Comparative Study Of Functional Outcome Of ACL Reconstruction With Arthroscopic Two Strands And Four Strands Hamstring Autograft

Abstract

Background: Anterior cruciate ligament (ACL) injuries are commonly observed conditions presented in sports medicine, which often require surgical reconstruction. Implication of two-strand and four-strand hamstring autografts are commonly used for ACL reconstruction modality. However, concerning with impact on graft diameter and recovery rates is not well understood. The present study intends to explore on the functional outcomes of two-strand and four-strand hamstring grafts on the study population.

Methods: A total of 60 patients underwent ACL reconstruction using either a two-strand semitendinosus tendon graft (n=30) or a four-strand semitendinosus and gracilis tendon graft (n=30). Graft fixation was achieved using suspensory endobutton and interference screw techniques. Functional outcomes were determined using the Lysholm Scoring System, IKDC Subjective Scoring, and Knee Flexion and Extension Strength Testing were evaluated during the followup time frame of 20-months, with mean followup period of 12 months.

Results: Findings showcased no significant differences between both the groups concerning with functional outcomes namely- knee strength, range of motion, thigh girth, or Lysholm scoring. Patients who are consistently subjected to physiotherapy and yoga during rehabilitation phase had a faster recovery and earlier return to work when on comparison to that of those individuals who were inconsistent. Males have regained full strength and power in their injured site much more earlier compared to females. Four-strand hamstring grafts showcased slightly superior outcomes notably with respect to rotational stability, anterior stability, and early return to day-to-day activities when compared with two-strand grafts.

Conclusion: Both groups of the ACL autografts presented as a viable option for reconstruction, with no significant differences from the measured functional outcomes. Consistent physiotherapy and yoga during rehabilitation showed direct association with patients’ faster recovery. Four-strand hamstring grafts may provide better advantages with regards to anterior stability, rotational stability, and early return for patients in performing their daily activities. These findings can inform surgical decision-making in ACL reconstruction