title: Anterior cruciate ligament reconstruction with a multistrand hamstring graft fixed with a Ligament Tension Screw: a new device that can be used to readjust graft tension after fixation.
abstract: We developed a new fixation device for reconstruction of the anterior cruciate ligament with a multistrand hamstring graft. This device allows the graft tension to be readjusted after fixation. This device, called a Ligament Tension Screw, consists of three parts, a screw, a washer, and a post. To create the graft, the tendons were formed into a loop. The device was hung from one end of the loop of the graft and a Kennedy-ligament augmentation device (LAD) artificial ligament was hung at the other end. The Kennedy-LAD artificial ligament was used extraarticularly for fixation at the tibia with double staples. Graft tension was increased by turning the screw, which pulls on the post suspending the graft. Fifty-two patients were evaluated after a minimum 2-year follow-up. The evaluation included physical examination, stability measurement with a KT2000 arthrometer, a Cybex muscle strength measurement, a functional test, and scoring of the knee according to the International Knee Documentation Committee (IKDC). Pivot test was negative in 47 patients (91%), but glide occurred in 5 patients (9%). No patient had a "clunk" or markedly poor result on the pivot test. All patients recovered full extension. Seven patients lost full flexion, but the loss of flexion was less than 5 degree in all seven. The KT 2000 arthrometer measurement with 133 N anterior drawer force indicated that 46 patients (88%) had less than 3-mm side-to-side difference. The mean muscle strength of the quadriceps and hamstrings was 91% and 94%, respectively, compared with the findings in the contralateral limb. The functional test showed a one-leg hop distance equal to 94% of that the opposite side. According to the final IKDC evaluation, 48 patients were graded as normal or nearly normal, and 4 patients as abnormal; none was severely abnormal. This study demonstrated satisfactory results for the reconstruction with a multistrand hamstring graft fixed with the new Ligament Tension Screw.
authors.affiliation: Department of Orthopaedic Surgery, Teikyo University, Ichihara Hospital, 3426-3 Anegasaki, Ichihara, Chiba 299-0111, Japan.
authors.forename: Ken-ichi
authors.initials: K
authors.lastname: Murase Ki
authors.forename: Tamio
authors.initials: T
authors.lastname: Takahei
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Obata
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Ohtsuka
mesh_terms: D000293:Adolescent; D000328:Adult; D016118:Anterior Cruciate Ligament / Q000000981:diagnostic imaging / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D001182:Arthroscopy / Q000379:methods; D001863:Bone Screws; D004867:Equipment Design; D004869:Equipment Safety; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015601:Injury Severity Score; D007718:Knee Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D018482:Muscle, Skeletal / Q000637:transplantation; D010147:Pain Measurement; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology; D019651:Plastic Surgery Procedures / Q000295:instrumentation* / Q000379:methods; D012189:Retrospective Studies; D013524:Surgical Flaps; D013718:Tensile Strength; D016896:Treatment Outcome