Skip to main content

Randomized prospective study of ACL reconstruction with interference screw fixation in patellar tendon autografts versus femoral metal plate suspension and tibial post fixation in hamstring tendon autografts: 5-year clinical and radiological follow-up results

Knee Surgery, Sports Traumatology, Arthroscopy volume 14, pages 517–528 (2006)Cite this article

Abstract

Patellar tendon graft has been the most frequently used material in anterior cruciate ligament (ACL) reconstruction, but the hamstring tendons have been increasingly used as well; however, which graft is to be preferred is not adequately supported by existing clinical studies. In this prospective randomized clinical trial, the study hypothesis was that the hamstring tendons are equally good graft material as the patellar tendon in ACL reconstruction. Ninety-nine patients with laxity due to a torn ACL underwent arthroscopically assisted reconstruction with graft randomization according to their birth year to either patellar tendon with metal interference screw fixation or double looped semitendinosus and gracilis tendons with fixation similar to the Endobutton technique using a titanium metal plate suspension proximally and screw-washer postdistally. Excluding preoperative Lysholm knee score, there were no significant differences between the two groups in the preoperative and operative data. A standard rehabilitation regimen was used for all the patients, including immediate postoperative mobilization without a knee brace, protected weight bearing for 2 weeks, and return to full activity at 6–12 months postoperatively. Forty patients in the patellar tendon group and 39 patients in the hamstring tendon group were available for clinical evaluation at median 5 years after surgery (ranges 3 years 11 months–6 years 7 months). The results revealed no statistically significant differences with respect to clinical and instrumented laxity testing, isokinetic muscle torque measurements, International Knee Documentation Committee ratings, Lysholm (knee score), Tegner (activity level) and Kujala patellofemoral knee scores. There was an enlargement of the drill tunnels, statistically more in the hamstring tendon group, but no increase from 2 to 5 years in either group. Narrowing of the joint spaces (IKDC measurement method) from 2 to 5 years postoperatively was seen in both the groups, however, without difference between the two groups.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3

References

  1. Aglietti P, Buzzi R, D’Andria S, Zaccherotti G (1993) Patellofemoral problems after intraarticular anterior cruciate ligament reconstruction. Clin Orthop 288:195–204

    PubMed  Google Scholar 

  2. Aglietti P, Zaccherotti G, Buzzi R, DeBiase P (1997) A comparison between patellar tendon and doubled semitendinosus/gracilis tendon for anterior cruciate ligament reconstruction. A minimum five-year follow-up. J Sports Traumatol 19:57–68

    Google Scholar 

  3. Aglietti P, Giron F, Buzzi R, Biddau F, Sasso F (2004) Anterior cruciate ligament reconstruction: bone-patellar tendon-bone compared with double semitendinosus and gracilis tendon grafts. A prospective, randomized clinical trial. J Bone Joint Surg Am 86:2143–2155

    PubMed  Google Scholar 

  4. Anderson AF, Snyder RB, Lipscomb AB (2001) Anterior cruciate ligament reconstruction. A prospective randomized study of three surgical methods. Am J Sports Med 29:272–279

    PubMed  CAS  Google Scholar 

  5. Asano H, Muneta T, Ikeda H, Yagishita K, Kurihara Y, Sekiya I (2004) Arthroscopic evaluation of the articular cartilage after anterior cruciate ligament reconstruction: A short-term prospective study of 105 patients. Arthroscopy 20:474–481

    PubMed  Article  Google Scholar 

  6. Aune AK, Holm I, Risberg MA, Jensen HK, Steen H (2001) Four-strand hamstring tendon autograft compared with patellar tendon-bone autograft for anterior cruciate ligament reconstruction. A randomized study with two-year follow-up. Am J Sports Med 29:722–728

    PubMed  CAS  Google Scholar 

  7. Barrett GR, Papendick L, Miller C (1995) Endobutton button endoscopic fixation technique in anterior cruciate ligament reconstruction. Arthroscopy 11:340–343

    PubMed  CAS  Article  Google Scholar 

  8. Beard DJ, Anderson JL, Davies S, Price AJ, Dodd CAF (2001) Hamstrings versus patella tendon for anterior cruciate ligament reconstruction: a randomised controlled trial. Knee 8:45–50

    PubMed  Article  CAS  Google Scholar 

  9. Beynnon BD, Johnson RJ, Fleming BC, Kannus P, Kaplan M, Samani J, Renström P (2002) Anterior cruciate ligament replacement: comparison of bone-patellar tendon-bone grafts with two-strand hamstring grafts. A prospective, randomized study. J Bone Joint Surg Am 84:1503–1513

    PubMed  Google Scholar 

  10. Buelow JU, Siebold R, Ellermann A (2002) A prospective evaluation of tunnel enlargement in anterior cruciate ligament reconstruction with hamstrings: extracortical versus anatomical fixation. Knee Surg Sports Traumatol Arthrosc 10:80–85

    PubMed  Article  Google Scholar 

  11. Clancy WG Jr, Nelson DA, Reider B, Narechania RG (1982) Anterior cruciate ligament reconstruction using one-third of the patellar ligament, augmented by extra-articular tendon transfers. J Bone Joint Surg Am 64:352–359

