Functional outcome of anterior cruciate ligament reconstruction with quadruple hamstring tendon graft using EndoButton and bioabsorbable interference screw: minimum 2-year follow-up

Shishir Murugharaj Suranigi, Kanagasabai R., Syed Najimudeen, James J. Gnanadoss


Background: Anterior cruciate ligament (ACL) is the most common ligament to be torn in the knee joint and ACL reconstruction (ACLR) is one of the most commonly performed surgery in orthopaedics nowadays. This study evaluated short term results of anterior cruciate ligament reconstruction with quadruple hamstring tendon (QHT) graft using EndoButton for femoral fixation and Bio absorbable interference screw for tibial fixation.

Methods: Out of the 68 patients who underwent single-bundle ACLR with QHT graft  using EndoButton for femoral fixation and Bio absorbable interference screw for tibial fixation, 60 patients were followed up for a minimum period of 2 years. Patients were followed up at regular intervals and evaluation was done using the anterior drawer test, Lachman test, pivot-shift test, modified Cincinnati rating system and Tegner-Lysholm knee scoring scale.

Results: There was improvement in the Lachman test and pivot-shift test at 2 year follow-up, from grade 2 (n=47) or grade 3 (n=6) to grade 1 (n=17) or grade 0 (n=42) and from grade 1 (n=38) or grade 2 (n=12) to grade 1 (n=14) or 0 (n=45), respectively. The mean Modified Cincinnati score and Tegner-Lysholm knee score improved from 59.57 to 99.03 and 64.45 to 98.87 respectively at 2 year follow-up. Complications occurred in 3 patients, a re-rupture due to trauma at 1 year after surgery, development of a cyclops lesion with restricted range of motion and a superficial infection at the graft harvest site.

Conclusions: The two year follow-up results of ACLR with QHT graft using EndoButton for femoral fixation and bioabsorbable interference screw for tibial fixation are satisfactory and comparable with other modalities of graft fixation.


Anterior cruciate ligament, EndoButton, Quadruple hamstring tendon graft, ACL reconstruction

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