showed cross pin breakages, of which 5 were found at the outside of distal femoral posterior cortex. 9 showed cross pin directed posteriorly in axial view. There was no significant correlation between clinical results and cross pin breakage. Conclusion: MRI examinations after ACL reconstructions are useful to evaluate the graft status, position of the graft and cross pins. Since the direction of the cross pin is important especially in 10 o'clock femoral position, care should be taken to avoid cross pin breakage.