Hamstring Tendon with Bone Plug to Repair ACL TearAn injury to the anterior cruciate ligament (ACL) doesn't have to mean the end of an athlete's career. Advances in surgical treatment have made it possible for many athletes to return to their former level of play. They may just have to sit on the sidelines for six to eight months.
There are several choices in ACL surgery. One is to replace the torn ligament with part of the patellar tendon and an attached piece of bone from the tibia (the shinbone). Bone-to-bone contact gives faster healing. The second is to use a strip of tendon from the hamstrings to reconstruct the torn ACL.
Many doctors favor the hamstring method. It gives good graft strength and only requires a small incision. Unlike the patellar tendon method, the hamstring graft doesn't normally come with connected bone plug. Doctors in Italy tried a new method of grafting. They used the hamstrings tendon with an added piece of bone. The graft they used is called a semitendinosus graft with a bone block (STB).
STB gives a faster bone-to-bone healing much like the method using the patellar tendon graft with bone plug. It also has a low rate of donor-site problems. Just how well does it work?
Eighty active athletes with an ACL injury were included. All participants got their muscle strength back within a year. They could return to high-risk sports activities by six to eight months. There were some cases of pain with kneeling and numbness from nerve damage.
Even with good motion and strength, some athletes were unable to return to their preinjury level of play. The authors think this might be due to the fear of a new injury. Some athletes changed their focus and moved away from sports participation.
This newer method of ACL grafting gives good knee stability. Patients generally regain strength and can often return to active sports. And patient satisfaction is high. The authors conclude that their STB method of reconstructing a torn ACL has merit.
Alberto Gobbi, MD, et al. Quadrupled Bone-Semitendinosus Anterior Cruciate Ligament Reconstruction: A Clinical Investigation in a Group of Athletes. In Arthroscopy. September 2003. Vol. 19. No. 7. Pp. 691-699.
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