title: Improved outcomes after anterior cruciate ligament reconstruction with quadrupled hamstring autografts and additional bone plug augmentation at five year follow-up.
abstract: OBJECTIVE
  Hybrid fixation has been proposed to improve outcomes of anterior cruciate ligament (ACL) reconstructions. This study evaluated midterm outcomes after transfemoral graft fixation using either a conventional or a modified technique using additional bone plug augmentation (BPA) of the femoral tunnel aperture.
  
  
  METHODS
  Seventy-one consecutive patients undergoing ACL reconstruction using a quadrupled hamstring autograft with transfemoral graft fixation and tibial interference screw fixation were included. Of these, 56 patients could be followed up 61 months (range 52-69 months) after ACL reconstruction both clinically and by magnetic resonance imaging (group A, conventional technique, n = 34; group B, modified technique, n = 22). Anteroposterior (AP) laxity measurements and International Knee Documentation Committee (IKDC), Lysholm and Tegner activity scoring were performed, while imaging included assessment of bone tunnel diameters, graft condition and graft filling at the femoral bone tunnel aperture.
  
  
  RESULTS
  Patients with additional BPA had a significantly higher degree of graft filling at the femoral bone tunnel aperture (p = .0135) and 'healthier' grafts (p = .0495). They also tended to display less AP laxity difference in terms of mean differences and total patient numbers. Lysholm, IKDC and Tegner activity index scores and bone tunnel diameters were not significantly different.
  
  
  CONCLUSIONS
  Additional BPA is an easy-to-perform, cheap and safe manoeuvre, which has the capacity to improve morphological and clinical outcomes at five year follow-up. However, femoral tunnel widening is unaffected by additional BPA.
authors.affiliation: Department of Rheumatology and Arthroscopy, Marienkrankenhaus Düsseldorf-Kaiserswerth, An St. Swidbert 17, 40489, Düsseldorf, Germany. svennebelung@gmx.de
authors.forename: Sven
authors.initials: S
authors.lastname: Nebelung
authors.forename: Gregor
authors.initials: G
authors.lastname: Deitmer
authors.forename: Rolf
authors.initials: R
authors.lastname: Gebing
authors.forename: Frank
authors.initials: F
authors.lastname: Reichwein
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Nebelung
mesh_terms: D000293:Adolescent; D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods*; D016025:Bone Transplantation; D005260:Female; D005269:Femur / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000637:transplantation; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D055815:Young Adult