title: Arthroscopic single-bundle anterior cruciate ligament reconstruction with periosteum-enveloping hamstring tendon graft: clinical outcome at 2 to 7 years.
abstract: OBJECTIVE
  In this case-series outcome study, we present our surgical technique for single-bundle anterior cruciate ligament (ACL) reconstruction with periosteum-enveloping hamstring tendon graft at a minimum of 2 years' follow-up.
  
  
  METHODS
  From 2000 to 2005, ACL reconstruction with a periosteum-enveloping hamstring tendon graft was performed in 368 patients (372 knees). Of those patients, 312 who completed at least 2 years of follow-up were included for analysis. Four-strand periosteum-enveloping hamstring tendon grafts were used for single-bundle reconstruction. Clinical assessments included the Lysholm knee score, International Knee Documentation Committee score, KT-1000 instrumented testing (MEDmetric, San Diego, CA), thigh muscle assessment, and radiographic evaluation. Radiographs were used to assess femoral and tibial tunnel widening.
  
  
  RESULTS
  The 312 study patients were followed up for a mean of 4.6 years (range, 2 to 7 years). The median Lysholm knee scores were 56 points (range, 40 to 70 points) and 95 points (range, 60 to 100 points) before and after surgery, respectively. After reconstruction, 85% of patients could return to moderate or strenuous activity, 5.1% exhibited grade 2 or higher ligament laxity with the anterior drawer test, and 6.1% had a positive pivot shift. Complete range of motion was achieved in 88% of patients. On the basis of International Knee Documentation Committee assessment, 93% of patients had a normal or nearly normal rating.
  
  
  CONCLUSIONS
  Satisfactory results can be achieved with the periosteum-enveloping hamstring tendon graft in single-bundle ACL reconstruction with minimal tunnel widening. Bone tunnel enlargement of more than 1 mm was identified in 5.4% of femoral tunnels and 6.1% of tibial tunnels, which was less than in other studies using comparable fixation.
  
  
  METHODS
  Level IV, therapeutic case series.
authors.affiliation: Department of Orthopaedic Surgery, Chang Gung University College of Medicine, Chang Gung Memorial Hospital at Keelung, 222 Maijin Road, Keelung City, Taiwan. afachen@doctor.com
authors.forename: Chih-Hwa
authors.initials: CH
authors.lastname: Chen
authors.forename: Chih-Hsiang
authors.initials: CH
authors.lastname: Chang
authors.forename: Chun-I
authors.initials: CI
authors.lastname: Su
authors.forename: Kun-Chung
authors.initials: KC
authors.lastname: Wang
authors.forename: Hsien-Tao
authors.initials: HT
authors.lastname: Liu
authors.forename: Chung-Ming
authors.initials: CM
authors.lastname: Yu
authors.forename: Chak-Bor
authors.initials: CB
authors.lastname: Wong
authors.forename: I-Chun
authors.initials: IC
authors.lastname: Wang
mesh_terms: D000293:Adolescent; D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D001175:Arthrography; D001182:Arthroscopy / Q000009:adverse effects; D001284:Atrophy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007593:Joint Instability / Q000209:etiology / Q000503:physiopathology; D007719:Knee Joint / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D053580:Muscle Strength; D018482:Muscle, Skeletal / Q000473:pathology / Q000637:transplantation*; D010146:Pain / Q000503:physiopathology; D010521:Periosteum / Q000637:transplantation*; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D012421:Rupture / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology; D013524:Surgical Flaps; D013710:Tendons / Q000637:transplantation*; D013848:Thigh; D014182:Transplantation, Autologous; D055815:Young Adult