Skip to main content

ACL reconstruction: patellar tendon versus hamstring grafts—economical aspects

Knee Surgery, Sports Traumatology, Arthroscopy volume 14, pages 536–541 (2006)Cite this article

Abstract

The aim of the present investigation was to compare the costs for the use of patellar tendon versus hamstring tendons as grafts for anterior cruciate ligament (ACL) reconstruction including the different fixation methods. The background is that during recent years there has been a dramatic shift from patellar tendon to hamstring tendons in ACL reconstructions in Sweden. All our patients with ACL reconstructions performed during 1 year (2004) were included. Knee joints numbering 440 in 439 patients were primary ACL reconstructions. A hamstring graft was used in 345 knee joints (78.4%) and a patellar tendon graft in 95 (21.6%) of the patients (Table 2). On average 34 (SD 12.9; range 14–63) ACL reconstructions per surgeon were performed by a total of 14 surgeons. The average cost for patellar tendon procedure was 197 € compared to 436 € for the hamstring procedure. Mean time for surgery in primary reconstructions was 11.5 min shorter (P<0.001) for patellar tendon reconstructions (71.3±31 min) compared to hamstring reconstructions (83.2±27 min). This means a difference in cost of 90 €. The total additional cost (fixation and surgery time) for the hamstring method compared to the patellar tendon method was on an average 329 €. From a strict economic point of view we therefore recommend or at least consider the use of the patellar tendon as a graft in ACL reconstructions.

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.

References

  1. Adachi N, Ochi M, Uchio Y, Sakai Y, Kuriwaka M, Fujihara A (2003) Harvesting hamstring tendons for ACL reconstruction influences postoperative hamstring muscle performance. Arch Orthop Trauma Surg. 123:460–465

    Article  PubMed  Google Scholar 

  2. 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-A:2143–2155

    PubMed  Google Scholar 

  3. 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 

  4. Beynnon BD, Johnson RJ, Fleming BC, Kannus P, Kaplan M, Samani J, Renstrom 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-A:1503–1513

    PubMed  Google Scholar 

  5. 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 11:170–177

    PubMed  Article  CAS  Google Scholar 

  6. Feller JA, Webster KE, Gavin B (2001) Early post-operative morbidity following anterior cruciate ligament reconstruction: patellar tendon versus hamstring graft. Knee Surg Sports Traumatol Arthrosc 9:260–266

    Article  PubMed  CAS  Google Scholar 

  7. Folksam (1994) Idrottsskador (Sports Injuries) 1986–1990. A report from Folksam Insurance Company, Stockholm, Sweden

    Google Scholar 

  8. Gobbi A, Mahajan S, Zanazzo M, Tuy B (2003) Patellar tendon versus quadrupled bone-semitendinosus anterior cruciate ligament reconstruction: a prospective clinical investigation in athletes. Arthroscopy 19:592–601

    PubMed  Article  Google Scholar 

  9. Gobbi A, Tuy B, Mahajan S, Panuncialman I (2003) Quadrupled bone-semitendinosus anterior cruciate ligament reconstruction: a clinical investigation in a group of athletes. Arthroscopy 19:691–699

    PubMed  Article  Google Scholar 

  10. Ibrahim SA, Al-Kussary IM, Al-Misfer AR, Al-Mutairi HQ, Ghafar SA, El Noor TA (2005) Clinical evaluation of arthroscopically assisted anterior cruciate ligament reconstruction: patellar tendon versus gracilis and semitendinosus autograft. Arthroscopy 21:412–417

    PubMed  Article  Google Scholar 

  11. Jansson KA, Linko E, Sandelin J, Harilainen A (2003) A prospective randomized study of patellar versus hamstring tendon autografts for anterior cruciate ligament reconstruction. Am J Sports Med 31:12–18

    PubMed  Google Scholar 

  12. Kartus J, Movin T, Karlsson J (2001) Donor-site morbidity and anterior knee problems after anterior cruciate ligament reconstruction using autografts. Arthroscopy 17:971–980

