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Comparison of "ligamentization" process between preserved insertion hamstring tendon autograft and bone-patellar
Ravi Gupta1, Sandeep Singh2, Anil Kapoor2
1Director Orthopaedics, Fortis Hospital, Mohali, Punjab, India.
Summary
The study found that both bone-patellar tendon-bone (BPTB) and semitendinosus gracilis tendon graft with preserved tibial insertion (STGPI) autografts show similar ligamentization rates and clinical outcomes after ACL reconstruction. Knee laxity was also comparable between the two graft types.
Area of Science:
- Orthopedic Surgery
- Biomedical Engineering
- Sports Medicine
Background:
- Ligamentization, the process of graft incorporation after anterior cruciate ligament (ACL) reconstruction, is crucial for graft function.
- The impact of preserving the hamstring tendon graft's tibial insertion on ligamentization remains under-investigated.
- This study compares the ligamentization of semitendinosus gracilis graft with preserved tibial insertion (STGPI) against bone-patellar tendon-bone (BPTB) autografts.
Purpose of the Study:
- To analyze and compare the ligamentization process of STGPI versus BPTB autografts following ACL reconstruction.
- To evaluate the effect of preserving hamstring tendon graft insertion on graft maturation.
- To assess clinical outcomes and knee laxity associated with both graft types.
Main Methods:
- A cohort of 50 patients undergoing ACL reconstruction was divided into two groups: 25 receiving BPTB autografts and 25 receiving STGPI autografts.
- Contrast-enhanced MRI scans were performed at 8 and 14 months post-surgery to assess ligamentization using signal-to-noise quotient (SNQ), graft intensity, and enhancement index.
- Clinical assessments included Lysholm scores and knee laxity measurements at 8 and 14 months post-operation.
Main Results:
- No significant differences in graft hyperintensity or SNQ were observed between BPTB and STGPI groups at 8 and 14 months.
- The enhancement index was significantly higher in the BPTB group at both 8 months (p=0.0001) and 14 months (p=0.003), indicating potentially faster graft remodeling.
- Functional outcomes (Lysholm score) and knee laxity were comparable between the BPTB and STGPI groups at both follow-up points.
Conclusions:
- Both BPTB and STGPI autografts demonstrate similar rates and extents of ligamentization after ACL reconstruction.
- Preserving the tibial insertion of the hamstring graft does not negatively impact graft maturation or clinical outcomes compared to BPTB.
- STGPI represents a viable alternative to BPTB autografts for ACL reconstruction, offering comparable functional results and knee stability.
