RESUMO
BACKGROUND: The removal of all adherent muscle tissue from the hamstring graft during anterior cruciate ligament reconstruction (ACLR) is common practice. However, there is a paucity of research to justify this removal or evaluate its biological implications. PURPOSE/HYPOTHESIS: The purpose of this study was to (1) evaluate the histological characteristics of the myotendinous muscle tissue harvested from hamstring tendons, (2) compare the final diameter of the prepared graft before and after the removal of the remnant musculature, and (3) evaluate patients who were treated with and without preservation of the graft-adhered muscle. The hypothesis was that the adherent musculature of the graft would have cells that could contribute to graft incorporation and revascularization, assist in the proprioceptive capacity of the neoligament, and increase the graft's diameter. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: We divided 84 patients into 2 groups: group 1 underwent ACLR using hamstring tendon autograft with adherent musculature, and group 2 underwent ACLR using hamstring tendon autograft stripped of its remnant muscle. All patients had minimum 2-year follow-up. The muscle harvested from the graft in group 2 was submitted for histological examination, and the graft diameter before and after muscle removal was compared. The Tegner activity scale and Lysholm scores were determined preoperatively and at 12 and 24 months postoperatively. RESULTS: There was a significant difference in graft diameter between groups. The evaluation of the graft diameter in group 2 showed a decrease of 11.52% after removal of muscle tissue from the tendon graft. Patients from group 1 had better Tegner and Lysholm scores (mean ± SD) after 12 months (Tegner, 8.03 vs 7 [P = .004]; Lysholm, 95.48 ± 1.2 vs 87.54 ± 3.21 [P = .002]) and better Lysholm scores after 24 months (95.76 ± 2.1 vs 89.32 ± 2.47; P = .002). The muscle tissue of the analyzed fragments presented a pattern with fibrous tissue beams, invaginating regularly and sequentially from the myotendinous junction into the muscles. CONCLUSION: Preserving the muscle tissue on tendon grafts promoted a volumetric increase in the final autograft diameter and demonstrated biological and regenerative potential. Patients who underwent ACLR using the tendon with the muscle attached had better functional scores at 2-year follow-up as compared with patients treated using the tendon with the muscle removed.
RESUMO
PURPOSE: To compare the outcomes of patients with an arthroscopic floating meniscus sign at 24-month follow-up when treated with and without medial compartment reconstruction surgery. Another aim of the present study was to compare magnetic resonance imaging and arthroscopic findings directly related to the characterization and localization medial collateral ligament (MCL) injuries. METHODS: A total of 112 patients diagnosed with combined anterior cruciate ligament (ACL)-MCL grade II injuries to be treated with ACL reconstruction surgery were included in the study. During arthroscopy, patients diagnosed with the "floating meniscus" sign were divided into 2 groups: group 1 (n = 58) was treated with ACL and medial compartment reconstruction surgery and group 2 (n = 54) was treated with ACL reconstruction and nonsurgical medial compartment treatment. Return to competitive sports (Tegner score), Lysholm scores, ACL reconstruction failure, and residual MCL laxity were evaluated 6, 12, and 24 months after surgery. RESULTS: After 24 months, patients from group 1 (n = 58) had an average Tegner score of 8.98 and Lysholm score of 89.67; 2 patients presented with ACL reconstruction failure and none presented with residual MCL laxity. Patients from group 2 (n = 54) had an average Tegner score of 6.7 and Lysholm score of 78.12; 16 patients presented with ACL reconstruction failure and 13 presented with residual MCL laxity. CONCLUSIONS: In the presence of a floating meniscus arthroscopic sign, patients with combined ACL and grade II MCL injuries treated with ACL and MCL reconstruction surgery had significantly lower frequency of ACL reconstruction failure, residual MCL laxity, and better Tegner and Lysholm scores at 24 months' follow-up (P < .05). Additionally, magnetic resonance imaging and arthroscopy differed significantly (P < .05) in their ability to identify mid-substance and tibial site MCL injuries. LEVEL OF EVIDENCE: Level I, randomized clinical trial.