    PubMed  CAS  Article  Google Scholar 

  13. Kohn D, Sander-Beuermann A (1994) Donor-site morbidity after harvest of a bone–tendon–bone patellar tendon autograft. Knee Surg Sports Traumatol Arthrosc 2:219–223

    Article  PubMed  CAS  Google Scholar 

  14. Kuo MH, Leong CP, Wang CJ (2003) Simultaneous patellar fracture and patellar tendon avulsion following arthroscopic anterior cruciate ligament reconstruction: a case report and literature review. Chang Gung Med J 26:592–597

    PubMed  Google Scholar 

  15. 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 

  16. Maletius W, Messner K (1999) Eighteen- to twenty-four-year follow-up after complete rupture of the anterior cruciate ligament. Am J Sports Med 27:711–717

    PubMed  CAS  Google Scholar 

  17. Mastrokalos DS, Springer J, Siebold R, Paessler HH (2005) Donor site morbidity and return to the preinjury activity level after anterior cruciate ligament reconstruction using ipsilateral and contralateral patellar tendon autograft: a retrospective, nonrandomized study. Am J Sports Med 33:85–93

    Article  PubMed  Google Scholar 

  18. Muller B, Rupp S, Kohn D, Seil R (2000) (Donor site problems after anterior cruciate ligament reconstruction with the middle third of the patellar ligament). Unfallchirurg 103:662–667

    Article  PubMed  CAS  Google Scholar 

  19. Papageorgiou CD, Kostopoulos VK, Moebius UG, Petropoulou KA, Georgoulis AD, Soucacos PN (2001) Patellar fractures associated with medial-third bone–patellar tendon–bone autograft ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 9:151–154

    Article  PubMed  CAS  Google Scholar 

  20. Pinczewski LA, Deehan DJ, Salmon LJ, Russell VJ, Clingeleffer A (2002) A five-year comparison of patellar tendon versus four-strand hamstring tendon autograft for arthroscopic reconstruction of the anterior cruciate ligament. Am J Sports Med 30:523–536

    PubMed  Google Scholar 

  21. Roos H, Lindberg H, Gardsell P, Lohmander LS, Wingstrand H (1994) The prevalence of gonarthrosis and its relation to meniscectomy in former soccer players. Am J Sports Med 22:219–222

    PubMed  Article  CAS  Google Scholar 

  22. Savalli L, Hernandez-Sendin MI, Puig PL, Trouve P (2004) Pain after anterior cruciate ligament reconstruction: detail and treatment. Ann Readapt Med Phys 47:299–308

    PubMed  CAS  Google Scholar 

  23. Torry MR, Decker MJ, Jockel JR, Viola R, Sterett WI, Steadman JR (2004) Comparison of tibial rotation strength in patients’ status after anterior cruciate ligament reconstruction with hamstring versus patellar tendon autografts. Clin J Sport Med 14:325–331

    Article  PubMed  Google Scholar 

Download references

Author information

Affiliations

  1. Capio Artro Clinic, Stockholm Sport Trauma Research Center, Sophiahemmet, 114 27, Stockholm, Sweden

    Magnus Forssblad, Anders Valentin, Björn Engström & Suzanne Werner

Authors
  1. Magnus Forssblad
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anders Valentin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Björn Engström
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Suzanne Werner
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Magnus Forssblad.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Forssblad, M., Valentin, A., Engström, B. et al. ACL reconstruction: patellar tendon versus hamstring grafts—economical aspects. Knee Surg Sports Traumatol Arthr 14, 536–541 (2006). https://doi.org/10.1007/s00167-006-0064-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-006-0064-3

Keywords

  • Anterior cruciate ligament reconstruction
  • Bone–tendon–bone
  • Graft
  • Hamstring tendons
  • Health economics
  • Patellar tendon