Lateral tenodesis combined with anterior cruciate ligament reconstruction using a unique semitendinosus and gracilis transplant

The aim of this study was to assess the anatomical results, functional results and the incidence of arthritis of a mixed intra- and extra-articular hamstring tendon based reconstruction for anterior instability of the knee. This retrospective study consists of 100 knees in 99 patients (22 female and 77 male) operated upon between November 2003 and March 2006. The average age was 29.7 +/- 10.4 years and the average interval between injury and surgery was 26.6 +/- 41.8 months (2-240). In our technique, the semitendinosus and gracilis tendons were left attached to the tibia and by means of a lateral transcondylar tunnel posterior and inferior to the proximal attachment of the lateral collateral ligament were passed around the knee before being sutured to the fascia lata at the level of Gerdy's tubercle. Sixty-eight knees were re-examined at an average follow-up of 76 +/- 12 months. The average differential anterior drawer test at the last review was 2.5 +/- 3.4 mm (p < 0.0001). Of the patients 75 % had a negative pivot shift test, 21 % a gliding test and 4 % a clear positive test (p < 0.0001); 84 % of patients had an International Knee Documentation Committee (IKDC) score rated A or B. The average IKDC subjective score was 90 +/- 9 (60-100). Mixed intra- and extra-articular reconstructions using hamstring grafts allow the knee to be stabilised in the sagittal plane and the rotatory instability to be controlled in the majority of cases. Only very minor progression of arthritic changes at an average 76 +/- 12 months was seen.