Skip to main content
SpringerLink
Log in

Independent clinical appraisal of the Tape Locking Screw (TLS®) anterior cruciate ligament reconstruction technique compared with the hamstring graft technique with a minimum of 12-month follow-up

  • Original Article • KNEE - ARTHROSCOPY
  • Published:
European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Introduction

The aim of this study was to assess the differential laxity after reconstruction of the anterior cruciate ligament (ACL) by the TLS® technique using a single tendon, the semitendinosus in four-strand graft, compared with the hamstring technique which uses both the gracilis and semitendinosus. We hypothesised that this surgical technique would provide post-surgical differential laxity measurements at least as good as those of the hamstring technique.

Materials and methods

We carried out a prospective monocentric study on patients undergoing unilateral anterior cruciate ligament repair between December 2014 and June 2016. All patients were followed up for at least 12 months. The series compares 61 patients operated on using the TLS® technique by the same surgeon, with 33 patients operated on using the hamstring technique by a second surgeon. The main objective of the study was to compare the post-operative differential laxity, measured using the KT1000, between the two techniques.

Results

There was no significant difference in the patients’ epidemiological characteristics and pre-operative scores between the two groups. Average pre-operative differential laxity was 6.5 mm ± 2.1 (min 3; max 12) in the TLS group and 6.4 mm ± 2.0 (min 0; max 11) in the hamstring group, with no statistically significant difference. The average post-operative difference in laxity was − 0.1 mm ± 1.9 (min − 5; max 4) in the TLS group and 0.3 mm ± 2.0 (min − 7; max 5) in the hamstring group. Again, no significant difference was observed between groups.

Discussion

This study demonstrates a level of post-operative differential laxity control using TLS comparable with that of the ACL reconstruction technique using a hamstring graft with preserved tibial insertion.

Level of evidence

II, prospective cohort study.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Source: Operative technique TLS® FH Orthopedics (with permission)

Similar content being viewed by others

References

  1. Collette M, Cassard X (2011) The Tape Locking Screw technique (TLS): a new ACL reconstruction method using a short hamstring graft. Orthop Traumatol Surg Res 97:555–559. https://doi.org/10.1016/j.otsr.2011.03.016

    Article  CAS  PubMed  Google Scholar 

  2. Kousa P, Järvinen TLN, Vihavainen M, Kannus P, Järvinen M (2003) The fixation strength of six hamstring tendon graft fixation devices in anterior cruciate ligament reconstruction. Part II: tibial site. Am J Sports Med 31:182–188. https://doi.org/10.1177/03635465030310020501

    Article  PubMed  Google Scholar 

  3. Adam F, Pape D, Schiel K, Steimer O, Kohn D, Rupp S (2004) Biomechanical properties of patellar and hamstring graft tibial fixation techniques in anterior cruciate ligament reconstruction: experimental study with roentgen stereometric analysis. Am J Sports Med 32:71–78. https://doi.org/10.1177/0095399703258608

    Article  PubMed  Google Scholar 

  4. Brown CH, Wilson DR, Hecker AT, Ferragamo M (2004) Graft-bone motion and tensile properties of hamstring and patellar tendon anterior cruciate ligament femoral graft fixation under cyclic loading. Arthroscopy 20:922–935. https://doi.org/10.1016/j.arthro.2004.06.032

    Article  PubMed  Google Scholar 

  5. Höher J, Livesay GA, Ma CB, Withrow JD, Fu FH, Woo SL (1999) Hamstring graft motion in the femoral bone tunnel when using titanium button/polyester tape fixation. Knee Surg Sports Traumatol Arthrosc 7:215–219. https://doi.org/10.1007/s001670050151

    Article  PubMed  Google Scholar 

  6. To JT, Howell SM, Hull ML (1999) Contributions of femoral fixation methods to the stiffness of anterior cruciate ligament replacements at implantation. Arthroscopy 15:379–387

    Article  CAS  PubMed  Google Scholar 

  7. Cavaignac E, Coulin B, Tscholl P, Fatmy NNM, Duthon V, Menetrey J (2017) Is quadriceps tendon autograft a better choice than hamstring autograft for anterior cruciate ligament reconstruction? A comparative study with a mean follow-up of 3.6 years. Am J Sports Med 45:1326–1332. https://doi.org/10.1177/0363546516688665

    Article  PubMed  Google Scholar 

  8. Rodeo SA, Kawamura S, Kim H-J, Dynybil C, Ying L (2006) Tendon healing in a bone tunnel differs at the tunnel entrance versus the tunnel exit: an effect of graft-tunnel motion? Am J Sports Med 34:1790–1800. https://doi.org/10.1177/0363546506290059

