Abstract
A variety of graft sources have been used for ACL reconstruction to improve functions and kinematics in ACL deficient knees. The two most commonly used autogenous grafts are the central third of the patellar tendon and the hamstring tendon constructs. The choice of different grafts and different construct influence the final clinical outcome of ACL reconstruction. The 3 groups, of 25 patients each, were generated by choosing the technique (PT tendon, 4 strand hamstring, and single hamstring plus extraarticular plasty) to utilize and followed for 5 years, with an alternate systematic sampling. Our comparison has shown significant kneeling pain in the patellar tendon with respect to the groups with hamstrings techniques. Single hamstring plus extraarticular plasty achieved subjective score significantly higher with respect to the other two groups as well as for the time to resume sport. The study confirms that patellar tendon and hamstring can be equivalent options for ACL reconstruction. This study demonstrated that a superior outcome as far as subjective clinical findings were concerned, was obtained in group III. Patients in the latter group were also able to return to sports sooner than those in the bone-patellar tendon graft group and the four-strand hamstring group.
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References
Aglietti P, Buzzi R, Zaccherotti G, De Biase P (1994) Patellar tendon versus doubled semitendinosus and gracilis tendons for anterior cruciate ligament reconstruction. Am J Sports Med 22(2):211–218
Aglietti P, Zaccherotti G, Buzzi R, De Biase P (1997) A comparison between patellar tendon and doubled semitendinosus and gracilis tendons for anterior cruciate ligament reconstruction. A minimum 5 year f.u.. J Sports Traumatol Rel Res 19:57–68
Anderson AF, Snyder RB, Lipscomb AB Jr (2001) Anterior cruciate ligament reconstruction. A prospective randomized study of three surgical methods. Am J Sports Med 29:272–279
Armour T, Forwell L, Litchfield R et al (2004) Isokinetic evaluation of internal/external tibial rotation strength after the use of hamstring tendons for anterior cruciate ligament reconstruction. Am J Sports Med 32(7):1639–1643
Arnoczky SP, Lavagnino M, Gardner KL, Tian T, Vaupel ZM, Stick JA (2004) In vitro effects of oxytetracycline on matrix metalloproteinase-1 mRNA expression and on collagen gel contraction by cultured myofibroblasts obtained from the accessory ligament of foals. Am J Vet Res 65(4):491–496
Aune AK, Holm I, Risberg MA et al (2001) Four strand hamstring tendon autograft compared with patellar tendon bone autograft for anterior cruciate ligament reconstruction. A randomized study with two years follow up. Am J Sports Med 29:722–728
Barrett GR, Richardson KJ (1995) The effect of added extra-articular procedure on results of ACL reconstruction. Am J Knee Surg Winter 8(1):1–6
Beard DJ, Anderson JL, Davies S, Price AJ, Dodd CA (2001) Hamstrings vs. patella tendon for anterior cruciate ligament reconstruction: a randomised controlled trial. Knee 8(1):45–50
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(9):1503–1513
Bonatus TJ, Alexander AH (1991) Patellar fracture and avulsion of the patellar ligament complicating arthroscopic anterior cruciate ligament reconstruction. Orthop Rev 20(9):770–774
Brandsson S, Faxen E, Eriksson BI et al (1998) Closing patellar tendon defects after anterior cruciate ligament reconstruction: absence of any benefit. Knee Surg Sports Traumatol Arthrosc 6(2):82–87
Carofino B, Fulkerson J (2005) Medial hamstring tendon regeneration following harvest for anterior cruciate ligament reconstruction: fact, myth, and clinical implication. Arthroscopy 21(10):257–265
Chen L, Cooley V, Rosenberg T (2003) ACL reconstruction with hamstring tendon (Review). Orthop Clin North Am 34(1):9–18
