Short graft, short tunnel ACL reconstruction with single hamstring and internal brace leads to comparable outcomes to conventional double hamstring technique: A retrospective study

Abstract

Purpose: The purpose of our study was to compare (1) ACL graft healing, (2) patient-reported outcome, and (3) complications after short graft (length < 65 mm), short tunnel (femoral tunnel < 20 mm) single hamstring ACL reconstruction with an internal brace (SGST-ACLR) technique and double hamstring autograft conventional ACL reconstruction (CON-ACLR) technique at minimum 2-year follow-up.

Methods: A retrospective cohort of patients underwent arthroscopic ACL reconstruction using a hamstring graft, with a minimum 2-year follow-up. Graft healing was evaluated at 1 year using a magnetic resonance imaging scan, with the mean signal-to-noise quotient ratio (SNQ) measured from three areas: proximal, middle, and distal to the ACL graft. Patients' demographics data, meniscal lesion, chondral lesion, time to operation, time to evaluation, PROMs (International Knee Documentation Committee [IKDC] scores, Tegner activity scale, and Lysholm score), and complications were evaluated. ACL laxity was measured using a side-to-side difference (SSD) by a lachmeter.

Results: A total of 51 patients, comprising 25 in the SGST-ACLR group and 26 in the CONV-ACLR group, were analysed. The ACL graft diameter was comparable between the two groups (p = 0.32). The mean SNQ at 1-year postoperative MRI showed no significant difference (p = 0.21). Furthermore, no statistically significant differences were observed in the postoperative IKDC scores (p = 0.36), Lysholm scores (p = 0.22), Tegner activity scores (p = 0.30), or side-to-side differences (p = 0.38) at the final follow-up.

Conclusion: At two years postoperatively, this study demonstrates that SGST-ACLR with an internal brace provides comparable outcomes in all parameters to CONV-ACLR. Thus, SGST-ACLR offers a viable alternative technique for ACL reconstruction, with the added advantage of minimising graft usage.

Level of evidence: Level IV, retrospective cohort study.

Keywords: all‐inside technique; anterior cruciate ligament reconstruction; short graft short tunnel ACLR.

Figure 1

Demonstrate anterior cruciate ligament (ACL) graft preparation. (a) Short ACL graft preparation, approximately 6 cm in length, attached to ACL TightRope (Arthrex, Naples, FL) on both the femoral and tibial sides. (b) The diameter of the ACL graft is approximately 9 mm.

Figure 2

Illustrates ACLR. (a) STSG‐ACLR, with the red line indicating the shortening strand of the femoral adjustable loop passing through the tibial tunnel and tying with the tibial ABS button. (b) CON‐ACLR femoral side fixed ACL TightRope (Arthrex, Naples, FL), tibial side fixed with an interference screw. ACLR, anterior cruciate ligament reconstruction; STSG, short graft short tunnel.

Figure 3

Shown SNQ ratio was measured on the sagittal PD image. (a) Signal intensity was measured at the proximal, middle, and distal ACL graft (b) at the mid‐substance of the PCL and (c) at the background at 2.0 cm anterior to the mid‐point of the patellar tendon. ACL, anterior cruciate ligament; SNQ, signal‐to‐noise quotient.

Figure 4

The flowchart illustrates the retrospective analysis of electronic data, focusing on patients who underwent hamstring graft anterior cruciate ligament reconstruction (ACLR). STSG, short graft short tunnel.