# Functional Outcome of Arthroscopic Anterior Cruciate Ligament Reconstruction Using a Quadrupled Hamstring Autograft: A Prospective Study

## TL;DR

This study shows that using a quadrupled hamstring graft for ACL surgery leads to excellent short-term recovery and knee stability.

## Contribution

The study evaluates the effectiveness of a specific arthroscopic ACL reconstruction technique using a quadrupled hamstring autograft in a single center.

## Key findings

- Patients showed significant improvement in knee function with a mean Lysholm score increasing from 49 to 95.
- 90% of patients achieved excellent outcomes and 10% achieved good outcomes.
- 95% returned to their pre-injury activity level within nine months.

## Abstract

Background

The anterior cruciate ligament (ACL) is one of the primary stabilisers of the knee, and injury to it often requires surgical intervention. ACL injuries are common sports injuries that tend to occur during sudden deceleration, pivoting, or landing movements, resulting in knee instability and decreased functionality. Different graft options have been proposed over the years for reconstructing the ACL.

Objective

This study aimed to evaluate the short-term functional, clinical stability, and biomechanical (muscle strength) outcomes following arthroscopic ACL reconstruction using a quadrupled semitendinosus and gracilis autograft performed in a single tertiary care centre.

Methodology

We conducted a prospective study involving 40 patients undergoing primary ACL reconstruction at a tertiary care centre in India. The study was conducted from March 2022 to May 2024. The surgical technique involved harvesting and quadrupling the hamstring (semitendinosus and gracilis) tendons, with arthroscopic fixation using an adjustable-loop device on the femur and a bioabsorbable interference screw on the tibia. All patients followed an accelerated rehabilitation protocol. The outcomes were assessed at a mean follow-up of 14.2 months using the Lysholm Knee Scoring Scale, isokinetic dynamometry, and clinical stability tests.

Results

The results were positive and demonstrated a significant improvement in knee function (p < 0.001). The mean Lysholm score increased from approximately 49 preoperatively to 95 at the final follow-up. Ninety percent of patients achieved an excellent outcome, and the remaining 10% achieved a good outcome. All patients demonstrated normal knee stability on clinical testing. Ninety-five per cent returned to their pre-injury level of work or sports nine months postoperatively. The most common presenting complaint was the knee "giving way" or instability of the knee joint. While 40% of patients reported mild, transient anterior knee pain, there were no cases of graft failure, infection, or other serious complications.

Conclusion

Arthroscopic ACL reconstruction with a quadrupled hamstring tendon autograft provides excellent short-term outcomes and is a reliable technique for restoring knee stability and function. Further studies are required to evaluate objective outcomes and long-term sequelae.