Preserved Tibial Attachment of Hamstring Graft Versus Detached Graft in Anterior Cruciate Ligament Reconstruction: A Randomized Controlled Study

Patricio Espinoza Dumlao III; Lyndon Lovina Bathan; Patrick Mia Dizon

doi:doi:10.11648/j.js.20200802.14

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Preserved Tibial Attachment of Hamstring Graft Versus Detached Graft in Anterior Cruciate Ligament Reconstruction: A Randomized Controlled Study

Patricio Espinoza Dumlao III, Lyndon Lovina Bathan, Patrick Mia Dizon

Published in Journal of Surgery (Volume 8, Issue 2)

Received: 5 March 2020 Accepted: 20 March 2020 Published: 31 March 2020

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Abstract

Background: Anterior cruciate ligament (ACL) reconstruction is one of the most frequent procedures done by orthopedic surgeons. Successful reconstruction is founded on fast healing and incorporation of tendon graft which translates to earlier and aggressive rehabilitation and faster return to dynamic activities. Recent studies highlighted the importance of biologic strategies in the enhancement of the recuperation process of autologous grafts for reconstruction. Current literature theorized the concept of maintaining the hamstring graft (HG) insertion but was unable to explicitly conclude an advantage of maintaining the attachment of the hamstring graft. Method: A prospective, double-blinded, randomized controlled study was done comparing graft integration through MRI (Figueroa) scoring system, and clinical outcomes through IKDC scores between the detached HG (control group) versus preserved tibial attachment of HG (test group) both augmented with interference screw fixation for ACL reconstruction. Results and Conclusion: A total of 32 patients were enrolled, 18 for the control group, 14 for the test group. Preoperative IKDC scores were similar for both groups. Post-operatively, a significant earlier peak at 3 months and continued improvement at 6 months is in favor of the test group. Consistently, there is also a 2.78-fold increased likelihood of graft healing and its constituent graft integration and ligamentization in the test group. This suggests that preservation of the neurovascular attachment of the HG is a contributory factor for efficient ligamentization and subsequent pain control, activities of daily living and functional capacity.

Published in	Journal of Surgery (Volume 8, Issue 2)
DOI	10.11648/j.js.20200802.14
Page(s)	62-66
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2020. Published by Science Publishing Group

Keywords

Anterior Cruciate Ligament Reconstruction, Preserved Tibial Attachment, Hamstring Graft Ligamentization, Figueroa Scoring

