Clinical Results

Stability Results of Hamstring Anterior Cruciate Ligament Reconstruction at 2- to 8-Year Follow-Up.

by Chadwick C Prodromos M.D., Yung S Han B.S., Brett L Keller B.S. B.A., and Richelle J Bolyard B.A.

published in: Arthroscopy: The Journal of Arthroscopic and Related Surgery


PURPOSE: The purpose of this study was to test the hypothesis that hamstring (HS) anterior cruciate ligament (ACL) reconstructions using EndoButton (Smith & Nephew, Andover, MA) femoral and whipstitch/screw tibial fixation can produce a high rate of objective stability in a population of reconstructed patients with low morbidity.

TYPE OF STUDY: Case series.

METHODS: We retrospectively reviewed 153 consecutive primary HS ACL reconstructions in skeletally mature patients without other ligament reconstructions. All knees had EndoButton femoral and whipstitch/screw tibial fixation; 139 patients were located and 133 were tested. Thirteen were geographically distant and tested subjectively only. Evaluations included KT-1000 testing; radiographs; and Noyes, Lysholm, and Single Assessment Numeric Evaluation (SANE) ratings. Follow-up was 24 to 104 months (mean, 54.4 months).

RESULTS: There were no graft failures. No patient had rupture of an implanted graft. No patient had repeat surgery for instability; 96.9% of reconstructions had maximum manual side-to-side differences of < or =3 mm, 85.7% had < or =2 mm; 3% of the knees had a 4-mm difference; none had > or =5-mm difference. There was no objective stability difference between male and female patients and no deterioration in results with increasing follow-up time. Median ratings were: Noyes, 94; Lysholm, 94.5; and SANE, 90. Radiographs showed that no EndoButtons had migrated. No EndoButton or tibial screw had to be removed due to symptoms from the implant. One hundred eighteen of 120 patients had full extension; the other 2 patients had a 2 degrees flexion loss. One patient required repeat arthroscopy for arthrofibrosis but had full range of motion at follow-up. There were no deep knee infections. One patient had a superficial wound infection requiring intravenous antibiotics. One patient had a calf deep vein thrombosis that resolved with treatment.

CONCLUSIONS: Hamstring ACL reconstructions can produce (1) reliable, durable stability in both males and females with no graft failures, (2) good clinical ratings, (3) excellent range of motion, and (4) low morbidity, without hardware problems.

LEVEL OF EVIDENCE: Level IV, Case Series.

This article was published in Arthroscopy: The Journal of Arthroscopic and Related Surgery,
Volume 21, by C.C. Prodromos, et al.
Posterior Mini-Incision Technique For Hamstring Anterior Cruciate Ligament Reconstruction Graft Harvest,
pages 138-146, Copyright 2005, and is posted with permission from the Arthroscopy Association of North America

Additional Publications by Dr C Prodromos, et al regarding clinical results.

Prodromos CC, Hecker A, Joyce B, Finkle S, Shi K. Elongation of Simulated Whipstitch Post Anterior Cruciate Ligament Reconstruction Tibial Fixation After Cyclic Loading. Knee Surg Sports Traumatol Arthrosc, Aug 2009; 17(8): 914-19. Abstract

Prodromos CC, Hecker A, Joyce B, Finkle S, Shi K. Elongation of simulated whipstitch post anterior cruicate ligament reconstruction tibial fixation after cyclic loading. Knee Surg Sports Traumatol Arthosc, Aug 2009; 17(8): 914-19. Abstract

Prodromos CC, Joyce BT. Hamstring ACL Reconstruction: Technique, Results, Meta-Analysis, and Posterior Graft Harvest Technique.  Techniques in Knee Surgery, June 2006; 5(2): 87-95. Abstract

Prodromos CC.  Low-Profile Cortical Screw Tibial Fixation for Hamstring Anterior Cruciate Ligament Reconstruction:  Surgical Technique and Stability Results. Techniques in Orthopaedics, Sept 2005; 20(3): 272-273. Abstract

Prodromos CC, Joyce B.  Five-Strand Hamstring Anterior Cruciate Ligament Reconstruction: Presentation of a New Technique With Better Stability at 7- to 9-Year Follow Up Than 4 Strand. Techniques in Orthopaedics, Sept 2005; 20(3): 192-3. Abstract

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