title: Anterior cruciate ligament reconstruction with a four-strand hamstring tendon autograft. Surgical technique.
abstract: 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 implemented.
  
  
  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.
authors.affiliation: The Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA. williamsr@hss.edu
authors.forename: Riley J
authors.initials: RJ
authors.lastname: Williams
authors.forename: Jon
authors.initials: J
authors.lastname: Hyman
authors.forename: Frank
authors.initials: F
authors.lastname: Petrigliano
authors.forename: Tamara
authors.initials: T
authors.lastname: Rozental
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Wickiewicz
mesh_terms: D016118:Anterior Cruciate Ligament / Q000000981:diagnostic imaging / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D001178:Arthroplasty / Q000295:instrumentation / Q000379:methods*; D001182:Arthroscopy; D005500:Follow-Up Studies; D006801:Humans; D007718:Knee Injuries / Q000503:physiopathology / Q000534:rehabilitation / Q000601:surgery; D011859:Radiography; D013536:Suture Techniques; D013710:Tendons / Q000637:transplantation*; D014182:Transplantation, Autologous; D017211:Treatment Failure; D016896:Treatment Outcome