References

[1]	Gianotti SM, Marshall SW, Hume PA, Bunt L. Incidence of anterior cruciate ligament injury and other knee ligament injuries: A national population-based study. Journal of Science and Medicine in Sport. 2009; 12 (6): 622–7.
[2]	Grassi A, Bailey JR, Signorelli C, Carbone G, Wakam AT, Lucidi GA, et al. Magnetic resonance imaging after anterior cruciate ligament reconstruction: A practical guide. World Journal of Orthopedics. 2016; 7 (10): 638.
[3]	Wilde J, Bedi A, Altchek DW. Revision anterior cruciate ligament reconstruction [Internet]. Sports health. SAGE Publications; 2014 [cited 2020Feb9]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4212350/.
[4]	Fabricant PD, Lakomkin N, Cruz AI, Spitzer E, Lawrence JTR, Marx RG. Early ACL reconstruction in children leads to less meniscal and articular cartilage damage when compared with conservative or delayed treatment. Journal of ISAKOS: Joint Disorders & Orthopaedic Sports Medicine. 2016; 1 (1): 10–5.
[5]	Fabricant PD, Lakomkin N, Cruz AI, Spitzer E, Marx RG. ACL reconstruction in youth athletes results in an improved rate of return to athletic activity when compared with non-operative treatment: a systematic review of the literature [Internet]. Journal of ISAKOS: Joint Disorders & Orthopaedic Sports Medicine. BMJ Publishing Group Limited; 2016 [cited 2020Feb9]. Available from: https://jisakos.bmj.com/content/1/2/62.
[6]	Wright RW, Huston LJ, Spindler KP, Dunn WR, Haas AK, Allen CR, et al. Descriptive Epidemiology of the Multicenter ACL Revision Study (MARS) Cohort. The American Journal of Sports Medicine. 2010; 38 (10): 1979–86.
[7]	Schuette HB, Kraeutler MJ, Houck DA, McCarty EC. Bone–Patellar Tendon–Bone Versus Hamstring Tendon Autografts for Primary Anterior Cruciate Ligament Reconstruction: A Systematic Review of Overlapping Meta-analyses - Hayden B. Schuette, Matthew J. Kraeutler, Darby A. Houck, Eric C. McCarty, 2017 [Internet]. SAGE Journals. [cited 2020Feb9]. Available from: https://journals.sagepub.com/doi/10.1177/2325967117736484.
[8]	Chen C-H. Graft healing in anterior cruciate ligament reconstruction. BMC Sports Science, Medicine and Rehabilitation. 2009; 1 (1)
[9]	Janssen RPA, Scheffler SU. Intra-articular remodelling of hamstring tendon grafts after anterior cruciate ligament reconstruction. Knee Surgery, Sports Traumatology, Arthroscopy. 2013; 22 (9): 2102–8.
[10]	Ruffilli A, Traina F, Evangelisti G, Borghi R, Perna F, Faldini C. Preservation of hamstring tibial insertion in anterior cruciate ligament reconstruction: a review of the current literature. Musculoskeletal Surgery. 2015Aug; 99 (2): 87–92.
[11]	Ruffilli A, Pagliazzi G, Ferranti E, Busacca M, Capannelli D, Buda R. Hamstring graft tibial insertion preservation versus detachment in anterior cruciate ligament reconstruction: a prospective randomized comparative study. European Journal of Orthopaedic Surgery & Traumatology. 2016Jul; 26 (6): 657–64.
[12]	Kulczycka P, Larbi A, Malghem J, Thienpont E, Berg BV, Lecouvet F. Imaging ACL reconstructions and their complications. Journal de Radiologie Diagnostique et Interventionnelle. 2015; 96.
[13]	Reliability and validity of the International Knee... [Internet]. [cited 2020Feb9]. Available from: https://www.researchgate.net/publication/5954930_Reliability_and_validity_of_the_International_Knee_Documentation_Committee_IKDC_Subjective_Knee_Form.
[14]	Review Article: Validity of the KT-1000 Knee Ligament... [Internet]. [cited 2020Feb9]. Available from: https: //www.researchgate.net/publication/24365888_Review_Article_Validity_of_the_KT-1000_Knee_Ligament_Arthrometer.
[15]	Figueroa D, Melean P, Calvo R, Vaisman A, Zilleruelo N, Figueroa F, et al. Magnetic Resonance Imaging Evaluation of the Integration and Maturation of Semitendinosus-Gracilis Graft in Anterior Cruciate Ligament Reconstruction Using Autologous Platelet Concentrate. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2010; 26 (10): 1318–25.
[16]	Zaffagnini S, Golanò P, Farinas O, Depasquale V, Strocchi R, Cortecchia S, et al. Vascularity and neuroreceptors of the pes anserinus: Anatomic Study. Clinical Anatomy. 2002; 16 (1): 19–24.
[17]	Zaffagnini S, Marcacci M, Presti ML, Giordano G, Iacono F, Neri MP. Prospective and randomized evaluation of ACL reconstruction with three techniques: a clinical and radiographic evaluation at 5 years follow-up. Knee Surgery, Sports Traumatology, Arthroscopy. 2006; 14 (11): 1060–9.
[18]	Lavagnino M, Arnoczky S, Tian T, Vaupel Z. Effect of Amplitude and Frequency of Cyclic Tensile Strain on the Inhibition of MMP-1 mRNA Expression in Tendon Cells: An In Vitro Study. Connective Tissue Research. 2003Jan; 44 (3): 181–7.

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APA Style

Patricio Espinoza Dumlao III, Lyndon Lovina Bathan, Patrick Mia Dizon. (2020). Preserved Tibial Attachment of Hamstring Graft Versus Detached Graft in Anterior Cruciate Ligament Reconstruction: A Randomized Controlled Study. Journal of Surgery, 8(2), 62-66. https://doi.org/10.11648/j.js.20200802.14

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ACS Style

Patricio Espinoza Dumlao III; Lyndon Lovina Bathan; Patrick Mia Dizon. Preserved Tibial Attachment of Hamstring Graft Versus Detached Graft in Anterior Cruciate Ligament Reconstruction: A Randomized Controlled Study. J. Surg. 2020, 8(2), 62-66. doi: 10.11648/j.js.20200802.14

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AMA Style

Patricio Espinoza Dumlao III, Lyndon Lovina Bathan, Patrick Mia Dizon. Preserved Tibial Attachment of Hamstring Graft Versus Detached Graft in Anterior Cruciate Ligament Reconstruction: A Randomized Controlled Study. J Surg. 2020;8(2):62-66. doi: 10.11648/j.js.20200802.14

