Skip to main content
Log in

Comparison of clinical outcomes and second-look arthroscopic findings after ACL reconstruction using a hamstring autograft or a tibialis allograft

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of this prospective randomized clinical study was to compare the clinical and radiological outcomes, including tibial tunnel widening and the progression of osteoarthritis after ACL reconstruction using a hamstring autograft or a tibialis allograft. In addition, we compared the graft tear and synovial coverage of grafts in patients that underwent the second-look arthroscopy.

Methods

Among 184 patients with an ACL injury who underwent ACL reconstruction, 68 patients of autograft group and 64 patients of tibialis allograft group were included for this study after minimum of 2-year follow-up. The Lachman and pivot-shift tests, Tegner activity score, Lysholm knee score, and IKDC score were compared between the two groups. The quadriceps and hamstring isokinetic strengths using dynamometer were also compared. Degree of OA was determined using the Kellgren–Lawrence grading system on the weight-bearing radiographs. In total, 51 patients (26 patients in autograft group and 25 in the tibialis allograft group) underwent the second-look arthroscopy, in which we compared the apparent tear of graft and synovial coverage of grafts.

Results

At the final follow-up, there were no statistical significances in the two groups in Lachman and pivot-shift tests (n.s.). The Tegner activity, Lysholm knee score, and IKDC scores were similar in the two groups. Moreover, no significant differences were observed in the muscle power (n.s.). Some patients showed the progression of OA (five in autograft and four in allograft groups) without intergroup difference (n.s.). Regarding the findings of second-look arthroscopy, although there was no significant difference in graft tear, synovial coverage was better in autograft group than in allograft group.

Conclusion

Even though hamstring autografts and tibialis allografts provided good functional outcomes without significant differences, the second-look arthroscopy revealed that hamstring autografts produced better synovial coverage than tibialis allograft.

Level of evidence

I.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Ageberg E, Roos HP, Silbernagel KG, Thomeé R, Roos EM (2009) Knee extension and flexion muscle power after anterior cruciate ligament reconstruction with patellar tendon graft or hamstring tendons graft: a crosssectional comparison 3 years post surgery. Knee Surg Sport Traumatol Arthrosc 17(2):162–169

    Article  Google Scholar 

  2. Ahn JH, Cho YB, Lee JY (2003) Second-look arthroscopy after ACL reconstruction: comparison of patellar tendon autografts with hamstring tendon autografts. J Korean Orthop Assoc 38:159–164

    Google Scholar 

  3. Almqvist KF, Jan H, Vercruysse C, Verbeeck R, Verdonk R (2007) The tibialis tendon as a valuable anterior cruciate ligament allograft substitute: biomechanical properties. Knee Surg Sports Traumatol Arthrosc 15(11):1326–1330

    Article  CAS  PubMed  Google Scholar 

  4. Barber FA, Cowden CH 3rd, Sanders EJ (2014) Revision rates after anterior cruciate ligament reconstruction using bone-patellar tendon-bone allograft or autograft in a population 25 years-old and younger. Arthroscopy 30(4):483–491

    Article  PubMed  Google Scholar 

  5. Bottoni CR, Smith EL, Shaha J, Shaha SS, Raybin SG, Tokish JM, Rowles DJ (2015) Autograft versus allograft anterior cruciate ligament reconstruction: a prospective, randomized clinical study with a minimum 10-year follow-up. Am J Sports Med 43(10):2501–2509

    Article  PubMed  Google Scholar 

  6. Carter TR, Edinger S (1999) Isokinetic evaluation of anterior cruciate ligament reconstruction: hamstring versus patellar tendon. Arthroscopy 15(2):169–172

    Article  CAS  PubMed  Google Scholar 

  7. Chang SK, Egami DK, Shaieb MD, Kan DM, Richardson AB (2003) Anterior cruciate ligament reconstruction: allograft versus autograft. Arthroscopy 19(5):453–462

    Article  PubMed  Google Scholar 

  8. Cohen SB, Pandarinath R, O’Hagan T, Marchetto PA, Hyatt A, Wascher J, Deluca PF (2015) Results of ACL reconstruction with tibial retroscrew fixation: comparison of clinical outcomes and tibial tunnel widening. Phys Sportsmed 43(2):138–142

    Article  PubMed  Google Scholar 

  9. Fu F, Christel P, Miller MD, Johnson DL (2009) Graft selection for anterior cruciate ligament reconstruction. Instr Course Lect 58:337–354

