TITLE:
Five Strand Hamstring Tendon Autograft for Anterior Cruciate Ligament Reconstruction Provides No Benefit over the Gold Standard Four Strand Repair for Anterior Stability of the Knee: A Prospective Cohort Study
AUTHORS:
A. Sideris, A. Hamze, N. Bertollo, D. Broe, WR Walsh
KEYWORDS:
Anterior Cruciate Ligament, ACL, Anterior Cruciate Ligament Reconstructive Surgery, Anterior Cruciate Ligament Reconstruction, ACL Reconstruction, Five Strand Hamstring Tendon Autograft, Four Strand Hamstring Tendon Autograft, KT-1000, AP Translation, Knee
JOURNAL NAME:
Open Journal of Orthopedics,
Vol.7 No.6,
June
28,
2017
ABSTRACT: The Four-Strand Hamstring Tendon Autograft has been long established as the gold standard for surgical reconstruction of the Anterior Cruciate Ligament. Some studies have suggested wider grafts, such as a Five-Strand hamstring graft, may provide greater strength and a larger scaffold for incorporation of the graft into the bone tunnels, leading to greater postoperative anterior stability of the knee. 28 (n = 18 Four-Strand and n = 10 Five-Strand) patients with planned ACL reconstructive surgery by a single surgeon were recruited for this study. The KT-1000 Arthrometer (MED metric, CA, USA) was used to quantify AP translation in the subjects’ knees before (T0) and after surgery at 6 (T1) and 12 (T2) weeks. At 12 weeks there was significantly higher (p = 0.01) mean anterior laxity on Maximum Manual Test in the Five- Strand group (9.1 ± 1.7 mm) than the Four Strand Group (6.9 ± 2.3 mm). Further, there were significantly higher mean side-to-side differences (p = 0.01) on Maximum Manual Test in the Five-Strand cohort (5.1 ± 3.5 mm) compared to the Four-Strand cohort (1.9 ± 2.2 mm). A significantly larger positive mean change in anterior laxity (p = 0.02) from 6 - 12 weeks was evident in the Five-Strand group (1.4 ± 0.9) than the Four-Strand group (-0.3 ± 1.9 mm). No significant correlations were seen between graft widths and measures of anterior stability on KT-1000. This study illustrated that there was no benefit to using a Five-Strand Hamstring Tendon Autograft when compared to the gold standard Four-Strand Repair specifically with regards to anterior stability of the knee.