Combined single-strand distal semitendinosus-iliotibial band tenodesis (Puddu) for anterior cruciate ligament augmentation.

Anterior cruciate ligament (ACL) reconstruction using the semitendinosus tendon has seen renewed interest recently. Puddu described a procedure in which the tendon is harvested at its insertion on the tibia with a bone plug. This study evaluates the efficacy of this approach and examines the long-term results. Between 1982 and 1986, 77 patients underwent this type of procedure; 51 (66%) patients who were reexamined comprised the study group. Thirty-five patients had acute tears, and 16 patients had chronic tears. Follow-up was both objective and subjective with an average follow-up of 7 years and 3 months (range: 5.8 to 9.2 years). In the acute group, six patients (17%) had a 2+ Lachman and seven (22%) had a 1+ Lachman. Pivot shift was 2+ to 3+ in three patients (8.6%) and 1+ in seven patients (22%). KT-100 results were > 5 mm in eight patients (23.3%). In the chronic group, four patients (25%) had 2+ and four had a 1+ Lachman. Seven patients (44%) had a positive pivot shift test. Five patients had > 5 mm difference. Using regression analysis, the KT-1000 results correlated well with the Lachman and pivot shift tests. Chronicity and partial meniscectomy were associated with a poor result. Although this technique has undergone an evolution and improvement to a four-strand reconstruction in recent years, the results of this review indicate satisfactory results can be obtained, especially in the acute setting.