    PubMed  Google Scholar 

  10. Furman W, Marshall JL, Girgis FG (1976) The anterior cruciate ligament. A functional analysis based on postmortem studies. J Bone Joint Surg Am 58(2):179–185

    Article  CAS  PubMed  Google Scholar 

  11. Giove TP, Miller SJ 3rd, Kent BE, Sanford TL, Garrick JG (1983) Nonoperative treatment of the torn anterior cruciate ligament. J Bone Joint Surg Am 65(2):184–192

    Article  CAS  PubMed  Google Scholar 

  12. Harner CD, Olson E, Irrang JJ, Silverstein S, Fu FH, Silbey M (1996) Allograft versus autograft anterior cruciate ligament reconstruction: 3-to-5-year outcome. Clin Orthop Relat Res 324:134–144

    Article  Google Scholar 

  13. Hu J, Qu J, Xu D, Zhou J, Lu H (2013) Allograft versus autograft for anterior cruciate ligament reconstruction: an up-to-date meta-analysis of prospective studies. Int Orthop 37(2):311–320

    Article  PubMed  Google Scholar 

  14. Janssen RP, du Mée AW, van Valkenburg J, Sala HA, Tseng CM (2013) Anterior cruciate ligament reconstruction with 4-strand hamstring autograft and accelerated rehabilitation: a 10-year prospective study on clinical results, knee osteoarthritis and its predictors. Knee Surg Sports Traumatol Arthrosc 21:1977–1988

    Article  PubMed  Google Scholar 

  15. Kim SJ, Bae JH, Lim HC (2014) Comparison of achilles and tibialis anterior tendon allografts after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 22:135–141

    Article  PubMed  Google Scholar 

  16. Kondo E, Yasuda K (2007) Second-look arthroscopic evaluations of anatomic double-bundle anterior cruciate ligament reconstruction: relation with postoperative knee stability. Arthroscopy 23(11):1198–1209

    Article  PubMed  Google Scholar 

  17. Kraeutler MF, Bravman JT, McCarty EC (2013) Bone-patellar tendon-bone autograft versus allograft in outcomes of anterior cruciate ligament reconstruction: a meta-analysis of 5182 patients. Am J Sports Med 41(10):2439–2448

    Article  PubMed  Google Scholar 

  18. Lawhorn KW, Howell SM, Traina SM, Gottlieb JE, Meade TD, Freedberg HI (2012) The effect of graft tissue on anterior cruciate ligament outcomes: a multicenter, prospective, randomized controlled trial comparing autograft hamstrings with fresh-frozen anterior tibialis allograft. Arthroscopy 28(8):1079–1086

    Article  PubMed  Google Scholar 

  19. Lee HY, Choi CJ, Choi CH (2009) Comparison of clinical results in anterior cruciate ligament reconstruction using hamstring tendon autograft and tibialis anterior tendon allograft. J Korean Orthop Soc Sports Med 8(2):109–114

    Google Scholar 

  20. Lee JH, Bae DK, Song SJ, Cho SM, Yoon KH (2010) Comparison of clinical results and second-look arthroscopy findings after arthroscopic anterior cruciate ligament reconstruction using three different types of grafts. Arthroscopy 26(1):41–49

    Article  PubMed  Google Scholar 

  21. Lipscomb AB, Johston RK, Snyder RB, Warburton MJ, Gilbert PP (1982) Evaluation of hamstring strength following use of semitendinosus and gracilis tendons to reconstruct the anterior cruciate ligament. Am J Sports Med 10(6):340–342

    Article  CAS  PubMed  Google Scholar 

  22. Maletis GB, Inacio MC, Funahashi TT (2013) Analysis of 16,192 anterior cruciate ligament reconstructions from a community-based registry. Am J Sports Med 41(9):2090–2098

    Article  PubMed  Google Scholar 

  23. Mariscalco MW, Magnussen RA, Mehta D, Hewett TE, Flanigan DC, Kaeding CC (2014) Autograft versus nonirradiated allograft tissue for anterior cruciate ligament reconstruction: a systematic review. Am J Sports Med 42(2):492–499

    Article  PubMed  Google Scholar 

  24. McDaniel WJ, Dameron TB (1980) Untreated ruptures of the anterior cruciate ligament. A follow-up study. J Bone Joint Surg Am 62(5):696–705

    Article  PubMed  Google Scholar 

  25. Miller SL, Gladstone JN (2002) Graft selection in anterior cruciate ligament reconstruction. Orthop Clin North Am 33:675–683

