https://onlinelibrary.wiley.com/doi/pdf/10.1016/S0736-0266%2803%2900133-5

Distribution of in situ forces in the anterior cruciate ligament in response to rotatory loads

Anterior cruciate ligament tears, common among athletes, are functionally disabling; they predispose the knee to subsequent injuries and the early onset of osteoarthritis. A total of 3810 studies published between January 1994 and the present were identified and reviewed to determine the current state of knowledge regarding the treatment of anterior cruciate ligament injuries. Part 1 of this article focused on studies pertaining to the biomechanical behavior of the anterior cruciate ligament, the prevalence of and risk factors for injuries related to it, the natural history of the ligament-deficient knee, injuries associated with anterior cruciate ligament disruption, indications for the treatment of anterior cruciate ligament injuries, as well as nonoperative and operative treatments. Part 2 includes technical aspects of anterior cruciate ligament surgery, bone tunnel widening, graft healing, rehabilitation after anterior cruciate ligament reconstruction, and the effects of sex, age, and activity level o...

Treatment of Anterior Cruciate Ligament Injuries, Part I:

Background: Patellar and hamstring tendon autografts are the most frequently used graft types for anterior cruciate ligament reconstruction, but few direct comparisons of outcomes have been published.Hypothesis: There is no difference in outcome between the two types of reconstruction.Study Design: Prospective randomized clinical trial.Methods: After isolated anterior cruciate ligament rupture, 65 patients were randomized to receive either a patellar tendon or a four-strand hamstring tendon graft reconstruction, and results were reviewed at 4, 8, 12, 24, and 36 months.Results: Pain on kneeling was more common and extension deficits were greater in the patellar tendon group. There were greater quadriceps peak torque deficits in the patellar tendon group at 4 and 8 months but not thereafter. In the hamstring tendon group, active flexion deficits were greater from 8 to 24 months, and KT-1000 arthrometer side-to-side differences in anterior knee laxity at 134 N were greater. Cincinnati knee scores, Internatio...

/pdf/a-randomized-comparison-of-patellar-tendon-and-hamstring-3n7unl10ze.pdf

A Randomized Comparison of Patellar Tendon and Hamstring Tendon Anterior Cruciate Ligament Reconstruction

Background: The aim of the study was to compare the results after arthroscopic anterior cruciate ligament (ACL) reconstruction using central-third bone—patellar tendon—bone (BTB) autografts and triple/quadruple semitendinosus (ST) autografts.Hypothesis: In the long-term, ACL reconstruction using BTB autografts will render more donor-site problems than ST autografts.Study Design: Randomized controlled trial; Level of evidence, 1.Methods: A randomized series of 71 patients (22 women and 49 men) with a unilateral ACL rupture who underwent reconstructive surgery were included in the study. The BTB graft was used in 34 patients (BTB group) and the ST-tendon graft was used in 37 patients (ST group). The patients were examined a median of 86 months (range, 68 to 114 months) after the reconstruction.Results: Sixty-eight of 71 patients (96%) were examined at follow-up. The clinical assessments at follow-up revealed no significant differences between the BTB group and the ST group in terms of the Lysholm score, Teg...

Patellar Tendon or Semitendinosus Tendon Autografts for Anterior Cruciate Ligament Reconstruction: A Prospective, Randomized Study With a 7-Year Follow-up

Purpose: A randomized clinical study was conducted to compare the outcome between double-bundle (DB) and single-bundle (SB) anterior cruciate ligament (ACL) reconstructions with 4-strand semitendinosus tendon (ST). Methods: We divided 68 patients with unilateral ACL injury into 2 groups according to their birth date, and they were followed up in person for a mean of 25 months (range, 18 to 41 months). Each group of 34 patients underwent either DB or SB ACL reconstruction using 4-strand ST with EndoButton femoral fixation (Smith & Nephew Endoscopy, Andover, MA) and anchor staple tibial fixation. There was no difference between the 2 groups with regard to age at surgery, sex, follow-up period, period before surgery, combined meniscus injuries, and athletic activity level. All patients followed the same postoperative program. They were evaluated using manual knee laxity tests, instrumented anterior laxity measurements (KT-1000 arthrometer [MEDmetric, San Diego, CA]), knee extension and flexion strength testing, and so on. General knee condition was evaluated by use of the Lysholm knee score and subjective rating scale. Results: There were no significant differences between the 2 groups with regard to range of motion, thigh girth, muscle strength, and Lysholm score. Manual knee laxity testing revealed that negative Lachman and pivot-shift test results were found in more patients in the DB group than in the SB group. KT measurements averaged 2.4 mm in the SB group and 1.4 mm in the DB group, which was statistically significantly different. Statistical analysis showed no significant difference regarding all of the modified International Knee Documentation Committee–categorized data between the 2 groups. Conclusions: This randomized controlled trial indicated that DB ACL reconstruction via 4-strand ST is superior to the SB technique with regard to anterior and rotational stability; however, it fails to show any subjective difference. Level of Evidence: Level I, prospective randomized controlled clinical study.

A Prospective Randomized Study of 4-Strand Semitendinosus Tendon Anterior Cruciate Ligament Reconstruction Comparing Single-Bundle and Double-Bundle Techniques

A prospective randomized study was performed to determine the differences in results between three methods of anterior cruciate ligament reconstruction: autogenous bone-patellar tendon-bone graft (group 1), semitendinosus and gracilis tendon graft reconstruction combined with an extraarticular procedure (group 2), and semitendinosus and gracilis tendon graft reconstruction alone (group 3). Preoperatively, there were no significant differences between groups. At a mean of 35.4±11.6 months postoperatively, 102 patients returned for evaluation. International Knee Documentation Committee knee evaluation revealed no significant differences in symptoms, function, return to pre-injury activity, harvest site abnormalities, or limitation of motion between groups 1 and 3. Patients in group 2 had a higher incidence of patellofemoral crepitation and loss of motion than did patients in group 3. The mean manual maximum KT-1000 arthrometer side-to-side difference was 2.1±2.0 mm in group 1, which was statistically signif...

Robert B. Snyder

Papers

Anterior Cruciate Ligament Reconstruction A Prospective Randomized Study of Three Surgical Methods