Quadrupled Semitendinosus ACL Reconstruction: 5 Year Results In Patients Without Meniscus Loss

Thomas D. Rosenberg, M.D., Kathleen T. Deffner, M.S., Vernon J. Cooley, M.D.

Background: While non-surgical treatment of an ACL injury is sometimes recommended, such management often results in reinjury episodes that can injure the cartilage in the knee joint. Such damage can lead to osteoarthritis that may necessitate an eventual knee replacement. Replacement of the ACL using a quadrupled semitendinosus (hamstring tendon) graft restores stability to the knee and minimizes the likelihood of reinjury.

The quadrupled semitendinosus tendon has consistently been used for ACL reconstruction by the senior author (TDR) since 1990. This evaluation was undertaken to study the outcomes of ACL reconstruction in patients without meniscus loss at least 5 years after surgery.

Methods: A comprehensive follow-up examination was performed on twenty patients at an average of 5.7 years (range, 5 to 7 years) after surgery. None of these patients had undergone extraarticular reconstruction or meniscus removal. Suture repair was performed in nearly half of the patients whose meniscal tears were repairable. Meniscal excoriation to stimulate healing in small, stable meniscal tears was performed in half the patients. One manipulation, one manipulation and debridement, and a debridement and notchplasty were performed to regain range of motion. Average age was 31 years at the time of follow-up. 75% of the patients were male, and the remaining 25% were female. A comprehensive knee examination with KT-1000 arthrometry, x-rays, and isokinetic strength testing was performed.

Results: Anterior tibial translation was reduced from a pre-operative average of 6.3 mm (side-to-side difference) to an average of 0 mm (range, -2.5 to 2 mm) with the manual maximum pull. Lachman examination was negative in all but two patients. Radiographically, one of the patients experienced mild narrowing in the lateral compartment; no other joint space narrowing was noted. Tegner activity level was maintained at the level prior to injury in nearly half the patients. The remaining patients felt that their change in activity level was due to a lifestyle change and not due to the inability to perform the same activities as prior to injury. Isokinetic strength deficits were less than 10%.

Discussion: The above data demonstrate minimal morbidity, a low re-operation rate, and excellent clinical outcome. Because the stability of the knee persists beyond 5 years after ACL reconstruction, patients are able to maintain pre-injury activity levels without reinjury episodes. Compared to conservative treatment, in which instability, meniscal tears, and pain are common, these results are superior. In addition, neither deterioration of results nor the high reoperation rates seen with allograft reconstructions exist.