    Article  PubMed  Google Scholar 

  9. Bedi A, Kawamura S, Ying L, Rodeo SA (2009) Differences in tendon graft healing between the intra-articular and extra-articular ends of a bone tunnel. HSS J 5:51–57. https://doi.org/10.1007/s11420-008-9096-1

    Article  PubMed  Google Scholar 

  10. Tashiro T, Kurosawa H, Kawakami A, Hikita A, Fukui N (2003) Influence of medial hamstring tendon harvest on knee flexor strength after anterior cruciate ligament reconstruction. A detailed evaluation with comparison of single and double tendon harvest. Am J Sports Med 31:522–529. https://doi.org/10.1177/03635465030310040801

    Article  PubMed  Google Scholar 

  11. Condouret J, Cohn J, Ferret J-M, Lemonsu A, Vasconcelos W, Dejour D, Potel J-F, Société française d’arthroscopie (2008) Isokinetic assessment with two years follow-up of anterior cruciate ligament reconstruction with patellar tendon or hamstring tendons. Rev Chir Orthop Reparatrice Appar Mot 94:375–382. https://doi.org/10.1016/j.rco.2008.09.006

    Article  CAS  PubMed  Google Scholar 

  12. Ardern CL, Webster KE (2009) Knee flexor strength recovery following hamstring tendon harvest for anterior cruciate ligament reconstruction: a systematic review. Orthop Rev 1:e12. https://doi.org/10.4081/or.2009.e12

    Article  Google Scholar 

  13. Nakamura N, Horibe S, Sasaki S, Kitaguchi T, Tagami M, Mitsuoka T, Toritsuka Y, Hamada M, Shino K (2002) Evaluation of active knee flexion and hamstring strength after anterior cruciate ligament reconstruction using hamstring tendons. Arthroscopy 18:598–602

    Article  PubMed  Google Scholar 

  14. Connaughton AJ, Geeslin AG, Uggen CW (2017) All-inside ACL reconstruction: how does it compare to standard ACL reconstruction techniques? J Orthop 14:241–246. https://doi.org/10.1016/j.jor.2017.03.002

    Article  PubMed  PubMed Central  Google Scholar 

  15. Boyer P, Djian P, Christel P, Paoletti X, Degeorges R (2004) Reliability of the KT-1000 arthrometer (Medmetric) for measuring anterior knee laxity: comparison with Telos in 147 knees. Rev Chir Orthop Reparatrice Appar Mot 90:757–764

    Article  CAS  PubMed  Google Scholar 

  16. Saragaglia D (2014) Ligamentoplastie du ligament croisé antérieur de type mono-faisceau. In: D. Huten Conférences d’enseignement 2014 SOFCOT under direction of Hulet C, Potel JF. Elservier, Masson, p 155

  17. Kilinc BE, Kara A, Celik H, Oc Y, Camur S (2016) Evaluation of the accuracy of Lachman and Anterior Drawer Tests with KT1000 ın the follow-up of anterior cruciate ligament surgery. J Exerc Rehabil 12:363–367. https://doi.org/10.12965//jer.1632622.311

    Article  PubMed  PubMed Central  Google Scholar 

  18. Sernert N, Kartus J, Köhler K, Ejerhed L, Karlsson J (2001) Evaluation of the reproducibility of the KT-1000 arthrometer. Scand J Med Sci Sports 11:120–125

    Article  CAS  PubMed  Google Scholar 

  19. Lewis PB, Parameswaran AD, Rue J-PH, Bach BR (2008) Systematic review of single-bundle anterior cruciate ligament reconstruction outcomes: a baseline assessment for consideration of double-bundle techniques. Am J Sports Med 36:2028–2036. https://doi.org/10.1177/0363546508322892

    Article  PubMed  Google Scholar 

  20. Robert H, Limozin R, de Polignac T (2011) Single-bundle reconstruction in quadruple Semi tendinosus graft of the ACL according to the TLS technique. Clinical results of a series of 74 knees with minimum 18 months follow-up. Rev Chir Orthop Trauma 97:40–45

    Google Scholar 

  21. Fujii M, Furumatsu T, Miyazawa S, Okada Y, Tanaka T, Ozaki T, Abe N (2015) Intercondylar notch size influences cyclops formation after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 23:1092–1099. https://doi.org/10.1007/s00167-014-2891-y

    Article  PubMed  Google Scholar 

  22. Aglietti P, Buzzi R, Giron F, Simeone AJ, Zaccherotti G (1997) Arthroscopic-assisted anterior cruciate ligament reconstruction with the central third patellar tendon. A 5-8-year follow-up. Knee Surg Sports Traumatol Arthrosc 5:138–144. https://doi.org/10.1007/s001670050041