    PubMed  Google Scholar 

  12. Corry IS, Webb JM, Clingeleffer AJ, Pinczewski LA (1999) Arthroscopic reconstruction of the anterior cruciate ligament. A comparison of patellar tendon autograft and four-strand hamstring tendon autograft. Am J Sports Med 27:444–454

    PubMed  CAS  Google Scholar 

  13. Ejerhed L, Kartus J, Sernert N, Köhler K, Karlsson J (2003) Patellar tendon or semitendinosus tendon autografts for anterior cruciate ligament reconstruction? A prospective randomized study with a two-year follow-up. Am J Sports Med 31:19–25

    PubMed  Google Scholar 

  14. Eriksson K, Anderberg P, Hamberg P, Löfgren AC, Bredenberg M, Westman I, Wredmark T (2001) A comparison of quadruple semitendinosus and patellar tendon grafts in reconstruction of the anterior cruciate ligament. J Bone Joint Surg Br 83:348–354

    PubMed  Article  CAS  Google Scholar 

  15. Fahey M, Indelicato PA (1994) Bone tunnel enlargement after anterior cruciate ligament replacement. Am J Sports Med 22:410–414

    PubMed  Article  CAS  Google Scholar 

  16. Feagin JA Jr, Wills RP, Lambert KL, Mott HW, Cunningham RR (1997) Anterior cruciate ligament reconstruction. Bone-patellar tendon-bone versus semitendinosus anatomic reconstruction. Clin Orthop 341:69–72

    PubMed  Google Scholar 

  17. 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 

  18. Ferretti A, Conteduca F, De Carli A, Fontana M, Mariani PP (1991) Osteoarthritis of the knee after ACL reconstruction. Int Orthop 15:367–371

    PubMed  Article  CAS  Google Scholar 

  19. Fink C, Zapp M, Benedetto KP, Hackl W, Hoser C, Rieger M (2001) Tibial tunnel enlargement following anterior cruciate ligament reconstruction with patellar tendon autograft. Arthroscopy 17:138–143

    PubMed  CAS  Article  Google Scholar 

  20. Freedman KB, D’Amato MJ, Nedeff DD, Kaz A, Bach BR (2003) Arthroscopic anterior cruciate ligament reconstruction: a metaanalysis comparing patellar tendon and hamstring tendon autografts. Am J Sports Med 31:2–11

    PubMed  Google Scholar 

  21. Harner CD, Marks PH, Fu FH, Irrgang JJ, Silby MB, Mengato R (1994) Anterior cruciate ligament reconstruction: endoscopic versus two-incision technique. Arthroscopy 10:502–512

    PubMed  CAS  Article  Google Scholar 

  22. Hefti F, Müller W, Jakob RP, Staubli HU (1993) Evaluation of knee ligament injuries with the IKDC form. Knee Surg Sports Traumatol Arthrosc 1:226–234

    PubMed  Article  CAS  Google Scholar 

  23. Hertel P, Behrend H, Cierpinski T, Musahl V, Widjaja G (2005) ACL reconstruction using bone-patellar tendon-bone press-fit fixation: 10-year clinical results. Knee Surg Sports Traumatol Arthrosc 13:248–255

    PubMed  Article  CAS  Google Scholar 

  24. Hoffmann F, Friebel H, Schiller M (1998) The semitendinosus tendon as replacement for the anterior cruciate ligament. Zentralbl Chir 123:994–1001

    PubMed  CAS  Google Scholar 

  25. L`Insalata JC, Klatt B, Fu FH, Harner CD (1997) Tunnel expansion following anterior cruciate ligament reconstruction: a comparison of hamstring and patellar tendon autografts. Knee Surg Sports Traumatol Arthrosc 5:234–238

    Article  CAS  Google Scholar 

  26. Jansson KA, Harilainen A, Sandelin J, Karjalainen PT, Aronen HJ, Tallroth K (1999) Bone tunnel enlargement after anterior cruciate ligament reconstruction with the hamstring tendon autograft and endobutton fixation technique. A clinical, radiographic and magnetic resonance imaging study with 2 years follow-up. Knee Surg Sports Traumatol Arthrosc 7:290–295

    PubMed  Article  CAS  Google Scholar 

  27. Jansson KA, Linko E, Sandelin J, Harilainen A (2003) Anterior Cruciate Ligament Reconstruction. A prospective randomized study of patellar and hamstring tendon autografts. Am J Sports Med 31:12–18

    PubMed  Google Scholar 

  28. Johnson RJ, Beynnon BD, Nichols CE, Renström PA (1992) The treatment of injuries of the anterior cruciate ligament. J Bone Joint Surg Am 74:140–151

    PubMed  CAS  Google Scholar 

  29. Jomha NM, Borton DC, Clingeleffer AJ, Pinczewski LA (1999) Long-term osteoarthritis changes in anterior cruciate ligament reconstructed knees. Clin Orthop 358:188–193

