The outcome of pes-sparing ACL reconstruction: a preliminary report

Introduction: The use of hamstring graft for anterior cruciate ligament (ACL) reconstruction has gained popularity over the years. Strategies to improve the outcome of ACL surgeries using the hamstring graft are being utilized. This study aims to describe a surgical technique used to preserve the hamstring insertion during ACL reconstruction and to report its outcome at a minimum of 1year follow-up.

Methods: This is a retrospective study involving patients who underwent primary ACL reconstruction performed by a single surgeon at private tertiary hospital from January 2014 to July 2014. The primary outcome of this study includes subjective evaluation of function using the Lysholm Knee Questionnaire and activity level at final follow-up using the Tegner Activity Scale. Secondary clinical outcome included range of motion at final follow-up and time to return to sports. Results were obtained via phone interview. Hop test results were also noted.

Results: Forty three (43) patients were included in the study. After a mean of 8+2.8 months from surgery, 93% (n=40) of the patients were able to return to sports. Of these, 67.5% (n=27) were able to return to preinjury level, 7.5% (n=3) reported better knee function, 22.5% (n=9) reported a lower level of play because of fear of reinjury, and the remaining 2.5% (n=1) was able to return to play but changed the type of sport. After at least 1-year follow-up, patients reported good to excellent knee function and only with minimal and occasional pain, swelling, and clicking for some. All patients also reported full range of motion at final follow-up. Hop test results also showed proprioceptive function of the injured knee comparable to the uninjured knee, with limb symmetry index of 101.409% for single hop, 102.066% for the timed hop, and 101.499% for the crossover hop.

Conclusion: Preservation of the tibial insertion of hamstring graft for ACL reconstruction results in favorable outcomes, with good to excellent knee function at final follow-up and return to preinjury level of activity for most patients. Inability to return to the preinjury level was related to fear of reinjury rather than to incapacitating symptoms, such as pain, clicking, and giving way.