The new auto graft technique in anterior cruciate ligament reconstruction

In our study, our aim was to compare the clinical outcomes of utilizing a 6-stranded hamstring autograft (HAG) lacking tibial attachment site separation in Anterior Cruciate Ligament Reconstruction (ACLR), an approach previously unreported in literature, with alternative methodologies.

A total of 85 patients admitted to our Orthopedics and Traumatology clinic between April 2019 and July 2022 with Anterior Cruciate Ligament (ACL) rupture, who underwent surgical treatment, were retrospectively analyzed. ACLR was initiated using HAG in all patients. The surgical procedure was determined based on the length of the HAG used during ACLR. In all cases, femoral fixation was performed with an adjustable loop endobutton. 3 methods were applied to all patients. These are: repair with a 6-strand hamstring tendon graft without severing the tibial insertion (new method), repair with 4-strand hamstring tendon graft without severing the tibial insertion and repair with 4-strand hamstring tendon graft without protecting the tibial insertion. Preoperative and postoperative International Knee Documentation Committee (IKDC) subjective evaluation score, Lysholm score and Tegner activity score were used in the evaluation of the patients. Comparisons between groups were made according to these scores.

78 patients were included in the study. There were 31 patients in Group 1, 23 in Group 2 and 24 in Group 3. The mean age of the patients was 29 (19-40) in Group 1, 32 (16-49) in Group 2 and 31 (18-54) in Group 3. In the comparison of the groups, there was a significant increase in tendon thickness in Group 1 (p<0.001) and a significant decrease in the rate of re-rupture as a complication (p<0.05). There was no statistically significant difference between the groups in terms of age, side of surgery, follow-up period, and length of hospital stay. There was statistical significance between Group 1 and Group 2 in terms of tendon diameter (p<0.05) and re-rupture (p<0.05). In the comparison of Group 2 and Group 3, there was statistical significance between Group 2 and Group 3 in terms of tendon thickness and length of hospital stay (p<0.05), while no significant difference was found in terms of re-rupture (p>0.05).

ACLR with 6-strand tendon graft with preservation of the HAG insertion is not a method described in the literature. As a result of our study, it was concluded that the functional results of this newly described method are as good as other methods and have lower re-rupture rates.