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Journal of Bone and Joint Surgery - British Volume, Vol 90-B, Issue 4, 455-459.
doi: 10.1302/0301-620X.90B4.19416  
Copyright © 2008 by British Editorial Society of Bone and Joint Surgery
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Changes in the four-strand hamstring graft in anterior cruciate ligament reconstruction in the skeletally-immature knee

S. Bollen, MB BS, FRCS(Orth), FFSEM(UK), Orthopaedic Surgeon1; F. Pease, MB BS, House Officer2; A. Ehrenraich, BSc, MD, Orthopaedic Fellow2; S. Church, MB BS, FRCS(Orth), Orthopaedic Surgeon2; J. Skinner, MB BS, FRCS(Orth), Orthopaedic Surgeon3; and A. Williams, MB BS, FRCS(Orth), FFSEM(UK), Orthopaedic Surgeon2

1 The Yorkshire Clinic, Bradford Road, Bingley, Yorkshire BD16 1TW, UK.
2 Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK.
3 The Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex HA5 4LP, UK.

Correspondence should be sent to Mr A. Williams; e-mail: zealey{at}btconnect.com

The potential harm to the growth plate following reconstruction of the anterior cruciate ligament in skeletally-immature patients is well documented, but we are not aware of literature on the subject of the fate of the graft itself. We have reviewed five adolescent males who underwent reconstruction of the ligament with four-strand hamstring grafts using MR images taken at a mean of 34.6 months (18 to 58) from the time of operation. The changes in dimension of the graft were measured and compared with those taken at the original operation. No growth arrest was seen on radiological or clinical measurement of leg-length discrepancy, nor was there any soft-tissue contracture. All the patients regained their pre-injury level of activity, including elite-level sport in three. The patients grew by a mean of 17.3 cm (14 to 24). The diameter of the grafts did not change despite large increases in length (mean 42%; 33% to 57%). Most of the gain in length was on the femoral side. Large changes in the length of the grafts were seen.

There is a considerable increase in the size of the graft, so some neogenesis must occur; the graft must grow.




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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General