Anterior cruciate ligament reconstruction with the Tape Locking Screw (TLS) and a short hamstring graft: Clinical evaluation of 61 cases with a minimum 12 months' follow-up

Orthop Traumatol Surg Res. 2018 Sep;104(5):701-705. doi: 10.1016/j.otsr.2018.03.016. Epub 2018 Jun 28.

Abstract

Introduction: The Tape Locking Screw (TLS®) technique for anterior cruciate ligament (ACL) reconstruction has the advantages of using only one hamstring tendon (semitendinosus) by preparing a short graft secured with screws and braided strips. The theoretical pitfall of this technique is that the graft length is determined arbitrarily. Thus, if the blind tunnels are not long enough, it will be impossible to tension the graft properly upon fixation. The primary objective of this study was to determine the postoperative side-to-side difference in knee laxity. We hypothesized that ACL reconstruction with the TLS(R) system would result in 3mm or less side-to-side difference in knee laxity.

Material and methods: This was a prospective single-center, single-surgeon study performed on patients operated between December 2014 and June 2016 who had a minimum 12 months' follow-up. The pre- and post-operative side-to-side difference in knee laxity was measured with a KT-1000 arthrometer. Secondary outcomes were the pre- and post-operative IKDC, Lysholm and Tegner functional scores.

Results: Sixty-one patients were included: 49 men (80%) and 12 women (20%). The average age was 31.6±13.7 years. The average follow-up was 19.3±6.3 months. The average side-to-side difference in laxity went from 6.5mm (min 3; max 12) preoperatively to -0.1mm postoperatively (min -5, max 4) (p<0.01). The average IKDC went from 39.7±12 preoperatively to 94.1±11.2 postoperatively (p<0.005), the average Lysholm score went from 41±12.9 to 95.5±9.8 (p<0.005), and the average Tegner score went from 6.3±1.5 to 4.3±1.4 (p<0.005). Patients were able to return to sports an average of 6.1 months after surgery. In terms of complications, 4.9% of patients developed a cyclops lesion and required surgical revision.

Discussion: This study found very good reduction in postoperative laxity after a minimum 12 months' follow-up when ACL reconstruction is performed with the TLS® technique.

Level of evidence: IV, prospective cohort study.

Keywords: Anterior cruciate ligament; Knee laxity; Ligament reconstruction; ST4; Short graft; Tape Locking Screw (TLS(®)).

MeSH terms

  • Adolescent
  • Adult
  • Anterior Cruciate Ligament Injuries / physiopathology
  • Anterior Cruciate Ligament Injuries / surgery*
  • Anterior Cruciate Ligament Reconstruction / instrumentation
  • Anterior Cruciate Ligament Reconstruction / methods*
  • Bone Screws*
  • Female
  • Follow-Up Studies
  • Hamstring Tendons / transplantation*
  • Humans
  • Joint Instability / etiology
  • Joint Instability / physiopathology
  • Joint Instability / surgery*
  • Knee Joint / physiopathology
  • Knee Joint / surgery
  • Lysholm Knee Score
  • Male
  • Middle Aged
  • Postoperative Complications / surgery
  • Prospective Studies
  • Reoperation
  • Return to Sport
  • Treatment Outcome
  • Young Adult