ArticleJBJS essential surgical techniques
Five-Strand Hamstring Autograft Anterior Cruciate Ligament Reconstruction.
Article in JBJS essential surgical techniques. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Hamstring tendon autograft remains a popular graft choice for anterior cruciate ligament (ACL) reconstruction because of its favorable biomechanical properties, lower donor-site morbidity, and comparable functional outcomes to bone-patellar tendon-bone (BPTB) autograft Description: The semitendinosus and gracilis are harvested after reflecting the sartorial fascia and removing the attached adhesions and bands from each tendon. If a 4-strand configuration is <8 mm in diameter, a 5-strand technique is utilized, tripling the semitendinosus and doubling the gracilis. A diagnostic knee arthroscopy is performed. The tibial tunnel is drilled through an accessory anteromedial portal over the residual ACL tibial footprint. The femoral tunnel is drilled with use of an over-the-top guide and subsequently reamed to a depth of 25 mm via independent femoral drilling at the center of the femoral ACL footprint. Femoral stabilization is then achieved with interference screw fixation, the knee is cycled, and screw-and-sheath tibial fixation is performed. Alternatives: Nonoperative treatment includes formal physical therapy that emphasizes strengthening, stretching, and neuromuscular control Rationale: Hamstring tendon autograft offers reliable long-term results for ACL reconstruction with a well-established biomechanical profile Expected Outcomes: Hamstring tendon autograft ACL reconstruction results in outcomes comparable to BPTB and quadriceps autografts, with similar graft failure rates, knee stability, and functional outcomes, and lower rates of anterior knee pain (11.5% versus 17.4%, respectively) Important Tips: Avoid injury to the superficial medial collateral ligament during harvest.Release all fascial bands prior to proximal tendon harvest to avoid premature amputation of the tendon.Harvesting the periosteal footprint may increase graft length by 3 to 4 cm.Remove graft creep with tensioning and knee cycling before fixation.A femoral interference screw should be placed parallel to the tunnel.Preserve 2 mm of posterior femoral wall to avoid posterior wall blowout. Acronyms and Abbreviations: ACL = anterior cruciate ligamentACLR = anterior cruciate ligament reconstructionAM = anteromedialBPTB = bone-patellar tendon-boneHT = hamstring tendonMRI = magnetic resonance imagingQT = quadriceps tendonROM = range of motion.
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