title: Hamstring graft tibial insertion preservation versus detachment in anterior cruciate ligament reconstruction: a prospective randomized comparative study.
abstract: BACKGROUND
  Anterior cruciate ligament (ACL) reconstruction with hamstring graft (HG) is a commonly performed procedure. Despite the type of reconstruction chosen, the detached HG undergoes a remodeling process known as ligamentization. In order to shorten the ligamentization process, the maintenance of HG tibial insertion, aimed to spare the tendons vascular supply, has been postulated. The aim of this paper is to report the results of a prospective randomized study comparing clinical and MRI results between two different ACL reconstructive procedures with and without HG tibial insertion preservation.
  
  
  METHODS
  Forty patients (mean age 27.5 ± 9.5 years) were enrolled and randomly divided into two groups. The study group underwent an ACL reconstruction using a distally inserted HG, while the control group underwent a technique encompassing HG tibial detachment. Subjective and objective IKDC score was administered preoperatively and at 3-, 6-, 12- and 24-month follow-up. Graft morphology was assessed through MRI evaluation performed at 6-month follow-up.
  
  
  RESULTS
  Clinical results were excellent in both groups. Regarding MRI results, a better intra-articular graft morphology was observed in the study group (Tau = 0.313, p = 0.024). No differences in graft integration were noticed.
  
  
  CONCLUSIONS
  The main finding of this preliminary study is that preservation of the hamstring tibial insertion seems to enhance graft ligamentization with improved morphology of the intra-articular portion of the graft compared to a detachment of the hamstring tendons from the tibial side. Further well-designed studies with higher number of patients as well as more serial MRI evaluations are required to validate these preliminary findings.
authors.affiliation: I Clinic, Rizzoli Orthopaedic Institute, Bologna University, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Ruffilli
authors.affiliation: I Clinic, Rizzoli Orthopaedic Institute, Bologna University, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy. gherardo.pagliazzi@gmail.com.
authors.forename: Gherardo
authors.identifier: http://orcid.org/0000-0001-8596-9221
authors.initials: G
authors.lastname: Pagliazzi
authors.affiliation: I Clinic, Rizzoli Orthopaedic Institute, Bologna University, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Ferranti
authors.affiliation: Service of Ecography and Radiology, Rizzoli Orthopaedic Institute, Via Giulio Cesare Pupilli 1, Bologna, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Busacca
authors.affiliation: Service of Ecography and Radiology, Rizzoli Orthopaedic Institute, Via Giulio Cesare Pupilli 1, Bologna, Italy.
authors.forename: Diana
authors.initials: D
authors.lastname: Capannelli
authors.affiliation: I Clinic, Rizzoli Orthopaedic Institute, Bologna University, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Buda
mesh_terms: D000328:Adult; D000070598:Anterior Cruciate Ligament Injuries / Q000175:diagnosis / Q000601:surgery*; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods; D001182:Arthroscopy / Q000379:methods; D005260:Female; D006085:Graft Survival / Q000502:physiology*; D006801:Humans; D007719:Knee Joint; D008023:Ligaments, Articular / Q000637:transplantation*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D013977:Tibia / Q000601:surgery; D016896:Treatment Outcome
keywords: ACL; All-inside; Hamstrings; Ligamentization