Purpose
To compare the tunnel enlargement of double-bundle (DB) anterior cruciate ligament
reconstruction (ACLR) with and without suturing of autologous ruptured tissue to hamstring
graft in patients with subacute anterior cruciate ligament injury.
Methods
Ten patients with subacute (≤3 months after injury) anterior cruciate ligament rupture
were randomly allocated to undergo DB ACLR with suturing of the ruptured tissue to
hamstring graft (n = 5) or conventional DB ACLR (n = 5). When autologous ruptured
tissue was used, remnant ruptured tissue was then harvested, divided into 4 pieces,
placed between the loops at the distal and proximal portions of the graft, and secured
with the suture. As the primary endpoint, tunnel volume assessment by 3-dimensional
multi–detector row computed tomography (MDCT) was performed 1 year after ACLR. To
assess the efficacy of these procedures, the Lysholm score, anterior tibial translation
(measured with a KT-1000 arthrometer [MEDmetric, San Diego, CA]), and rotational instability
(measured by the pivot-shift test) were evaluated after 2 years.
Results
Tunnel volume enlargement between 3 weeks and 1 year after ACLR as assessed by 3-dimensional
MDCT was significantly less for ACLR using ruptured tissue than for conventional ACLR,
especially at the femoral site (P < .05). However, the postoperative Lysholm score, anterior stability of the knee
measured with the KT-1000 arthrometer, and rate of negative manual pivot-shift test
results did not differ significantly between the 2 groups. There was no correlation
to the clinical outcomes in terms of tunnel size.
Conclusions
The Lysholm score, anterior laxity measured with the KT-1000 arthrometer, and rotational
instability according to the pivot-shift test did not differ significantly between
ACLR using ruptured tissue and the conventional technique. However, ACLR using ruptured
tissue produced less femoral tunnel enlargement as assessed by MDCT, warranting further
long-term follow-up to elucidate its effectiveness.
Level of Evidence
Level II, prospective comparative study.
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Article info
Publication history
Published online: February 27, 2014
Accepted:
December 17,
2013
Received:
August 28,
2013
Footnotes
The authors report that they have no conflicts of interest in the authorship and publication of this article.
Identification
Copyright
© 2014 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
