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Short Grafts Acl Reconstruction: Mri Findings And Clinical Outcome In Acl Reconstruction Using Quadrupled Semitendinosus Graft
ESSKA Academy. plaweski s. May 12, 2018; 218116; FP43-748
Prof. stephane plaweski
Prof. stephane plaweski
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Abstract
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Objectives: The success of ligament reconstruction of ACL (ACLR) is multifactorial. A key links concerns the mechanical primary and secondary biological fixation of the graft in the bone tunnels. No study in humans has determined its necessary and sufficient length within the bone tunnels.
Hypothesis:The consolidation of the tendon graft within the bone structure of the femoral and tibial tunnels is due to Sharpey's fibers within the interface of the tendon with the articular surface.
The aim of this paper was to assess the MRI findings and clinical results of short grafts with minimum 2 years of follow up.

Methods: This prospective cohort study included 35 patients who were operated of complete ACL rupture with ST4 technique (exclusion criteria: peripheral lesions ligament of the same knee surgery history, age below 18 years). The average age was 24 years (18- 42) (18 men and 12 women).The attachment of the graft to the femur was realized by cortical support system and to the tibia by a tape locking screw system. Conducting an MRI imaging with 3D reconstructions enabled the calculation of the length and size of the graft: length of the intra-articular portion (ACLIA), femoral and tibial length of tunnels (TT and TF), graft length tibial and femoral in tunnels (TTG and TFG). The Clinical evaluation was performed according to the classification IKDC 2000 to a minimum follow up of 2 years (objectiv score).

Results: The respective lengths were: TT: 34 +/- 2.9 (28-42), TF: 31 +/- 3,7 (30-39), TTG: 12 +/- 2.2 (7-18), TFG: 11 +/- 1 9 (9-17). According to the classification IKDC 2000 30 patients (85%) were class A and 5 class B (15%). The average of residual differential laxity was 1.2 mm +/- 0.7 (0-4).The length of the graft in the tunnel was less than 18 mm in all cases (femur or tibia) with minimum values of 7 mm. Correlated with the absence of residual significativ laxity (less than 4mm) these results confirm the working hypothesis.

Conclusions: The results of short graft ACLR allow to obtain excellent clinical outcomes at 2 years follow-up and suggest that the biological secondary fixation is mainly in the first millimeters of bone structure tunnels at the interface between the tendon structures and the articular surface.

Keywords:
ACL Reconstruction, Short Graft, MRI, Quadrupled Semitendinosus
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