    PubMed  Google Scholar 

  30. Kujala UM, Jaakkola LH, Koskinen SK, Taimela S, Hurme M, Nelimarkka O (1993) Scoring of patellofemoral disorders. Arthroscopy 9:159–163

    PubMed  CAS  Article  Google Scholar 

  31. Laxdal G, Kartus J, Hansson L, Heidvall M, Ejerhed L, Karlsson J (2005) A prospective randomized comparison of bone-patellar tendon-bone and hamstring grafts for anterior cruciate ligament reconstruction. Arthroscopy 21:34–42

    PubMed  Article  Google Scholar 

  32. Ma CB, Francis K, Towers J, Irrgang J, Fu FH, Harner CD (2004) Hamstring Anterior Cruciate Ligament Reconstruction: a Comparison of bioabsorbable interference screw and endobutton-post fixation. Arthroscopy 20:122–128

    PubMed  Article  Google Scholar 

  33. Marder RA, Raskind JR, Carroll M (1991) Prospective evaluation of arthroscopically assisted anterior cruciate ligament reconstruction. Patellar tendon versus semitendinosus and gracilis tendons. Am J Sports Med 19:478–484

    PubMed  Article  CAS  Google Scholar 

  34. 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

    PubMed  Article  Google Scholar 

  35. Noyes FR, Mooar PA, Matthews DS, Butler DL (1983) The symptomatic anterior cruciate-deficient knee. Part I: the long-term functional disability in athletically active individuals. J Bone Joint Surg Am 65:154–162

    PubMed  CAS  Google Scholar 

  36. O’Neill DB (2001) Arthroscopically assisted reconstruction of the anterior cruciate ligament. A follow-up report. J Bone Joint Surg Am 83:1329–1332

    PubMed  Google Scholar 

  37. Otero AL, Hutcheson L (1993) A comparison of the doubled semitendinosus/gracilis and central third of the patellar tendon autografts in arthroscopic anterior cruciate ligament reconstruction. Arthroscopy 9:143–148

    PubMed  CAS  Article  Google Scholar 

  38. Prodromos C, Han YS, Keller BL, Bolyard RJ (2005) Stability results of hamstring anterior cruciate ligament reconstruction at 2- to 8-year follow-up. Arthroscopy 21:138–146

    PubMed  Article  Google Scholar 

  39. Rosenberg TD, Deffner KT (1997) ACL reconstruction: semitendinosus tendon is the graft of choice. Orthopedics 20:396–398

    PubMed  CAS  Google Scholar 

  40. Sachs RA, Daniel DM, Stone ML, Garfein RF (1989) Patellofemoral problems after anterior cruciate ligament reconstruction. Am J Sports Med 17:760–765

    PubMed  Article  CAS  Google Scholar 

  41. Sgaglione NA, Warren RF, Wickiewicz TL, Gold DA, Panariello RA (1990) Primary repair with semitendinosus tendon augmentation of acute anterior cruciate ligament injuries. Am J Sports Med 18:64–73

    PubMed  Article  CAS  Google Scholar 

  42. Shaieb MD, Kan DM, Chang SK, Marumoto JM, Richardson AB (2002) A prospective randomized comparison of patellar tendon versus semitendinosus and gracilis tendon autografts for anterior cruciate ligament reconstruction. Am J Sports Med 30:214–220

    PubMed  Google Scholar 

  43. Simonian PT, Erickson M, Larson TV, O’Kane JW (2000) Tunnel expansion after hamstring anterior cruciate ligament reconstruction with 1-incision Endobutton femoral fixation. Arthroscopy 16:707–714

    PubMed  CAS  Article  Google Scholar 

  44. Steiner ME, Hecker AT, Brown CH Jr, Hayes WC (1994) Anterior cruciate ligament graft fixation. Comparison of hamstring and patellar tendon grafts. Am J Sports Med 22:240–247

    PubMed  Article  CAS  Google Scholar 

  45. Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop 198:43–49

    PubMed  Google Scholar 

  46. Yunes M, Richmond JC, Engels EA, Pinczewski LA (2001) Patellar versus hamstring tendons in anterior cruciate ligament reconstruction: a meta-analysis. Arthroscopy 17:248–257

    PubMed  Article  Google Scholar 

Download references

Author information

Affiliations

  1. ORTON Orthopaedic Hospital, Invalid Foundation, Tenholantie 10, 00280, Helsinki, Finland

    Arsi Harilainen & Jerker Sandelin

  2. Deaconess Hospital Diacor, Alppikatu 2, 00530, Helsinki, Finland

    Eric Linko

Authors
  1. Arsi Harilainen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Eric Linko
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jerker Sandelin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Arsi Harilainen.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Harilainen, A., Linko, E. & Sandelin, J. Randomized prospective study of ACL reconstruction with interference screw fixation in patellar tendon autografts versus femoral metal plate suspension and tibial post fixation in hamstring tendon autografts: 5-year clinical and radiological follow-up results. Knee Surg Sports Traumatol Arthr 14, 517–528 (2006). https://doi.org/10.1007/s00167-006-0059-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-006-0059-0

Keywords

  • Anterior cruciate ligament
  • Patellar tendon
  • Hamstring tendon
  • Randomized study