Clancy WG Jr, Nelson DA, Reider B, Narechania RG (1982) Anterior cruciate ligament reconstruction using one-third of the patellar ligament, augmented by extraarticular tendon transfers. J Bone Joint Surg Am 64(3):352–359
Clatworthy MG, Annear P, Bulow JU, Bartlett RJ (1999) Tunnel widening in anterior cruciate ligament reconstruction: a prospective evaluation of hamstring and patella tendon grafts. Knee Surg Sports Traumatol Arthros 7(3):138–145
Corry IS, Webb JM, Clingeleffer AJ, Pinczewsky 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(4):444–454
DeLee JC, Craviotto DF (1991) Rupture of the quadriceps tendon after a central third patellar tendon anterior cruciate ligament reconstruction. Am J Sports Med 19(4):415–416
Ejerhed L, Kartus J, Sernert N, Kohler 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(1):19–25
Eriksson K, Anderberg P, Hamberg P et al (2001) A comparison of quadruple semitendinosus and patellar tendon grafts in reconstruction of the anterior cruciate ligament. J Bone Joint Surg Br 83(3):348–354
Feller JA, Webster KE (2003) A randomized comparison of patellar tendon and hamstring tendon anterior cruciate ligament reconstruction. Am J Sports Med 31(4):564–573
Good L, Odensten M, Gillquist J (1987) Precision in reconstruction of the anterior cruciate ligament. A new positioning device compared with hand drilling. Acta Orthop Scand 58(6):658–661
Hoher J, Scheffler SU, Withrow JD, Livesay GA et al (2000) Mechanical behavior of two hamstring graft constructs for reconstruction of the anterior cruciate ligament. J Orthop Res 18(3):456–461
Holmes PF, James SL, Larson RL et al (1991) Retrospective direct comparison of three intraarticular anterior cruciate ligament reconstructions. Am J Sports Med 19(6):596–600
Howell SM, Wallace MP, Hull ML, Deutsch ML (1999) Evaluation of the single-incision arthroscopic technique for anterior cruciate ligament replacement: a study of tibial tunnel placement, intraoperative graft tension, and stability. Am J Sports Med 27(3):284–293
Howell SM, Gittins ME, Gottlieb JE, Traina SM, Zoellner TM (2001) The relationship between the angle of the tibial tunnel in the coronal plane and loss of flexion and anterior laxity after anterior cruciate ligament reconstruction. Am J Sports Med 29(5):567–574
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(1):12–18
Jarvela T, Kannus P, Jarvinen M (2000) Anterior knee pain 7 years after an anterior cruciate ligament reconstruction with a bone patellar tendon bone autograft. Scand J Med Sci Sports 10(4):221–227
Kartus J, Magnusson L, Stener S et al (1999) Complications following arthroscopic anterior cruciate ligament reconstruction. A 2–5 year follow up of 604 patients with special emphasis on anterior knee pain. Knee Surg Sports Traumatolol Arthrosc 7(1):2–8
Kartus J, Ejerhed L, Sernert N, Brandsson S, Karlsson J (2000) Comparison of traditional and subcutaneous patellar tendon harvest. A prospective study of donor site-related problems after anterior cruciate ligament reconstruction using different graft harvesting techniques. Am J Sports Med 28(3):328–335
Lavagnino M, Arnoczky SP, Tian T, Vaupel Z (2003) Effect of amplitude and frequency of cyclic tensile strain on the inhibition of MMP-1 mRNA expression in tendon cells: an in vitro study. Connect Tissue Res 44(3–4):181–187
Lerat JL, Chotel F, Besse JL et al (1998) Les résultats après 10 à 16 ans du traitement de la laxité chronique antérieure du genou par une reconstruction du ligament croisé antérieur avec une greffe de tendon rotulien associée à une plastie extra-articulaire externe. A propos de 138 cas. Rev Chir Orthop Reparatrice Appar Mot 84(8):712–727
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(4):234–238
Marcacci M, Zaffagnini S, Iacono F, Neri MP, Loreti I, Petitto A (1998) Arthroscopic intra- and extra-articular anterior cruciate ligament reconstruction with gracilis and semitendinosus tendons. Knee Surg Sports Traumatol Arthrosc 6(2):68–75
