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PAPER NO. 91

MRI of the Semitendinosus and Gracilis Tendons Minimum Six Years After Autograft Harvest for ACL Reconstruction

Martina Ahlen, MD, Uddevalla, Sweden Mattias Liden, MD, Uddevalla, Sweden ke Bovaller, MD, Trollhattan, Sweden Ninni Sernert, RPT, Trollhattan, Sweden Juri Kartus, MD, Trollhattan, Sweden

INTRODUCTION: The aim of the study was to investigate to what extent the semitendinosus and gracilis tendons had regenerated a minimum of six years after harvest for anterior cruciate ligament (ACL) reconstruction. The place of insertion and the area of the regenerated tendons were compared with the normal contra lateral side. To evaluate the function of the regenerated tendons, the strength in knee flexion and internal rotation of the tibia were measured on both sides. METHODS: Twenty patients (nine female and 11 male) who had undergone ipsilateral ACL reconstruction a minimum six years earlier, median 8.5 (6-11), using semitendinosus and gracilis autografts underwent bilateral magnetic resonance imaging (MRI) of their knees. An experienced independent muscleoskeletal radiologist evaluated all MRI examinations. Strength measurements in deep knee flexion and internal rotation were performed. RESULTS: The semitendinosus tendon had regenerated in 18/20 (90%) and the gracilis tendon in 19/20 (95%) of the patients as seen on MRI. There were no significant differences between the insertion place of the tendons on the operated and non-operated side. The cross sectional areas of the regenerated tendons revealed no significant differences compared to the normal tendons on the contralateral side, as measured 4 cm above the joint line. The patients were significantly weaker in deep knee flexion at 60 and 180 deg/s but stronger in internal rotation of the tibia at 60 deg/s in the operated leg compared to the non-operated knee. DISCUSSION AND CONCLUSION: The semitendinosus and gracilis tendons regenerated in the majority of patients and regained a nearly normal insertion place on the pes anserinus minimum six years after harvest. The regenerated tendons had a cross-sectional area similar to the non-operated contralateral side. The patients revealed a strength deficit in deep knee flexion but not in internal rotation.

PAPER NO. 92

Double-bundle ACL Reconstruction Cannot Prevent Osteoarthritis Compared with Single-bundle Technique

Jong-Keun Seon, MD, Hwasun, Republic of Korea Eun-Kyoo K. Song, MD, Hwasungun, Republic of Korea Chan-Hee Park, Jeonnam, Republic of Korea Kyung-Do Kang, Hwasun, Republic of Korea

INTRODUCTION: The intent of double-bundle (DB) anterior cruciate ligament (ACL) reconstruction is to reproduce the normal ACL anatomy and improve knee joint rotational stability, and eventually prevent osteoarthritis after surgery. However, no consensus has been reached on the advantages of this technique over the single-bundle (SB) technique, especially for prevention of osteoarthritis after ACL reconstruction. The purpose of this study was to evaluate whether DB ACL reconstruction can prevent osteoarthritis or failure after ACL reconstruction compared with SB technique. METHODS: One-hundred-thirty patients with ACL injury in one knee were recruited for this prospective study. Among them, 112 patients who were followed up with a minimum of four years (DB group; n=52 vs. SB group; n=60). Both groups were comparable with regard to preoperative data. We evaluated the stability result regarding Lachman test, Pivot shift test, and instrumented laxity based on Telos device. And we also compared Functional outcomes based on Lysholm knee scores, Tegner activity scores, and International Knee Documentation Committee (IKDC) subjective form scale. For the radiologic evaluation, we determined the degree of osteoarthritis based on Kellgren and Lawrence grade system at the time of final follow up and compared the number of patients with progression of osteoarthritis more than grade I. All of the operations were performed by one experienced orthopedic surgeon, and all clinical assessments were made by two independent examiners. RESULTS: All the patients recovered full range of motion within six months from surgery. Stability results of the Lachman test, pivot-shift test, and knee joint laxity test failed to reveal any significant intergroup differences (P > 0.05). In the pivot-shift result, double-bundle group showed four cases of grade II and single-bundle three cases of grade II (p=0.27). Clinical outcomes including Lysholm knee and Tegner activity scores were similar in the two groups (P > 0.05). However, statistical significance was only achieved for the IKDC subjective form scale (78.2 DB vs 73.1 SB; P=0.03). Concerning osteoarthritis at the final follow up, five patients (10%) in the DB group and six patients (12%) in the SB group progressed osteoarthritis more than one Kellgren-Lawrence grade at final follow up (P=.75). Eight patients (four in the DB group and two in the SB group) had graft failure during the follow up and had anterior cruciate ligament revision surgery (P = 0.06). DISCUSSION AND CONCLUSION: This trial showed that DB ACL reconstruction cant prevent osteoarthritis progression compared with SB technique and the failure rate of the ACL reconstruction. Although DB ACL reconstruction produces better IKDC subjective form than SB ACL reconstruction, the two modalities were found to be similar in terms of clinical outcomes and stabilities after a minimum of four years of follow up.

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