Summary

Single hamstring all-inside ACL reconstruction with recycling internal brace

Abstract

Background

Anterior cruciate ligament reconstruction (ACLR) using a double hamstring graft is a standard technique. However, harvesting a double hamstring graft can lead to morbidity. The single hamstring all-inside ACLR with a recycling internal brace is a technique that preserves the hamstring graft. Despite this, no comparison has been made between these two techniques.


Objectives: The purpose of our study was to compare the outcomes in terms of imaging and function between the single hamstring autograft all-inside ACL reconstruction with internal brace (AI-ACLR+IB) technique and double hamstring autograft conventional ACL reconstruction (CON-ACLR) technique at a minimum 2-year follow-up.

Methods

Our data was retrospectively collected from patients with ACL injuries in our hospital. Graft healing was evaluated at 1-year with a magnetic resonance imaging scan using the mean signal noise quotient ratio (SNQ) from 3 areas: proximal, middle and distal of the ACL graft. Patients’ demographics , meniscal lesions, chondral lesions, time to operation, time to evaluation, patient-reported outcome(PROs) including International Knee Documentation Committee (IKDC) scores, Tegner activity scale and Lysholm score, as well as complications were assessed. ACL laxity was measured as the side-to-side difference (SSD) using a Lachmeter.

Results

A total of 40 patients were included: 19 patients in AI-ACLR+IB group (mean age 28.3 ± 10.6 years) and 21 patients in CONV-ACLR group (mean age 32.8 ± 10.1 years). All patients had a minimal 2-year follow-up after ACL reconstruction with a hamstring graft. The mean SNQ was 52.6 ± 42.3 in AI-ACLR+IB group and 42.7 ± 32.7 in CONV-ACLR group (P = .34). The side-to-side difference was 1.6 ± 1.1 in AI-ACLR+IB group and 2 ± 1.5 in CONV-ACLR group (P = .20). There was no statistically significant difference between the groups in postoperative IKDC score (AI-ACLR+IB vs CONV-ACLR: 80 vs 70.8; P =.46), Lysholm (95.1 vs 94.9; P=.46), or Tegner activity (7.6 vs 7.4; P=.41) scores.

Conclusions

At a minimum of 2-year postoperative, ACL graft healing, PROs and laxity of single hamstring AI-ACLR with internal brace were similar to those in double hamstring ACLR. The result indicates that a single hamstring ACLR with this technique has good clinical outcome in term of function, graft healing and laxity, comparable to double hamstring ACLR, while preserving another graft for the patient.