Evaluation of Knee Muscles in Patients undergoing Anterior Cruciate Ligament Reconstruction with Hamstring Tendon Graft (original) (raw)
BAC K G R O U N D Anterior cruciate ligament (ACL) inj ur ies are successfully r econstructed arthroscopically especially in young and active patients. The main purposes of these reconstructions are to achieve a stable and functional knee joint. Recently most frequently used autogenous graft types are mainly bone- patellar tendon- bone and quadruple hamstring tendon. The various advantages and disadvantages and their superiorities to each other are still debated. For this purpose we have compared the general symptomatology, stability, proprioception and functional results of ACL reconstruction operations that we used these graft types. M ET H O D S Twenty ACL reconstructed patients in two groups with 10 subjects each were included in our study. In one group ACL reconstruct ions were made with bone - patellar tendon one and in the other group with quadruple hamstring tendon. Anterior knee pain, thigh atrophy, stability, proprioception, Lysholm and Tegner activity level scores were ev...
Swiss Sports & Exercise Medicine
Purpose: Comparison of surgical techniques by evaluating functional capacities: power, strength, velocity and dynamic stability of knee extensor and flexor muscles after ACL reconstruction. Material and Methods: a prospective study with a retrospective comparative cohort of 111 patients (mean age 30 years (14.4 - 49.7). Outcomes: 18 outcomes were considered. Objective outcomes were the difference of power, strength, velocity and dynamic stability. Subjective outcomes included Tegner activity scale, Lysholm score, KOS, KOS-SAS (Knee Outcome Survey-Sport Activities Score), Tampa scale-Q. Results: The BPTB group performed better in 14 of 18 observed outcomes. 6 were statistically significant (velocity in quadriceps and hamstring, hamstring power-max, mean-power, Tegner score and KOS-SAS). No statistical difference in the stability capacities was shown between the both groups. The results were adjusted for age, gender, body-mass-index and follow-up time. Conclusions: The use of a BPTB a...
Acta Orthopaedica, 2002
We designed a prospective study to examine the influence of graft type (hamstring or patella tendon) on thigh muscle torque recovery after anterior cruciate ligament reconstruction. 60 patients undergoing ACL reconstruction, using a hamstring or patella tendon graft, were studied and 45 were followed up to 1 year. Concentric and eccentric quadriceps and hamstring torque were recorded, using an isokinetic dynamometer preoperatively, 6 and 12 months after ACL reconstruction. We found an improvement in all muscle functions in both the operated and unoperated legs during the recovery period. Graft type had no effect on recovery. During the first 6 months, torque was restored to preoperative levels and continued to improve in all muscles and actions between 6 months and 1 year.
The Results of Anterior Cruciate Ligament Reconstruction with Autogenous Hamstring Tendons
Introduction: Anterior cruciate ligament (ACL) injuries are the most common type of injury among knee ligament injuries. Despite the high success rates at ligament reconstruction with arthroscopic techniques, efforts for choosing the best grafts and fixation materials and appropriate post-operative rehabilitation are still ongoing. Materials and Methods: Between January 2007 and December 2010, 105 patients who underwent arthroscopic anterior cruciate ligament reconstruction using autogenous hamstring tendons were included in our study. The mean follow-up time was 16.3 months (7-46 months). The patients were evaluated according to physical examination findings like Lachman tests, Pivot-Shift, anterior drawer tests, thigh circumference measurement and clinical scores like Lysholm, IKDC score and VAS scores. Results: All patients underwent arthroscopy using standard arthroscopy portals. The residues of the ACL were cleaned and notchplasty was performed, and the semitendinosus and grasilis tendons were placed with transtibial technique in accordance with the trace of the natural ACL. Preoperatively, the Lysholm score was 56.16 ± 17.4 and postoperatively, the score was 90.16 ± 6.6 and the result was statistically significant. Lachman was found to be 86.7% negative, pivot shift was 100% negative and the anterior drawer test was 95.2% negative. Preoperative VAS was 6.28 ± 1.9 and postoperative VAS was 3.41 ± 1.2. According to the IKDC score, 4,8% of the patients were A, 41% B, 41,9% C and 12,4% D groups, 54,8% of the patients in the postoperative evaluation. A, 36.2% B, 8.6% C and 1% D groups. 12% of the patients felt numbness around the graft site. No other complication was observed. Conclusion: When ACL surgery with hamstring tendons is performed with appropriate surgical technique, satisfactory results are obtained. Anterior knee pain and pa-tella-related complications are frequently seen at patellar tendon grafts. This problem can be a reason for the preference of hamstring tendons in ACL repairs.
