RECONSTRUCTION OF THE ACL USING INTRA- AND EXTRA-ARTICULAR HAMSTRING PLASTY: COMPARATIVE STUDY OF TWO SERIES WITH AND WITHOUT LATERAL REINFORCEMENT, 100 CASES

Abstract

Purpose: The purpose of this study was to: 1) assess outcome of ACL reconstruction with intra- and extra-articular hamstring plasty; 2) analyse the contribution of a synthetic lateral reinforcement by comparing two series.

Material and methods: This population of 100 patients was divided into two groups: group 1 with a synthetic lateral reinforcement (70 patients) and group 2 without lateral reinforcement (30 patients). Eighty-nine percent of the patients were reviewed. Mean age at operation was 28 years. Fifty-six percent of the patients were competition-level athletes (pivot sports) and lesions of the medial meniscus was observed peroperatively in 74% of the patients. Mean follow-up was 40 months. The two groups were comparable for all parameters studied except follow-up and age which were slightly lower in group 2 without reinforcement. ARPEGE and IKDC scores (with KT1000 at 89N) were established. We performed a precise analysis of residual laxity (TELOS at 15 kg). The position and the width of the bore holes were also analysed.

Results: According to the ARPEGE scores, outcome was excellent or very good in 71% of the patients and 87% were in IKDC classes A and B. Seventy percent of the patients who were competition-level athletes (pivot sports) resumed their activities at the same level. Residual differential laxity (TELOS) was 5.7 mm (mean). Tunnel width was 3.5 mm (mean). This work demonstrated the safety of hamstring harvesting.

Discussion Residual laxity was strongly correlated with clinical outcome: residual differential laxity less than 6 mm (threshold value) ensured a negative pivot test and 94% good results. We did not find any correlation between tunnel width and residual laxity. An overly anterior femoral position and medial meniscectomy significantly increased residual laxity. The femoral bore hole should be sufficiently posterior, 60 to 70% of the anteroposterior condylar width. Use of a synthetic reinforcement did not improve clinical or laximetric outcome in the reinforcement group; a natural plasty without synthetic reinforcement would be preferable.