title: Lack of stability at more than 12 months of follow-up after anterior cruciate ligament reconstruction using all-inside quadruple-stranded semitendinosus graft with adjustable cortical button fixation in both femoral and tibial sides.
abstract: The use of the semitendinosus tendon alone for anterior cruciate ligament reconstruction keeps the gracilis muscle intact and decreases anterior pain in comparison with the use of the patellar tendon. Recently, Lubowitz described a new all-inside technique with an ST4 tendon fixed with a cortical button in both femoral and tibial sides. We hypothesized that this type of graft with cortical button fixation provides well-controlled residual anterior tibial translation (<3mm). The aim of this study was to assess the results obtained with this technique in terms of laxity and IKDC score at more than 1 year of follow-up.
  
  
  
  We performed a prospective single-center study to evaluate the results with this procedure with at least 1 year of follow-up. The primary endpoint was the objective IKDC score and side-to-side anterior tibial translation difference. The secondary endpoint was the subjective assessment using the subjective IKDC and Lysholm scores. Tunnel positioning was assessed using the Aglietti criteria.
  
  
  
  Thirty-five patients were included and reviewed with a mean follow-up of 19.7 months. Sixty-three percent of the patients were male and the mean age at the procedure was 28 years. The IKDC score was A or B in 43% of the patients and C or D in 57%; 54% of the patients had a residual side-to-side anterior tibial translation difference less than 3mm and 29% presented significant pivot shift (grade C or D). Five patients underwent revision surgery, including one for rupture of the ACL reconstruction. The meniscal status did not influence postoperative laxity and the IKDC grade.
  
  
  
  Our hypothesis was not verified and the postoperative stability of the knee was insufficient. Postoperative side-to-side anterior tibial translation difference remained greater than 3mm for 16 patients and the analysis seems to indicate that the distal cortical fixation of the graft with an adjusted loop is insufficient.
  
  
  
  Prospective study - Level IV.
authors.affiliation: Service de chirurgie orthopédique et traumatologique, CHU de Reims, hôpital Maison-Blanche, 45, rue Cognacq-Jay, 51092 Reims cedex, France. Electronic address: guillaume.bressy@gmail.com.
authors.forename: G
authors.initials: G
authors.lastname: Bressy
authors.affiliation: Service de chirurgie orthopédique et traumatologique, CHU de Reims, hôpital Maison-Blanche, 45, rue Cognacq-Jay, 51092 Reims cedex, France.
authors.forename: V
authors.initials: V
authors.lastname: Brun
authors.affiliation: Service de chirurgie orthopédique et traumatologique, CHU de Reims, hôpital Maison-Blanche, 45, rue Cognacq-Jay, 51092 Reims cedex, France.
authors.forename: A
authors.initials: A
authors.lastname: Ferrier
authors.affiliation: Service de chirurgie orthopédique et traumatologique, CHU de Reims, hôpital Maison-Blanche, 45, rue Cognacq-Jay, 51092 Reims cedex, France.
authors.forename: D
authors.initials: D
authors.lastname: Dujardin
authors.affiliation: Unité d'aide méthodologique, CHU de Reims, hôpital Robert-Debré, avenue du Général-Koenig, 51092 Reims cedex, France.
authors.forename: N
authors.initials: N
authors.lastname: Oubaya
authors.affiliation: Service de chirurgie orthopédique et traumatologique, CHU de Reims, hôpital Maison-Blanche, 45, rue Cognacq-Jay, 51092 Reims cedex, France.
authors.forename: N
authors.initials: N
authors.lastname: Morel
authors.affiliation: Service de chirurgie orthopédique et traumatologique, CHU de Reims, hôpital Maison-Blanche, 45, rue Cognacq-Jay, 51092 Reims cedex, France.
authors.forename: N
authors.initials: N
authors.lastname: Fontanin
authors.affiliation: Service de chirurgie orthopédique et traumatologique, CHU de Reims, hôpital Maison-Blanche, 45, rue Cognacq-Jay, 51092 Reims cedex, France.
authors.forename: X
authors.initials: X
authors.lastname: Ohl
mesh_terms: D000328:Adult; D000070598:Anterior Cruciate Ligament Injuries / Q000601:surgery*; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods*; D005260:Female; D005269:Femur / Q000601:surgery; D005500:Follow-Up Studies; D000070632:Hamstring Tendons / Q000637:transplantation*; D006305:Health Status Indicators; D006801:Humans; D007593:Joint Instability / Q000175:diagnosis / Q000209:etiology*; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis; D011446:Prospective Studies; D013977:Tibia / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult
keywords: Anterior cruciate ligament; Cortical button; Reconstruction; ST4; Semitendinosus