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A comparison of ACL reconstruction using patellar tendon versus hamstring autograft in female patients: a prospective randomised study

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Abstract

Purpose

The incidence of an anterior cruciate ligament (ACL) tear is highest in female patients; however, it is not apparent whether graft choice affects clinical results. The aim of this prospective randomised study was to evaluate clinical results of an ACL reconstruction using patellar tendon [bone–patellar tendon–bone (BTB)] or hamstring graft (HS) in female patients.

Methods

Inclusion criteria were traumatic instability, no signs of osteoarthritis, no previous instability and no contralateral knee instability. Inclusion criteria were met in 150 patients, mean age 26 (17–47) years. Patients were randomised into two groups of 75 patients according to graft type; all had the same rehabilitation protocol. Tegner Lysholm knee score and stability were evaluated pre-operatively and one and two years postoperatively. The difference between groups was statistically evaluated using unpaired t test.

Results

Of the 150 patients, all completed one year follow-up; three were lost to follow-up at two years. There was no significant difference in functional scores and knee stability between groups. The HS group had significantly less anterior knee pain in the first six months postoperatively.

Conclusion

ACL reconstruction significantly improves clinical results and stability of the knee. Difference in Lysholm score and stability between groups was not significant. Neither group showed higher tendency to graft failure within two years. Graft choice for reconstruction in female patients should be surgeon specific and individualised, as both grafts studied achieved comparable results.

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References

  1. Hewett TE, Ford KR, Hoogenboom BJ, Myer GD (2010) Understanding and preventing ACL injuries: current biomechanical and epidemiologic considerations - update 2010. N Am J Sports Phys Ther 5(4):234–251

    PubMed Central  PubMed  Google Scholar 

  2. Cimino F, Volk BS, Setter D (2010) Anterior cruciate ligament injury: diagnosis, management, and prevention. Am Fam Physician 82(8):917–922

    PubMed  Google Scholar 

  3. Heijne A, Hagströmer M, Werner S. (2013) A two- and five-year follow-up of clinical outcome after ACL reconstruction using BPTB or hamstring tendon grafts: a prospective intervention outcome study. Knee Surg Sports Traumatol Arthrosc

  4. Hill CL, Seo GS, Gale D, Totterman S, Gale ME, Felson DT (2005) Cruciate ligament integrity in osteoarthritis of the knee. Arthritis Rheum 52(3):794–799

    Article  PubMed  Google Scholar 

  5. Murray JR, Lindh AM, Hogan NA, Trezies AJ, Hutchinson JW, Parish E, Read JW, Cross MV (2012) Does Anterior Cruciate Ligament Reconstruction Lead to Degenerative Disease? Thirteen-Year Results After Bone-Patellar Tendon-Bone Autograft. Am J Sports Med 40(2):404–413

    Article  PubMed  Google Scholar 

  6. Ahn JH, Kim JG, Wang JH, Jung CH, Lim HC (2012) Long-Term Results of Anterior Cruciate Ligament Reconstruction Using Bone-Patellar Tendon-Bone: An Analysis of the Factors Affecting the Development of Osteoarthritis. Arthroscopy 28(8):1114–1123

    Article  PubMed  Google Scholar 

  7. Poolman RW, Farrokhyar F, Bhandari M (2007) Hamstring tendon autograft better than bone patellar-tendon bone autograft in ACL reconstruction: a cumulative meta-analysis and clinically relevant sensitivity analysis applied to a previously published analysis. Acta Orthop 78(3):350–354

    Article  PubMed  Google Scholar 

  8. Elias JJ, Kilambi S, Ciccone WJ 2nd (2009) Tension level during preconditioning influences hamstring tendon graft properties. Am J Sports Med 37(2):334–338

    Article  PubMed  Google Scholar 

  9. Persson A, Fjeldsgaard K, Gjertsen JE, Kjellsen AB, Engebretsen L, Hole RM, Fevang JM (2014) Increased risk of revision with hamstring tendon grafts compared with patellar tendon grafts after anterior cruciate ligament reconstruction: a study of 12,643 patients from the Norwegian Cruciate Ligament Registry, 2004-2012. Am J Sports Med 42(2):285–291

    Article  PubMed  Google Scholar 

  10. Rahr-Wagner L, Thillemann TM, Pedersen AB, Lind M (2014) Comparison of hamstring tendon and patellar tendon grafts in anterior cruciate ligament reconstruction in a nationwide population-based cohort study: results from the danish registry of knee ligament reconstruction. Am J Sports Med 42(2):278–284

    Article  PubMed  Google Scholar 

  11. Ageberg E, Forssblad M, Herbertsson P, Roos EM (2010) Sex differences in patient-reported outcomes after anterior cruciate ligament reconstruction: data from the Swedish knee ligament register. Am J Sports Med 38(7):1334–1342

    Article  PubMed  Google Scholar 

  12. Eriksson K, Anderberg P, Hamberg P, Olerud P, Wredmark T (2001) There are differences in early morbidity after ACL reconstruction when comparing patellar tendon and semitendinosus tendon graft. A prospective randomized study of 107 patients. Scand J Med Sci Sports 11(3):170–177