Hamstrings and Quadriceps Muscles Function in Subjects with Prior ACL Reconstruction Surgery
Journal of Functional Morphology and Kinesiology
Background: As the knee joint is a common site for injury among younger people, the purpose of this study was to measure the skeletal muscle endurance and strength on people with prior anterior cruciate ligament (ACL) knee reconstruction surgery. Method: Young healthy female subjects who reported having knee reconstruction surgery more than one-year prior were tested. The skeletal muscle endurance index (EI) of the hamstrings and quadriceps muscles was determined as the decline in the specific muscle acceleration in response to 2 Hz, 4 Hz, and 6 Hz electrical stimulation. Maximal isometric muscle strength (MVC) was measured in the hamstrings and quadriceps muscles. Results: The hamstrings muscles in the injured leg had less endurance than the non-injured leg at 6 Hz stimulation (55.5 ± 13.2% versus 78.0 ± 13.3%, p < 0.01). Muscle endurance was not reduced in the quadriceps muscles in the injured leg compared to the non-injured leg at 6 Hz stimulation (78.0 ± 13.3% versus 80.3 ± 1...
Medicine & Science in Sports & Exercise, 2000
The purpose of this study was to examine the strength of the knee flexors and knee extensors after two surgical techniques of ACL reconstruction and compare them to an age and activity level matched control group. Methods: Twenty-four subjects who had undergone ACL reconstruction greater than 1 yr previously were placed into one of two groups according to autograft donor site: patellar tendon (BPB; N ϭ 8) and hamstring (H; N ϭ 16), and compared with an active, control group (N ϭ 30). Knee flexor and extensor strength was evaluated using isovelocity dynamometry (5 speeds, eccentric and concentric, 5-95°ROM). Strength maps were used to graphically analyze strength over a broad operational domain of the neuromuscular system. Average strength maps were determined for each autograft group and compared with controls. A difference map (control minus graft group) and confidence (t-test) maps were used to quantitatively identify strength deficits. Results: The combined ACL group (N ϭ 24) revealed a global 25.5% extensor strength deficit, with eccentric regional (angle and velocity matched) deficits up to 50% of control. Strength deficits covered over 86% of the sampled strength map area (P Ͻ 0.01). These knee extensor strength deficits are greater than previously reported. In addition, the BPB group demonstrated a concentric, low velocity, knee extensor strength deficit at 60-95°that was not observed in the H group. Significant graft site dependent, regional knee flexor deficits of up to 50% of control were observed for the H group. Conclusions: Strength deficits localized to specific contraction types and ranges of motion were demonstrated between the ACL and control groups that were dependent upon autograft donor site. Postoperative rehabilitation protocols specific to these deficits should be devised.
IP innovative publication pvt. ltd, 2019
Introduction: Selection of graft for primary anterior cruciate ligament reconstruction have long been a topic of controversy. Among the vast range of graft options, hamstring autograft is most commonly used and quadriceps tendon autograft is less common. Purpose: To compare the functional outcomes in quadriceps tendon graft and quadruple hamstring graft in primary anterior cruciate ligament reconstruction. Materials and Methods: Thirty patients with post traumatic anterior cruciate ligament injury were taken into study. All 30 patients were randomised and two group were made. Group H Included 15 patients in which ACL reconstruction was done using quadruple hamstring graft and Group Q included 15 patients in which ACL reconstruction was done using quadriceps tendon graft. All patients were prospectively analysed. In post-operative period all patients were treated with standardized rehabilitation protocol and were evaluated at 6 weeks, 3 months and 6months by Lysholm knee score, quadriceps weakness, extension lag, quadriceps wasting, anterior drawer test, Lachman test and pivot shift test and compared. Results: Mean difference in extensor lag between both groups was 1.07(p value 4.48), - 0.22(p value 3.59) and - 0.32(p value 2.28) at first, second and third follow-up but was not significant. Mean difference in quadriceps strength between both groups was 4.10(p value 0.172), 2.04(p value 0.955) and - 2.46(p value 0.218) at first, second and third follow-up but was not significant. Mean difference in quadriceps wasting between both groups was - 0.29(p value 0.380), - 0.33(p value 0.349) and - 0.26(p value 0.217) at first, second and third follow-up but was not significant. Mean difference in Lysholm knee score between both groups was 4.10(p value 0.172), 2.04(p value 0.955) and - 2.46 (p value 0.218) at first, second and third follow up but was not significant. No significant difference was found in both groups. Conclusion: All the patients in whom ACL reconstruction were done showed good results irrespective of the choice of graft. The results showed no clinically significant difference at different follow-ups. Considering the small number of the study of short follow up, we recommend the study at larger scale for longer follow up to evaluate the results of both the procedures.
