ACL reconstruction using a quadruple semitendinosus graft with cortical fixations gives suitable isokinetic and clinical
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ACL reconstruction using a quadruple semitendinosus graft with cortical fixations gives suitable isokinetic and clinical outcomes after 2 years Julien Roger2 · Antoine Bertani1 · Florence Vigouroux3 · Franck Mottier5 · Romain Gaillard2 · Laurence Have4 · Frédéric Rongièras1 Received: 13 December 2019 / Accepted: 24 June 2020 © European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2020
Abstract Purpose The objective of this single-center randomized single-blinded trial was to assess the hypothesis that anterior cruciate ligament reconstruction (ACLR) using a four-strand semitendinosus (ST) graft with adjustable femoral and tibial cortical fixation produced good outcomes compared to an ST/gracilis (ST/G) graft with femoral pin transfixation and tibial bioscrew fixation. Follow-up was 2 years. Methods Patients older than 16 years who underwent primary isolated ACLR included for 1 year until August 2017 were eligible. The primary outcome measures were the subjective International Knee Documentation Committee (IKDC) score, isokinetic muscle strength recovery, and return to work within 2 years. The study was approved by the ethics committee. Results Of 66 eligible patients, 60 completed the study and were included, 33 in the 4ST group and 27 in the ST/G group. Mean age was 30.5 ± 8.9 years in the 4ST group and 30.3 ± 8.5 in the ST/G group (n.s.). No significant between-group differences were found for mean postoperative subjective IKDC (4ST group, 80.2 ± 12.5; ST/G group, 83.6 ± 13.6; n.s.), sideto-side percentage deficits in isokinetic hamstring strength (at 60°/s: ST group, 17% ± 16%; ST/G group, 14% ± 11%; n.s.) or quadriceps strength (at 60°/s: ST group, 14% ± 12%; ST/G group, 19% ± 17%; n.s.), return to work, pain during physical activities, side-to-side differential laxity, balance, loss of flexion/extension, or surgical complications. Conclusion This trial demonstrates that functional outcomes after 4ST for ACLR with cortical fixations could be as good, although not better, than those obtained using ST/G. The 4ST technique spares the gracilis tendon, which thus preserves the medial sided muscle and thereby could improve function and limit donor-side morbidity. Level of evidence Level I. Keywords Short semitendinosus graft · ACL fixation devices · Isokinetic strength · Arthrometer ACL · Posturography
Previous presentations Data from this case series (in an earlier form) has previously been presented at a national meeting in France: Laureate of the best work of the diploma of arthroscopy presented to the French Society of Arthroscopy in 2016. Permissions Permission has been obtained for use of the copyrighted material from other sources, including the technical note of the laboratories on the Web.
Abbreviations ACL Anterior cruciate ligament ACLR Anterior cruciate ligament reconstruction ICRS International cartilage repair society IKDC International knee documentation committee LFS Length-function–surface area Nm Newton meter ROM Range of motion ST Semitendinosus ST/G
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