    Article  CAS  PubMed  Google Scholar 

  13. Milano G, Mulas PD, Ziranu F, Piras S, Manunta A, Fabbriciani C (2006) Comparison between different femoral fixation devices for ACL reconstruction with doubled hamstring tendon graft: a biomechanical analysis. Arthroscopy 22(6):660–668

    Article  PubMed  Google Scholar 

  14. Gobbi A, Domzalski M, Pascual J (2004) Comparison of anterior cruciate ligament reconstruction in male and female athletes using the patellar tendon and hamstring autografts. Knee Surg Sports Traumatol Arthrosc 12:534–539

    Article  PubMed  Google Scholar 

  15. Lidén M, Ejerhed L, Sernert N, Laxdal G, Kartus J (2007) Patellar tendon or semitendinosus tendon autografts for anterior cruciate ligament reconstruction: a prospective, randomized study with a 7-Year follow-up. Am J Sports Med 35(5):740–748

    Article  PubMed  Google Scholar 

  16. Feller JA, Webster KE (2003) A randomized comparison of patellar tendon and hamstring tendon anterior cruciate ligament reconstruction. Am J Sports Med 31:564–573

    PubMed  Google Scholar 

  17. Struewer J, Ziring E, Oberkircher L, Schüttler KF, Efe T (2013) Isolated anterior cruciate ligament reconstruction in patients aged fifty years: comparison of hamstring graft versus bone-patellar tendon-bone graft. Int Orthop 37(5):809–817

    Article  PubMed Central  PubMed  Google Scholar 

  18. Sañudo B, Feria A, Carrasco L, Hoyo MD, Santos R, Gamboa H (2012) Gender differences in knee stability in response to whole body vibration. J Strength Cond Res 26(8):2156–2165

    Article  PubMed  Google Scholar 

  19. Ford KR, Myer GD, Schmitt LC, Uhl TL, Hewett TE (2011) Preferential quadriceps activation in female athletes with incremental increases in landing intensity. J Appl Biomech 27(3):215–222

    PubMed Central  PubMed  Google Scholar 

  20. Chambat P, Guier C, Sonnery-Cottet B, Fayard JM, Thaunat M (2013) The evolution of ACL reconstruction over the last fifty years. Int Orthop 37(2):181–186

    Article  PubMed Central  PubMed  Google Scholar 

  21. Muller B, Hofbauer M, Wongcharoenwatana J, Fu FH (2013) Indications and contraindications for double-bundle ACL reconstruction. Int Orthop 37(2):239–246

    Article  PubMed Central  PubMed  Google Scholar 

  22. Brown CH Jr, Spalding T, Robb C (2013) Medial portal technique for single-bundle anatomical anterior cruciate ligament (ACL) reconstruction. Int Orthop 37(2):253–269

    Article  PubMed Central  PubMed  Google Scholar 

  23. Garofalo R, Moretti B, Kombot C, Moretti L, Mouhsine E (2007) Femoral tunnel placement in anterior cruciate ligament reconstruction: rationale of the two incision technique. J Orthop Surg Res 2:10

    Article  PubMed Central  PubMed  Google Scholar 

  24. Ageberg E, Roos HP, Gravare-Silbernagel K, Thomeé R, Roos E (2009) Knee extension and flexion muscle power after anterior cruciate ligament reconstruction with patellar tendon graft or hamstring tendons graft: a cross-sectional comparison 3 years post surgery. Knee Surg Sports Traumatol Arthrosc 17:162–169

    Article  PubMed  Google Scholar 

  25. Palmieri-Smith RM, Thomas AC, Wojtys EM (2008) Maximizing quadriceps strength after ACL reconstruction. Clin Sports Med 27:405–424

    Article  PubMed  Google Scholar 

  26. Vymazal T, Horacek M, Durpekt R, Hladikova M, Cvachovec K (2009) Is allogeneic blood transfusion a risk factor for sternal dehiscence following cardiac surgery? A prospective observational study. Int Heart J 50(5):601–607

    Article  PubMed  Google Scholar 

  27. Genuario JW, Faucett SC, Boublik M, Schlegel TF (2012) A cost-effectiveness analysis comparing 3 anterior cruciate ligament graft types: bone-patellar tendon-bone autograft, hamstring autograft, and allograft. Am J Sports Med 40(2):307–314

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The study was supported by the grant project GAČR - P304/10/0326 and the research institution grant project No. 00064203. Authors acknowledge the kind review input to the manuscript by Robert LaPrade and Bruce Reider.

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Correspondence to Vojtech Havlas.

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Kautzner, J., Kos, P., Hanus, M. et al. A comparison of ACL reconstruction using patellar tendon versus hamstring autograft in female patients: a prospective randomised study. International Orthopaedics (SICOT) 39, 125–130 (2015). https://doi.org/10.1007/s00264-014-2495-7

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  • DOI: https://doi.org/10.1007/s00264-014-2495-7

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