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Joint German Congress of Orthopaedics and Trauma Surgery

02. - 06.10.2006, Berlin

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Tibial rotation is not restored after ACL reconstruction with a hamstrings graft

Meeting Abstract

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  • V. Chouliaras - Orthopaedic Sports Medicine Center, Department of Orthopaedic Surgery, University of Ioannina, Ioannina, Greece
  • S. Ristanis - Orthopaedic Sports Medicine Center, Department of Orthopaedic Surgery, University of Ioannina, Ioannina, Greece
  • C. Moraiti - Orthopaedic Sports Medicine Center, Department of Orthopaedic Surgery, University of Ioannina, Ioannina, Greece
  • N. Stergiou - HPER Biomechanics Laboratory, University of Nebraska at Omaha, Omaha, NE, United States of America
  • A. Georgoulis - Orthopaedic Sports Medicine Center, Department of Orthopaedic Surgery, University of Ioannina, Ioannina, Greece

Deutscher Kongress für Orthopädie und Unfallchirurgie. 70. Jahrestagung der Deutschen Gesellschaft für Unfallchirurgie, 92. Tagung der Deutschen Gesellschaft für Orthopädie und Orthopädische Chirurgie und 47. Tagung des Berufsverbandes der Fachärzte für Orthopädie. Berlin, 02.-06.10.2006. Düsseldorf, Köln: German Medical Science; 2006. DocP.2.4.1-927

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgu2006/06dgu0288.shtml

Published: September 28, 2006

© 2006 Chouliaras et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Introduction: Due to the morbidity associated with the use of a bone-patellar tendon-bone graft for ACL reconstruction, many surgeons currently prefer hamstrings as the graft source, and specifically a quadrupled semitendinosus/gracilis (ST/G) graft. In-vitro research has showed though, that this graft cannot restore excessive tibial rotation. The purpose of our study was to explore this finding in-vivo with gait analysis.

Methods: Eleven patients ACL reconstructed with an ST/G graft and eleven matched controls were assessed. Kinematic data were collected (50Hz) with a six-camera optoelectronic system, while the subjects descended stairs and immediately after, pivoted on their landing leg. The dependent variable examined was the tibial internal-external rotation during pivoting. All patients in both groups were also assessed clinically and with the use of a KT-1000 to evaluate anterior tibial translation.

Results: The results demonstrated that ACL reconstruction successfully restored anterior tibial translation. No significant differences (p=0.892) were found for the maximum range of motion of tibial rotation during the identified evaluation period, between the healthy leg of the control group and the intact leg of the ACL reconstructed group. However, significant differences were identified within the ACL reconstructed group and between the reconstructed and intact leg (p=0.002), as well as between the control knee and the ACL reconstructed knee (p=0.011).

Conclusions: Therefore, we found that ACL reconstruction with the ST/G graft did not restore tibial rotation to previous physiological levels. The tibial movement pattern remained abnormal in ACL reconstructed patients, even though pathological tibial translation was restored. This excessive rotation may degenerate soft tissues (i.e. cartilage) longitudinally, as these abnormal rotational movements of the articulating bones at the knee may apply loads at areas of the cartilage that are not commonly loaded in a healthy knee, thus resulting in osteoarthritis. It seems that another type of graft or a different reconstruction technique is needed that could replicate more accurately the natural ACL, regarding its actual anatomy and functional rotational abilities.

Level of Evidence:Therapeutic study, level III (prospective case-control study).