## 5 Periosteum-Enveloped Graft
\begin{table}
\begin{tabular}{c c c c c} \hline \hline
**Author.** & **Year of Publication** & **Study Design** & **Intervention** & **Mean Follow-Up** & **Key Findings** \\ \hline [PERSON] et al. & 2017 & Randomized controlled trial & ACLR with pedunculated hamstring autograft & 24 months & Significantly better arthrometer results, higher Cincinnati knee score and lower difference between the preinjury and post-surgery Tegner level of sports activity in pedunculated hamstring group. \\ \hline [PERSON] et al. & 2019 & Randomized controlled trial & Functional double bundle ACL reconstruction with pedunculated hamstring graft vs. single-bundle ACL reconstruction with free hamstring autograft & 28.2 months & Significantly better Tegner Activity Scale score, IKDC, KOOS and Lysholm Knee Scoring Scale in the functional bundle reconstruction group. \\ \hline [PERSON] et al. & 2019 & Case series & ACLR with pedunculated hamstring autograft & 30 months & Significantly better Tegner Activity Scale score, IKDC, KOOS and Lysholm Knee Scoring Scale in the functional bundle reconstruction group. \\ \hline  & & & & Lower Pivot-shift grade in the functional double bundle reconstruction group. \\ \hline  & & & & [PERSON] score 95/100 and IKDC score 91/100 at the final follow up. \\ [PERSON] et al. & 2019 & Case series & ACLR with pedunculated hamstring autograft & 2 mm difference of the anteroposterior laxity compared to the contralateral knee at the final follow up. \\ [PERSON] et al. & 2019 & Case series & ACLR with pedunculated hamstring autograft & 30 months & Significantly decrease of the quadriceps and flexor muscles strength deficit during the follow up. \\ \hline  & & & & IKDC score above 90 in the both groups at the final follow-up. \\ [PERSON] et al. & 2016 & Randomized controlled trial & ACLR with pedunculated hamstring autograft & 24 months & Better intra-articular morphology of the pedunculated graft at the final MRI. No differences in graft integration between the both groups. \\ \hline [PERSON] et al. & 2020 & Randomized controlled trial & Over-the-top ACLR with pedunculated hamstring graft & 18 months & Less liquid within the graft, smaller tunnel diameter and lower SNQ of the intra-tunnel graft in the pedunculated graft group in the follow up MRIs. \\ \hline  & & & Lower and stable SNQ in the pedunculated hamstring group in the follow up MRIs. \\ \hline [PERSON] et al. [29] & 2018 & Randomized Controlled Trial & ACLR with pedunculated hamstring autograft & 24 months & Lower and stable SNQ in the pedunculated hamstring group in the follow up MRIs. \\ \hline  & & & & Significantly lower SNQ values in the study group versus the control group at 6 and 12 months of the follow up. \\ \hline \hline \end{tabular}
\end{table} 
Table 2: Cont. evaluation of patients treated with this technique revealed significant improvement in the Lysholm score and the normal or nearly normal results of the majority of patients regarding the IKDC score 2-3 years postoperatively [37]. Tunnel enlargement over 1 mm was found in 5% of femoral and 6% of tibial tunnels. Further evaluation performed at2-7 years of follow-up supported these results [38]. [PERSON] et al. prospectively compared the outcomes of the conventional hamstring graft reconstruction and reconstruction with periosteum enveloped around the graft near the femoral tunnel entrance [39]. The periosteum-enhanced reconstruction presented significantly lower femoral tunnel enlargement on plain radiographs throughout the follow-up. These authors concluded that a periosteal flap both enhances the creation of osteotendinous junction and also acts as a seal, preventing the synovial fluid inflow to the tunnel in the early postoperative period.