    Article  PubMed  Google Scholar 

  26. Nyland J, Caborn DN, Rothbauer J, Kocabey Y, Couch J (2003) Two-year outcomes following ACL reconstruction with allograft tibialis anterior tendons: a retrospective study. Knee Surg Sports Traumatol Arthrosc 11(4):2012–2218

    Article  Google Scholar 

  27. 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

    Article  CAS  PubMed  Google Scholar 

  28. Peterson RK, Shelton WR, Bomboy AL (2001) Allograft versus autograft patellar tendon anterior cruciate ligament reconstruction: a-5-year follow-up. Arthroscopy 17(1):9–13

    Article  CAS  PubMed  Google Scholar 

  29. Pinczewski LA, Lyman J, Salmon LJ, Russell VJ, Roe J, Linklater J (2007) A 10-year comparison of anterior cruciate ligament reconstructions with hamstring tendon and patellar tendon autograft: a controlled, prospective trial. Am J Sports Med 35:564–574

    Article  PubMed  Google Scholar 

  30. Seon JK, Park SJ, Lee KB, Seo HY, Kim MS, Song EK (2011) In vivo stability and clinical comparison of anterior cruciate ligament reconstruction using low or high femoral tunnel positions. Am J Sports Med 39(1):127–133

    Article  PubMed  Google Scholar 

  31. Shelton WR, Papendick L, Dukes AD (1997) Autograft versus allograft anterior cruciate ligament reconstruction. Arthroscopy 13(4):446–449

    Article  CAS  PubMed  Google Scholar 

  32. Sherman OH, Banffy MB (2004) Anterior cruciate ligament reconstruction: which graft is best? Arthroscopy 20(9):974–980

    Article  PubMed  Google Scholar 

  33. Stringham DR, Pelmas CJ, Burks RT, Newman AP, Marcus RL (1996) Comparison of anterior cruciate ligament reconstructions using patellar tendon autograft or allograft. Arthroscopy 12(4):414–421

    Article  CAS  PubMed  Google Scholar 

  34. Sun K, Zhang J, Wang Y et al (2011) Arthroscopic reconstruction of the anterior cruciate ligament with hamstring tendon autograft and fresh-frozen allograft: a prospective, randomized controlled study. Am J Sports Med 39(7):1430–1438

    Article  PubMed  Google Scholar 

  35. Tavakoli Darestani R, Bagherian Lemraski MM, Hosseinpour M, Kamrani-Rad A (2013) Electrophysiological assessment of injury to the infra-patellar branch(es) of the saphenous nerve during anterior cruciate ligament reconstruction using medial hamstring auto-grafts: vertical versus oblique harvest site incisions. Arch Trauma Res 2(3):118–123

    Article  PubMed  PubMed Central  Google Scholar 

  36. Wilcox JF, Gross JA, Sibel R, Backs RA, Kaeding CC (2005) Anterior cruciate ligament reconstruction with hamstring tendons and cross-pin femoral fixation compared with patellar tendon autografts. Arthroscopy 21:1186–1192

    Article  PubMed  Google Scholar 

  37. Yan F, Xie F, Gong X, Wang F, Yang L (2015) Influence of anterior cruciate ligament rupture on secondary damage to menisci and articular cartilage. Knee 15:160

    Google Scholar 

  38. Yang JH, Yoon JR, Jeong HI, Hwang DH, Woo SJ, Kwon JH, Nha KW (2012) Second-look arthroscopic assessment of arthroscopic single-bundle posterior cruciate ligament reconstruction: comparison of mixed graft versus achilles tendon allograft. Am J Sports Med 40:2052–2060

    Article  PubMed  Google Scholar 

  39. Yoon KH, Bae DK, So DH, Lee JH, Kim JW, Park SY (2007) Clinical results after ACL 299 reconstruction using tibialis anterior tendon allograft and hamstring tendon autograft. J Korean Arthrosc Soc 11:85–91

    Google Scholar 

Download references

Acknowledgments

This study was supported by a grant of the National Research Foundation of Korea funded by the Ministry of Education, Science and Technology (2014R1A1A2059147).

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jong-Keun Seon.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yoo, SH., Song, EK., Shin, YR. et al. Comparison of clinical outcomes and second-look arthroscopic findings after ACL reconstruction using a hamstring autograft or a tibialis allograft. Knee Surg Sports Traumatol Arthrosc 25, 1290–1297 (2017). https://doi.org/10.1007/s00167-015-3955-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-015-3955-3

Keywords

Navigation