    Article  CAS  PubMed  Google Scholar 

  23. Sherman SL, Chalmers PN, Yanke AB, Bush-Joseph CA, Verma NN, Cole BJ, Bach BR (2012) Graft tensioning during knee ligament reconstruction: principles and practice. J Am Acad Orthop Surg 20:633–645. https://doi.org/10.5435/JAAOS-20-10-633

    Article  PubMed  Google Scholar 

  24. Bressy G, Brun V, Ferrier A, Dujardin D, Oubaya N, Morel N, Fontanin N, Ohl X (2016) Lack of stability at more than 12 months of follow-up after anterior cruciate ligament reconstruction using all-inside quadruple-stranded semitendinosus graft with adjustable cortical button fixation in both femoral and tibial sides. Orthop Traumatol Surg Res 102:867–872. https://doi.org/10.1016/j.otsr.2016.08.011

    Article  CAS  PubMed  Google Scholar 

  25. Orfeuvre B, Pailhé R, Sigwalt L, Duval BR, Lateur G, Plaweski S, Saragaglia D (2018) 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 OTSR. https://doi.org/10.1016/j.otsr.2018.03.016

    Article  PubMed  Google Scholar 

  26. Lubowitz JH (2012) All-inside anterior cruciate ligament graft link: graft preparation technique. Arthrosc Tech 1:e165–168. https://doi.org/10.1016/j.eats.2012.06.002

    Article  PubMed  PubMed Central  Google Scholar 

  27. Schurz M, Tiefenboeck TM, Winnisch M, Syre S, Plachel F, Steiner G, Hajdu S, Hofbauer M (2016) Clinical and Functional Outcome of All-Inside Anterior Cruciate Ligament Reconstruction at a Minimum of 2 Years’ Follow-up. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc 32:332–337. https://doi.org/10.1016/j.arthro.2015.08.014

    Article  Google Scholar 

  28. Poehling-Monaghan KL, Salem H, Ross KE, Secrist E, Ciccotti MC, Tjoumakaris F, Ciccotti MG, Freedman KB (2017) Long-term outcomes in anterior cruciate ligament reconstruction: a systematic review of patellar tendon versus hamstring autografts. Orthop J Sports Med 5:23. https://doi.org/10.1177/2325967117709735

    Article  Google Scholar 

  29. Anderson AF, Irrgang JJ, Kocher MS, Mann BJ, Harrast JJ, International Knee Documentation Committee (2006) The International Knee Documentation Committee Subjective Knee Evaluation Form: normative data. Am J Sports Med 34:128–135. https://doi.org/10.1177/0363546505280214

    Article  PubMed  Google Scholar 

  30. Notarnicola A, Maccagnano G, Barletta F, Ascatigno L, Astuto L, Panella A, Tafuri S, Moretti B (2016) Returning to sport after anterior cruciate ligament reconstruction in amateur sports men: a retrospective study. Muscles Ligaments Tendons J 6:486–491. https://doi.org/10.11138/mltj/2016.6.4.486

    Article  PubMed  Google Scholar 

  31. Hetsroni I, van-Stee M, Marom N, Koch JEJ, Dolev E, Maoz G, Nyska M, Mann G (2017) Factors Associated With Improved Function and Maintenance of Sports Activities at 5 to 10 Years After Autologous Hamstring ACL Reconstruction in Young Men. Orthop J Sports Med 5:2325967117700841. https://doi.org/10.1177/2325967117700841

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Orthopaedic Surgery and Sports Traumatology Department, Hôpital Sud, Grenoble Alpes University Hospital, 38130, Échirolles, France

    B. Orfeuvre, R. Pailhé, J. Gaillot, B. Rubens Duval & D. Saragaglia

  2. The Royal Orthopaedic Hospital, Birmingham, UK

    A. Sharma

Authors
  1. B. Orfeuvre
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R. Pailhé
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. Sharma
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. Gaillot
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. B. Rubens Duval
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. D. Saragaglia
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to B. Orfeuvre.

Ethics declarations

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Orfeuvre, B., Pailhé, R., Sharma, A. et al. Independent clinical appraisal of the Tape Locking Screw (TLS®) anterior cruciate ligament reconstruction technique compared with the hamstring graft technique with a minimum of 12-month follow-up. Eur J Orthop Surg Traumatol 29, 1271–1276 (2019). https://doi.org/10.1007/s00590-019-02418-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00590-019-02418-2

Keywords

Search

Navigation