Volume : X, Issue : IV, April - 2020

Hamstring tendon harvest in ACL Reconstruction, Follow up study on recovery of Range of Movements.

Jeevan Mp, John T John

Abstract :

BACKGROUND: Autografts play an important role in ligament reconstruction. The semitendinosus and gracillis have been a significant source of graft material for reconstruction. There are two schools of thought whether to use a doubled semitendinosus and gracillis graft or a quadrupled semitendinosus graft. Numerous studies have shown that harvesting the semitendinosus and gracillis reduce knee flexion, especially deep flexion angles of the knee. Harvesting the gracillis impacts semitendinosus regeneration and decreases post–operative range of movements hence harvesting the semitendinosus alone maybe the best option for reconstruction in athletes who require high levels of knee flexion strength and a faster recovery from reconstruction. Following graft harvest the hamstring tendons regenerate within 24 months but the degree of recovery and redevelopment of semitendinosus varies from individual to individual. The purpose of this study was to document the recovery of Loss in Range of movements associated with the use of both semitendinosus and gracillis and semitendinosus alone as graft material for ACL reconstruction. MATERIALS AND METHODS: The retrospective study was conducted at Lourdes Hospital, Ernakulam, Kerala. Data regarding preoperative physical examination, Operative technique were gathered from chart reviews Patients who presented with tears were grouped based on the tendon used for reconstruction into ST group in whom the semitendinosus alone was used for reconstruction and STG group in whom the semitendinosus and gracillis was used for reconstruction. To compensate for the recovery of range of movements associated with acute ACL rupture patients was further grouped based on time of injury to reconstruction. GROUP I included patients who underwent ACL Reconstruction within 2 months of injury, GROUP II within 2–6 months of injury and GROUP III within 6–12 Months of injury. The range of motion of the knee was evaluated in the outpatient department when the patients came for review. Measurement was done with the patient supine on an examination bed using a goniometer. The interlimb difference was recorded. Patients were followed up after reconstruction and range of movements assessed at 3 months,6 months and one year RESULTS: In group 1 There was no significant difference in change between Relative Range of movements (ROM) at 3, 6 or12 months’ time in both ST and STG Patients. (All P values>0.05). The range of movements in Group I Improved steadily with time in all patients who were Operated with semitendinosus (ST) and semitendinosus and gracillis (STG) grafts. But On comparison of ROM with the opposite limb pre–operative levels STG patients could attain only 87% whereas ST patients attained 98% results. In group II There was a significant difference in the relative improvement of ROM at 3rd month(p<0.05) between patients operated with ST and STG. Pt operated with ST alone showed significant improvement, but there was no difference at 6th Month or 1 year time (other P Values>0.05).In comparison with opposite limb Patients attained more than 90% Rom in ST group compared to STG. In group III the relative improvement of ROM was less in third month (P value>0.05). But there was a significant improvement at 6th month and one year in both ST and STG group (P values<0.05). But On comparison of ROM with the opposite limb in ST patients 13/21 (62%) reached 100% ,6 reached 96%,2 reached 90%. Whereas in STG patients 5 reached 90% and the remaining 2 patients attained 81%, 78%. Statistically minor significant difference between relative Range of Movement was found at 3 months and 6 months of follow up in Group I, II and III but at 1–year period there was no significant difference in relative ROM or on comparison with the opposite limb as all p values were >0 CONCLUSION: Irrespective of the graft used at one year there was no statistically significant difference between overall Range of Movement, Relative range of movement at 3,6 and one year follow up and functional loss compared to opposite limb (p values>0). We did not find significant differences with the final outcome but the rate of recovery was better with the use of semitendinosus alone hence surgeon may always consider reconstruction using semitendinosus, especially in athletes demanding deep flexion of the knee.

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Article: Download PDF    DOI : 10.36106/ijar  

Cite This Article:

HAMSTRING TENDON HARVEST IN ACL RECONSTRUCTION, FOLLOW UP STUDY ON RECOVERY OF RANGE OF MOVEMENTS., Jeevan MP, John T John INDIAN JOURNAL OF APPLIED RESEARCH : Volume-10 | Issue-4 | April-2020

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