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@article{10.11648/j.js.20200802.14,
  author = {Patricio Espinoza Dumlao III and Lyndon Lovina Bathan and Patrick Mia Dizon},
  title = {Preserved Tibial Attachment of Hamstring Graft Versus Detached Graft in Anterior Cruciate Ligament Reconstruction: A Randomized Controlled Study},
  journal = {Journal of Surgery},
  volume = {8},
  number = {2},
  pages = {62-66},
  doi = {10.11648/j.js.20200802.14},
  url = {https://doi.org/10.11648/j.js.20200802.14},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.js.20200802.14},
  abstract = {Background: Anterior cruciate ligament (ACL) reconstruction is one of the most frequent procedures done by orthopedic surgeons. Successful reconstruction is founded on fast healing and incorporation of tendon graft which translates to earlier and aggressive rehabilitation and faster return to dynamic activities. Recent studies highlighted the importance of biologic strategies in the enhancement of the recuperation process of autologous grafts for reconstruction. Current literature theorized the concept of maintaining the hamstring graft (HG) insertion but was unable to explicitly conclude an advantage of maintaining the attachment of the hamstring graft. Method: A prospective, double-blinded, randomized controlled study was done comparing graft integration through MRI (Figueroa) scoring system, and clinical outcomes through IKDC scores between the detached HG (control group) versus preserved tibial attachment of HG (test group) both augmented with interference screw fixation for ACL reconstruction. Results and Conclusion: A total of 32 patients were enrolled, 18 for the control group, 14 for the test group. Preoperative IKDC scores were similar for both groups. Post-operatively, a significant earlier peak at 3 months and continued improvement at 6 months is in favor of the test group. Consistently, there is also a 2.78-fold increased likelihood of graft healing and its constituent graft integration and ligamentization in the test group. This suggests that preservation of the neurovascular attachment of the HG is a contributory factor for efficient ligamentization and subsequent pain control, activities of daily living and functional capacity.},
 year = {2020}
}

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TY  - JOUR
T1  - Preserved Tibial Attachment of Hamstring Graft Versus Detached Graft in Anterior Cruciate Ligament Reconstruction: A Randomized Controlled Study
AU  - Patricio Espinoza Dumlao III
AU  - Lyndon Lovina Bathan
AU  - Patrick Mia Dizon
Y1  - 2020/03/31
PY  - 2020
N1  - https://doi.org/10.11648/j.js.20200802.14
DO  - 10.11648/j.js.20200802.14
T2  - Journal of Surgery
JF  - Journal of Surgery
JO  - Journal of Surgery
SP  - 62
EP  - 66
PB  - Science Publishing Group
SN  - 2330-0930
UR  - https://doi.org/10.11648/j.js.20200802.14
AB  - Background: Anterior cruciate ligament (ACL) reconstruction is one of the most frequent procedures done by orthopedic surgeons. Successful reconstruction is founded on fast healing and incorporation of tendon graft which translates to earlier and aggressive rehabilitation and faster return to dynamic activities. Recent studies highlighted the importance of biologic strategies in the enhancement of the recuperation process of autologous grafts for reconstruction. Current literature theorized the concept of maintaining the hamstring graft (HG) insertion but was unable to explicitly conclude an advantage of maintaining the attachment of the hamstring graft. Method: A prospective, double-blinded, randomized controlled study was done comparing graft integration through MRI (Figueroa) scoring system, and clinical outcomes through IKDC scores between the detached HG (control group) versus preserved tibial attachment of HG (test group) both augmented with interference screw fixation for ACL reconstruction. Results and Conclusion: A total of 32 patients were enrolled, 18 for the control group, 14 for the test group. Preoperative IKDC scores were similar for both groups. Post-operatively, a significant earlier peak at 3 months and continued improvement at 6 months is in favor of the test group. Consistently, there is also a 2.78-fold increased likelihood of graft healing and its constituent graft integration and ligamentization in the test group. This suggests that preservation of the neurovascular attachment of the HG is a contributory factor for efficient ligamentization and subsequent pain control, activities of daily living and functional capacity.
VL  - 8
IS  - 2
ER  -

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Author Information

Patricio Espinoza Dumlao III

Sports Medicine and Arthroscopy Service, Department of Orthopedics, Philippine General Hospital, University of the Philippines, Ermita, Manila, Philippines
Lyndon Lovina Bathan

Sports Medicine and Arthroscopy Service, Department of Orthopedics, Philippine General Hospital, University of the Philippines, Ermita, Manila, Philippines
Patrick Mia Dizon

Sports Medicine and Arthroscopy Service, Department of Orthopedics, Philippine General Hospital, University of the Philippines, Ermita, Manila, Philippines

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APA Style

Patricio Espinoza Dumlao III, Lyndon Lovina Bathan, Patrick Mia Dizon. (2020). Preserved Tibial Attachment of Hamstring Graft Versus Detached Graft in Anterior Cruciate Ligament Reconstruction: A Randomized Controlled Study. Journal of Surgery, 8(2), 62-66. https://doi.org/10.11648/j.js.20200802.14