Marcacci M, Zaffagnini S, Iacono F, Vascellari A, Loreti I, Kon E, Lo Presti M (2003) Intra- and extra-articular anterior cruciate ligament reconstruction utilizing autogeneous semitendinosus and gracilis tendons: 5-year clinical results. Knee Surg Sports Traumatol Arthrosc 11(1):2–8
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(5):478–484
Noyes FR, Barber SD (1991) The effect of an extra-articular procedure on allograft reconstructions for chronic ruptures of the anterior cruciate ligament. J Bone Joint Surg Am 73(6):882–892
O’Neill DB (1996) Arthroscopically assisted reconstruction of the anterior cruciate ligament. A prospective randomized analysis of three techniques. J Bone Joint Surg Am 78(6):803–813
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(2):143–148
Peyrache MD, Djian P, Christel P, Witvoet J (1996) Tibial tunnel enlargement after reconstruction by autogenous bone-patellar tendon-bone graft. Knee Surg Sports Traumatol Arthrosc 4(1):2–8
Pinczewski LA, Deehan D, 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(4):523–536. Erratum in: Am J Sports Med 2005 Jun;33(6):927
Rosenberg TD, Paulos LE, Parker RD, Coward DB, Scott SM (1988) The forty-five degree posteroanterior flexion weight bearing radiograph of the knee. J Bone Joint Surg Am 70(10):1479–1483
Roth JH, Kennedy JC, Lockstadt H et al (1987) Intra-articular reconstruction of the anterior cruciate ligament with and without extra-articular supplementation by transfer of the biceps femoris tendon. J Bone Joint Surg 69(2):275–278
Sgaglione NA, Del Pizzo W, Fox JM et al (1992) Arthroscopic-assisted anterior cruciate ligament reconstruction with the semitendinous tendon: comparison of results with and without braided polypropylene augmentation. Arthroscopy 8(1):65–77
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(2):214–220
Shelbourne KD, Klootwyk TE et al (1995) Ligament stability two to six years after anterior cruciate ligament reconstruction with autogenous patellar tendon graft and participation in accelerated rehabilitation program. Am J Sports Med 23(5):575–579
Shelbourne KD, Trumper RV (1997) Preventing anterior knee pain after anterior cruciate ligament reconstruction. Am J Sports Med 25(1):41–47
Simonian PT, Mann FA, Mandt PR (1995) Indirect forces and patella fracture after anterior cruciate ligament reconstruction with the patellar ligament. Case report. Am J Knee Surg 8(2):60–65
Spindler KP, Kuhn JE, Freedman KB et al (2004) Anterior cruciate ligament reconstruction autograft choice: bone-tendon-bone versus hamstring: does it really matter? A systematic review. Am J Sports Med 32(8):1986–1995
Strum GM, Fox JM, Ferkel RD et al (1989) Intraarticular versus intraarticular and extraarticular reconstruction for chronic anterior cruciate ligament instability. Clin Orthop 245:188–198
Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 198:43–49
Zaffagnini S, Golano P, Farinas O, Depasquale V, Strocchi R, Cortecchia S, Marcacci M, Visani A (2003) Vascularity and neuroreceptors of the pes anserinus: anatomic study. Clin Anat 16(1):19–24
Zaricznyj B (1987) Reconstruction of the anterior cruciate ligament of the knee using a doubled tendon graft. Clin Orthop 220:162–175
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We are grateful to Dr. Daniele Di Motta, Mr. Simone Bignozzi and Mr. Gianpaolo Bernagozzi for technical assistance.
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Zaffagnini, S., Marcacci, M., Lo Presti, M. et al. Prospective and randomized evaluation of ACL reconstruction with three techniques: a clinical and radiographic evaluation at 5 years follow-up. Knee Surg Sports Traumatol Arthrosc 14, 1060–1069 (2006). https://doi.org/10.1007/s00167-006-0130-x
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DOI: https://doi.org/10.1007/s00167-006-0130-x