Cureus, 2021
To date, the proper choice of graft for anterior cruciate ligament (ACL) reconstruction remains a matter of conflict. We aimed to compare the clinical and functional outcomes of the two most commonly utilized autografts, bone-patella tendon-bone (BPTB) and four-strand hamstring tendon (HT) graft, at 6 and 12 months after surgery. In a prospective randomized study, we included a total of 60 patients undergoing ACL reconstruction, thirty in BPTB and thirty in HT group. All patients were amateur athletes and were evaluated at 6 and 12 months after surgery for: (a) postoperative functionality of the operated knee by the Tegner, the Lysholm and the International Knee Documentation Committee (IKDC) scoring scales, (b) anterior cruciate ligament (ACL) instability of the operated knee compared to the healthy contralateral knee by the KT-1000 arthrometer and (c) the extension and flexion muscle strength of the operated knee by a CYBEX isokinetic dynamometer. Patients in the two groups did not differ regarding demographics, and pre-injury functionality status. Significantly more patients in the HT group (n=6) compared to the BPTB group (n=1) experienced ACL rerupture and underwent revision surgery before follow-up end (p=0.044). All patients, regardless of graft, showed significant improvement within each group of functional assessments by Lysholm, Tegner and IKDC scores, as well as of Cybex measurements -with an increase of peak torque at 60° extension and 180°extension and 60° flexion and 180° flexion-at 12 months compared to 6 months follow-up (p<0.05). However, there was no difference between the two groups regarding knee function improvement or extension measurements neither at 6 nor 12 months. Contrarily, the BPTB graft group had higher values of peak torque (Nm) at 60° and 180° flexion compared to the HT group, both at 6 (p=0.014 and 0.029, respectively) and 12 months (p=0.033 and 0.030, respectively). Postoperative stability was similar between the two groups at 12 months (p=0.519). Both BPTB and HT grafts present with benefits and drawbacks and remain viable autograft options for primary ACL reconstruction as each has, although HT grafts seem to be more susceptible to re-rupture. The graft selection should be based on the needs and activities of each patient.
Knee Surgery, Sports Traumatology, Arthroscopy, 2018
Purpose In this prospective, double-center cohort study, we aim to assess how the anterior cruciate ligament (ACL) signal intensity on magnetic resonance imaging (MRI) potentially varies between a group of patients with anatomic ACL reconstruction using autogenous hamstring grafts 6 months postoperatively and a healthy ACL control group, and how MRI-based graft signal intensity is related to knee laxity. Methods Sixty-two consecutive patients who underwent ACL reconstruction using quadrupled hamstring tendon autograft were prospectively invited to participate in this study, and they were evaluated with MRI after 6 months of follow-up. 50 patients with an MRI of their healthy ACL (Clinica Luganese, Lugano, Switzerland) and 12 patients of their contralateral healthy knee (Department of Orthopaedic and Trauma Surgery, Medical University of Vienna, Austria) served as the control group. To evaluate graft maturity, the signal-to-noise quotient (SNQ) was measured in three regions of interest (ROIs) of the proximal, mid-substance and distal ACL graft and the healthy ACL. KT-1000 findings were obtained 6 months postoperatively in the ACL reconstruction group. Statistical analysis was independently performed to outline the differences in the two groups regarding ACL intensity and the correlation between SNQ and KT-1000 values. Results There was a significant difference in the mean SNQ between the reconstructed ACL grafts and the healthy ACLs in the proximal and mid-substance regions (p = 0.001 and p = 0.004). The distal region of the reconstructed ACL showed a mean SNQ similar to the native ACL (n.s). Patients with a KT-1000 between 0 and 1 mm showed a mean SNQ of 0.1; however, a poor correlation was found between the mean SNQ and KT-1000 findings, probably due to the small sample size of patients with higher laxity. Conclusion After 6 months of follow-up, hamstring tendon autografts for anatomic ACL reconstruction do not show equal MRI signal intensity compared to a healthy ACL and should therefore be considered immature or at least not completely healed even if clinical laxity measurement provides good results. However, in the case of a competitive athlete, who is clinically stable and wants to return to sports at 6 months, performing an MRI to confirm the stage of graft healing might be an option. Level of evidence Prospective, comparative study II.