Quadruple Semitendinosus Tendon for Anterior Cruciate Ligament Reconstruction

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Significant advances have been achieved in anterior cruciate ligament (ACL) reconstruction during the past decades. At present, the most commonly used type of graft for reconstruction is either bone-patellar tendon (BPT) or hamstring (HT) grafts. Long-term favorable results have both been reported with the use of either graft type. However, concern remains with the use of HT grafts because it has a relatively slower tendon-to-bone healing interval when compared with ACL reconstruction using BPT, whereas donor site complications have been known to be associated with the use BPT grafts. To address these problems, we describe the use of a quadrupled semitendinosus tendon graft with a bone block harvested from the tibial end of the tendon. This technique combines the advantage of having low donor site morbidity and at the same time achieves bone-to-bone healing with bone blocks incorporated in the tunnels. Results revealed that in 100 cases reviewed, 90% of the knees were either normal or nearly normal on final follow up. Computerized analysis of knee laxity also demonstrated 90% with side-to-side difference of <3 mm. Magnetic resonance imaging studies reveal that as early as 3 to 6 months, 30 cases already demonstrated evidence of graft incorporation in the tunnels. These findings suggest that the use of a quadrupled semitendinosus construct with bone block is a viable technique for ACL reconstruction.

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