Analysis of Arthroscopic ACL Reconstruction Using Single Bundle Four Strand Semitendinosus Graft in ACL Tear in Indian Patients

  • Dushyant Chouhan M.S. Ortho, Senior Resident, Lady Hardinge Medical College, New Delhi, 110029
  • Mukesh Kalra M.S. Ortho, Director Professor, Department of Orthopaedics, Lady Hardinge Medical College, New Delhi
  • Saumya Agarwal J.N. Medical College, Belagavi Karnataka, India
  • Amit Narang M.S. Ortho, Senior Resident, Department of Orthopaedics, Lady Hardinge Medical College, New Delhi
  • Manish Kanwat M.S. Ortho, Senior Resident, Department of Orthopaedics, Lady Hardinge Medical College, New Delhi
  • Ramesh Kumar M.S. Ortho, Senior Resident, Central Institute of Orthopaedics, VMMC and Safdarjang Hospital, New Delhi


Purpose: The best graft option to replace the injured Anterior Cruciate Ligament (ACL) has been a matter of discussion. There has been paucity in the literature regarding arthroscopic ACL Reconstruction using four strand single Semitendinosus graft. Method: 30 patients underwent arthroscopic ACL reconstruction using single semitendinosus tendon after quadrupling the tendon and fixing on femoral side with endobutton and tibial side with interference screw. The functional outcome was compared using preoperative and postoperative Lysholm II scoring and anterior tibial translation. The secondary outcomes were measurement of harvested and quadrupled Semitendinosus graft length and thickness and its complications. Result: All patients had Poor Lysholm score pre-operatively (mean= 48) but showed improvement in Lysholm score at 3 months (mean=89) and 6 months post-operatively (mean=93). The mean pre-operative anterior tibial translation was 11.2mm. Post-operative mean anterior tibial translation was 2.96mm at 1 month, 2.93mm at 3 months and 3.5mm 6 months. Superficial wound infection at harvested semitendinosus graft site was observed in one case which resolved on daily dressing and antibiotic therapy for 7 days and recurrent knee effusion was observe in two patients who were managed conservatively in the form of anti-inflammatory medications. Conclusion: The reconstruction of the ACL by a quadrupled semitendinosus tendon graft with an endobutton and a bioabsorbable screw can achieve excellent clinical and subjective results after a short/intermediate follow-up of 6 months.


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Author Biography

Saumya Agarwal, J.N. Medical College, Belagavi Karnataka, India

post graduate in dept of orthopaedics


Mohtadi NG, Chan DS, Dainty KN, Whelan DB. Patellar tendon versus hamstring tendon auto graft for anterior cruciate ligament rupture in adults. Cochrane Database Syst Rev. 2011; 1; 9.

Chen L, Cooley V, Rosenberg T ACL reconstruction with hamstring tendon. Orthopedic Clinics of North America. 2003; 34(1): 9-18.

Beynnon BD, Johnson RJ, Fleming BC, Kannus P, Kaplan M, Samani J, Renström P. Anterior Cruciate ligament replacement: comparison of bone-patellar tendon bone graft s with two strand hamstring grafts. The Journal of Bone & Joint Surgery. 2002; 84(9):1503-13.

Sgaglione NA, Warren RF, Wickiewicz TL, Gold DA, Panariello RA. Primary repair with semitendinosus tendon augmentation of acute anterior cruciate ligament injuries. Am J Sports Med. 1990; 18(1): 64-73.

Brophy RH, Silvers HJ, and M and Elbaum BR. Anterior cruciate ligament injuries: Etiology and prevention. Sports Med Arthrosc 2010; 18:2–11.

DeHaven KE. Diagnosis of acute knee injuries with hemarthrosis. Am J Sports Med. 1980; 8(1): 9-14.

Kennedy JC. Complete Dislocation of the knee Joint. Can Med Assoc J. 1963; 89(17): 903–904.

Schulz MS 1, Russe K, Weiler A, Eichhorn HJ, Strobel MJ. Epidemiology of posterior cruciate ligament injuries. Arch Orthop Trauma Surg. 2003; 123(4):186-91.

Shelbourne KD, Patel DV. Timing of surgery in anterior cruciate ligament‐injured knees. knee Surg Sports Traumatol Arthrosc.1995; 3(3):148‐56.

Almekinders LC, Moore T, Freedman D, Taft TN. Post‐operative problems following anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 1995; 3(2):78‐82.

Eitzen I Holm, I Risberg MA. Preoperative quadriceps strength is a significant predictor of knee function two years after anterior cruciate ligament reconstruction. Br J Sports Med. 2009; 43(5):371‐76.

Colombet P, Graveleau N. An Anterior Cruciate Ligament Reconstruction Technique With 4-Str and Semitendinosus grafts, Using Outside-In Tibial Tunnel Drilling and Suspensory Fixation Devices. Arthroscopy Techniques. 2015; 4(5): e507-e511.

Eajazi A, Madadi F, Boreiri M. Comparison of different methods of femoral fixation anterior cruciate ligament reconstruction. Acta Med Iran. 2013; 51(7): 444-8.

Jonsson H, Riklund-Ahlstrom K, Lind J. Positive pivot shift after ACL reconstruction predicts later osteoarthrosis: 63 patients followed 5–9 years after surgery. Acta Orthop Scand. 2004; 75(5): 594–99.

Kocher MS, Steadman JR, Briggs KK, Sterett WI, Hawkins RJ. Relationships between objective assessment of ligament stability and subjective assessment of symptoms and function after anterior cruciate ligament reconstruction. Am J Sports Med. 2004; 32(3): 629–34.

Beard DJ and Dodd CAF. Home or supervised rehabilitation following anterior cruciate ligament rupture: a randomized controlled trial. Journal of Orthopaedic and Sports Physical Therapy 1998; 27:134–43.

Podesta L, Magnusson J and Gillette T. Anterior cruciate ligament reconstruction. In Maxey L and Magnusson J (Eds.): Rehabilitation for the Post surgical Orthopedic Patient. St. Louis: Mosby, 2001; 206–26.

Burks RT, Friederichs MG, Fink B, Luker MG, West HS, Greis PE. Treatment of post operative anterior cruciate ligament infections with graft removal and early reimplantation. Am J Sports Med 2003; 31: 414–18.
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How to Cite
Chouhan, D., Kalra, M., Agarwal, S., Narang, A., Kanwat, M., & Kumar, R. (2019). Analysis of Arthroscopic ACL Reconstruction Using Single Bundle Four Strand Semitendinosus Graft in ACL Tear in Indian Patients. International Journal of Biomedical and Advance Research, 10(2), e5017.
Original Research Articles