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ACS Style

Patricio Espinoza Dumlao III; Lyndon Lovina Bathan; Patrick Mia Dizon. Preserved Tibial Attachment of Hamstring Graft Versus Detached Graft in Anterior Cruciate Ligament Reconstruction: A Randomized Controlled Study. J. Surg. 2020, 8(2), 62-66. doi: 10.11648/j.js.20200802.14

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AMA Style

Patricio Espinoza Dumlao III, Lyndon Lovina Bathan, Patrick Mia Dizon. Preserved Tibial Attachment of Hamstring Graft Versus Detached Graft in Anterior Cruciate Ligament Reconstruction: A Randomized Controlled Study. J Surg. 2020;8(2):62-66. doi: 10.11648/j.js.20200802.14

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@article{10.11648/j.js.20200802.14,
  author = {Patricio Espinoza Dumlao III and Lyndon Lovina Bathan and Patrick Mia Dizon},
  title = {Preserved Tibial Attachment of Hamstring Graft Versus Detached Graft in Anterior Cruciate Ligament Reconstruction: A Randomized Controlled Study},
  journal = {Journal of Surgery},
  volume = {8},
  number = {2},
  pages = {62-66},
  doi = {10.11648/j.js.20200802.14},
  url = {https://doi.org/10.11648/j.js.20200802.14},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.js.20200802.14},
  abstract = {Background: Anterior cruciate ligament (ACL) reconstruction is one of the most frequent procedures done by orthopedic surgeons. Successful reconstruction is founded on fast healing and incorporation of tendon graft which translates to earlier and aggressive rehabilitation and faster return to dynamic activities. Recent studies highlighted the importance of biologic strategies in the enhancement of the recuperation process of autologous grafts for reconstruction. Current literature theorized the concept of maintaining the hamstring graft (HG) insertion but was unable to explicitly conclude an advantage of maintaining the attachment of the hamstring graft. Method: A prospective, double-blinded, randomized controlled study was done comparing graft integration through MRI (Figueroa) scoring system, and clinical outcomes through IKDC scores between the detached HG (control group) versus preserved tibial attachment of HG (test group) both augmented with interference screw fixation for ACL reconstruction. Results and Conclusion: A total of 32 patients were enrolled, 18 for the control group, 14 for the test group. Preoperative IKDC scores were similar for both groups. Post-operatively, a significant earlier peak at 3 months and continued improvement at 6 months is in favor of the test group. Consistently, there is also a 2.78-fold increased likelihood of graft healing and its constituent graft integration and ligamentization in the test group. This suggests that preservation of the neurovascular attachment of the HG is a contributory factor for efficient ligamentization and subsequent pain control, activities of daily living and functional capacity.},
 year = {2020}
}

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TY  - JOUR
T1  - Preserved Tibial Attachment of Hamstring Graft Versus Detached Graft in Anterior Cruciate Ligament Reconstruction: A Randomized Controlled Study
AU  - Patricio Espinoza Dumlao III
AU  - Lyndon Lovina Bathan
AU  - Patrick Mia Dizon
Y1  - 2020/03/31
PY  - 2020
N1  - https://doi.org/10.11648/j.js.20200802.14
DO  - 10.11648/j.js.20200802.14
T2  - Journal of Surgery
JF  - Journal of Surgery
JO  - Journal of Surgery
SP  - 62
EP  - 66
PB  - Science Publishing Group
SN  - 2330-0930
UR  - https://doi.org/10.11648/j.js.20200802.14
AB  - Background: Anterior cruciate ligament (ACL) reconstruction is one of the most frequent procedures done by orthopedic surgeons. Successful reconstruction is founded on fast healing and incorporation of tendon graft which translates to earlier and aggressive rehabilitation and faster return to dynamic activities. Recent studies highlighted the importance of biologic strategies in the enhancement of the recuperation process of autologous grafts for reconstruction. Current literature theorized the concept of maintaining the hamstring graft (HG) insertion but was unable to explicitly conclude an advantage of maintaining the attachment of the hamstring graft. Method: A prospective, double-blinded, randomized controlled study was done comparing graft integration through MRI (Figueroa) scoring system, and clinical outcomes through IKDC scores between the detached HG (control group) versus preserved tibial attachment of HG (test group) both augmented with interference screw fixation for ACL reconstruction. Results and Conclusion: A total of 32 patients were enrolled, 18 for the control group, 14 for the test group. Preoperative IKDC scores were similar for both groups. Post-operatively, a significant earlier peak at 3 months and continued improvement at 6 months is in favor of the test group. Consistently, there is also a 2.78-fold increased likelihood of graft healing and its constituent graft integration and ligamentization in the test group. This suggests that preservation of the neurovascular attachment of the HG is a contributory factor for efficient ligamentization and subsequent pain control, activities of daily living and functional capacity.
VL  - 8
IS  - 2
ER  -

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