Background: In this study, we analyzed the clinical outcomes at a
minimum of two years following reconstruction of the anterior cruciate
ligament with use of a four-strand hamstring tendon autograft in patients who
had presented with a symptomatic torn anterior cruciate ligament.
Methods: One hundred and twenty-two consecutive patients who had an
isolated, symptomatic anterior tibial subluxation associated with rupture of
the anterior cruciate ligament were treated with reconstruction of the
anterior cruciate ligament with a four-strand autologous
semitendinosus-gracilis tendon graft. One surgeon performed all of the
operations. Prior to surgery and at the follow-up examination, physical
findings and functional scores were recorded and knee radiographs were
analyzed. Following surgery, a six-month rehabilitation regimen was
Results: Eighty-five patients (70%) were available for follow-up,
which included physical examination, scoring of function, KT-1000 arthrometric
testing, and radiographs, at a mean of twenty-eight months. Seventy-six (89%)
of the patients had negative Lachman and pivot shift tests. The mean Lysholm
score improved from 55 points preoperatively to 91 points at the time of
follow-up (p < 0.01). The mean Tegner score improved from 5 to 6 points (p
< 0.01). Sixty-five patients had <3 mm of knee translation on
arthrometric testing, but six patients with marked laxity were not tested.
Three patients (4%) had a positive pivot shift test but had no history of
additional trauma to the knee. Six patients (7%) had a traumatic rupture of
the graft, occurring at a mean of 10.7 months postoperatively. Assessment of
the follow-up radiographs demonstrated no evidence of progressive degenerative
change compared with the appearance on the preoperative radiographs. However,
tunnel expansion was noted in all patients. The tibial tunnel expanded a mean
of 17% (range, 0% to 32%), and the femoral tunnel expanded a mean of 29%
(range, 0% to 40%).
Conclusions: Reconstruction of the anterior cruciate ligament with
use of a four-strand hamstring tendon autograft eliminated anterior tibial
subluxation in 89% of patients who were examined at a minimum of two years
postoperatively. The overall rate of failure was 11%. The functional knee
scores were significantly increased at the time of follow-up, but these
results did not correlate with the results of knee arthrometric testing.
Level of Evidence: Therapeutic study, Level IV (case
series [no, or historical, control group]). See Instructions to Authors for a
complete description of levels of evidence.