title: Quadruple hamstring anterior cruciate ligament reconstruction: a multicenter study.
abstract: OBJECTIVE
  The use of blunt-threaded titanium interference screws for arthroscopic-assisted fixation of a quadruple-strand hamstring anterior cruciate ligament (ACL) reconstruction has recently been reported. However, the pitfalls of the low medial portal technique, rehabilitation protocol, and long-term results have not. The purpose of this multicenter study was to prospectively evaluate this technique's application to ACL instability in symptomatic patients as well as to develop a standardized rehabilitation protocol.
  
  
  METHODS
  Observation cohort study.
  
  
  METHODS
  One hundred-twenty patients had quadruple hamstring ACL reconstructions, followed the study protocol, and were seen at 2 years follow-up. They were evaluated using Lysholm score, Lachman test, anterior drawer test, pivot-shift test, KT-1000, effusion assessment, and the Tegner Sports Activity Scale.
  
  
  RESULTS
  The average Lysholm score improved 42 points; Lachman test, effusion assessment, anterior drawer test, KT-1000, and Tegner Sports Activity Scale scores all improved. Of 120 ACL reconstructions, 5 failed. Of these, 3 failed from new late injury, 1 from technical error, and 1 from patient nonadherence to rehabilitation protocol. Some anterior knee pain was present in 30% of patients, and 22% had at some time experienced hamstring pain that did not interfere with athletic activity.
  
  
  CONCLUSIONS
  This multicenter study reports success with quadruple hamstring ACL reconstruction using the low medial portal technique. Specific pitfalls and a rehabilitation protocol are also discussed. Low medial portal position is critical in successful surgery. Variations in screw size to accommodate the variation in graft construct size are also recommended.
authors.affiliation: Orthopedics International, Seattle, Washington, USA. piercescranton@hotmail.com
authors.forename: Pierce E
authors.initials: PE
authors.lastname: Scranton
authors.forename: James E
authors.initials: JE
authors.lastname: Bagenstose
authors.forename: Brick A
authors.initials: BA
authors.lastname: Lantz
authors.forename: Marc J
authors.initials: MJ
authors.lastname: Friedman
authors.forename: E Edward
authors.initials: EE
authors.lastname: Khalfayan
authors.forename: M Kevin
authors.initials: MK
authors.lastname: Auld
mesh_terms: D000293:Adolescent; D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery* / Q000637:transplantation; D001182:Arthroscopy / Q000379:methods*; D001863:Bone Screws; D002985:Clinical Protocols / Q000592:standards; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007593:Joint Instability / Q000534:rehabilitation / Q000601:surgery; D007719:Knee Joint / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016059:Range of Motion, Articular; D019651:Plastic Surgery Procedures / Q000295:instrumentation / Q000379:methods*; D014025:Titanium / Q000627:therapeutic use; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D014025:Titanium