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No differences found in long-term outcomes of a randomized controlled trial comparing ipsilateral versus contralateral hamstring graft in ACL reconstruction

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Contralateral graft harvest in primary ACL reconstruction is relatively uncommon and the long-term comparative of this approach relative to ipsilateral harvest has not been described. The purpose of this study was to evaluate ACL graft and contralateral rupture following ipsilateral or contralateral semitendinosus and gracilis (STG) graft harvest at follow-up of a minimum 10 years post-reconstruction in the treatment of a complete ACL tear.

Methods

Patients from a previous randomized trial were evaluated. The primary outcome measures were ipsilateral and contralateral reinjury as well as the International Knee Documentation Committee (IKDC) knee assessment form, the ACL Quality of Life questionnaire (ACL-QoL) and the Tegner activity scale. Participants completed four different single-leg hop tests and concentric knee flexion and extension strength were assessed on an isokinetic dynamometer.

Results

Of the original 100 patients, 50 patients (41.3 ± 9.5 years of age, 31 males, 19 females) reported on re-injury at 12.6 ± 1.4 years post-operative. Thirty-eight patients returned for full assessment and 12 responded by mail or phone survey. There were no differences between groups for graft rupture, contralateral injury, ACL-QoL score, IKDC categorization, or anterior tibial translation, though both groups experienced a reduction in the Tegner Activity Scale from their preinjury scores. There was no difference in knee flexor and extensor isokinetic concentric strength, or single leg hop test performance. Knee flexor strength limb symmetry index was reduced when measured in the supine relative to the seated position in both groups, indicating persistent deficits in knee flexor strength when measured in the supine position.

Conclusion

Contralateral hamstring harvest does not put patients at an increased risk of a contralateral ACL tear and long-term outcomes of ACL reconstruction do not differ based on the side of graft harvest. Contralateral STG harvest may provide a safe alternative surgical option for select patients.

Level of evidence

Level II.

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References

  1. Lobo Júnior P, Santos Neto ED, Borges JHDS, Dias LJRV, Machado RDS, Freitas A (2018) Contralateral patellar tendon autograft in anterior cruciate ligament reconstruction. Acta Ortop Bras 26:140–144

    Article  Google Scholar 

  2. McRae SM, Chahal J, Leiter JR, Marx RG, Macdonald PB (2011) Survey study of members of the Canadian Orthopaedic Association on the natural history and treatment of anterior cruciate ligament injury. Clin J Sport Med 21:249–258

    Article  Google Scholar 

  3. Rubinstein RA, Shelbourne KD, VanMeter CD, McCarroll JC, Rettig AC (1994) Isolated autogenous bone-patellar tendon-bone graft site morbidity. Am J Sports Med 22:324–327

    Article  Google Scholar 

  4. Yasuda K, Tsujino J, Ohkoshi Y, Tanabe Y, Kaneda K (1995) Graft site morbidity with autogenous semitendinosus and gracilis tendons. Am J Sports Med 23:706–714

    Article  CAS  Google Scholar 

  5. Ohkoshi Y, Inoue C, Yamane S, Hashimoto T, Ishida R (1998) Changes in muscle strength properties caused by harvesting of autogenous semitendinosus tendon for reconstruction of contralateral anterior cruciate ligament. Arthroscopy 14:580–584

    Article  CAS  Google Scholar 

  6. McRae S, Leiter J, McCormack R, Old J, MacDonald P (2013) Ipsilateral versus contralateral hamstring grafts in anterior cruciate ligament reconstruction: a prospective randomized trial. Am J Sports Med 41:2492–2499

    Article  Google Scholar 

  7. Cancienne JM, Browning R, Werner BC (2020) Patient-related risk factors for contralateral anterior cruciate ligament (ACL) tear after ACL reconstruction: an analysis of 3707 primary ACL reconstructions. HSS J 16:226–229

    Article  Google Scholar 

  8. Grassi A, Macchiarola L, Lucidi GA, Stefanelli F, Neri M, Silvestri A, Della Villa F, Zaffagnini S (2020) More Than a 2-fold risk of contralateral anterior cruciate ligament injuries compared with ipsilateral graft failure 10 years after primary reconstruction. Am J Sports Med 48:310–317

    Article  Google Scholar 

  9. Rahardja R, Zhu M, Love H, Clatworthy MG, Monk AP, Young SW (2020) Rates of revision and surgeon-reported graft rupture following ACL reconstruction: early results from the New Zealand ACL Registry. Knee Surg Sports Traumatol Arthrosc 28:2194–2202

    Article  Google Scholar 

  10. Mohtadi N (1998) Development and validation of the quality of life outcome measure (questionnaire) for chronic anterior cruciate ligament deficiency. Am J Sports Med 26:350–359

    Article  CAS  Google Scholar 

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

    Article  Google Scholar 

  12. Briggs KK, Lysholm J, Tegner Y, Rodkey WG, Kocher MS, Steadman JR (2009) The reliability, validity, and responsiveness of the lysholm score and tegner activity scale for anterior cruciate ligament injuries of the knee: 25 years later. Am J Sports Med 37:890–897

    Article  Google Scholar 

  13. Hefti E, Müller W, Jakob RP, Stäubli H-U (1993) Evaluation of knee ligament injuries with the IKDC form. Knee Surg Sports Traumatol Arthrosc 1:226–234

    Article  CAS  Google Scholar 

  14. Reid A, Birmingham TB, Stratford PW, Alcock GK, Giffin JR (2007) Hop testing provides a reliable and valid outcome measure during rehabilitation after anterior cruciate ligament reconstruction. Phys Ther 87:337–349

    Article  Google Scholar 

  15. Toor AS, Limpisvasti O, Ihn HE, McGarry MH, Banffy M, Lee TQ (2019) The significant effect of the medial hamstrings on dynamic knee stability. Knee Surg Sports Traumatol Arthrosc 27:2608–2616

    Article  Google Scholar 

  16. Andernord D, Desai N, Björnsson H, Gillén S, Karlsson J, Samuelsson K (2015) Predictors of contralateral anterior cruciate ligament reconstruction: a cohort study of 9061 patients with 5-year follow-up. Am J Sports Med 43:295–302

    Article  Google Scholar 

  17. Cronström A, Tengman E, Häger CK (2021) Risk factors for contra-lateral secondary anterior cruciate ligament injury: a systematic review with meta-analysis. Sports Med 51:1419–1438

    Article  Google Scholar 

  18. von Essen C, Hallgren A, Barenius B, Eriksson K (2021) Utilizing a contralateral hamstring autograft facilitates earlier isokinetic and isometric strength recovery after anterior cruciate ligament reconstruction: a randomised controlled trial. Knee Surg Sports Traumatol Arthrosc 29:2684–2694

    Article  Google Scholar 

  19. Leiter JRS, Gourlay R, McRae S, de Korompay N, MacDonald PB (2013) Long-term follow-up of ACL reconstruction with hamstring autograft. Knee Surg Sports Traumatol Arthrosc 22:1061–1069

    PubMed  Google Scholar 

  20. Tengman E, Olofsson LB, Nilsson KG, Tegner Y, Lundgren L, Häger CK (2014) Anterior cruciate ligament injury after more than 20 years: I. Physical activity level and knee function. Scand J Med Sci Sports 24:e491-500

    Article  CAS  Google Scholar 

  21. Shelbourne KD, Benner RW, Gray T (2017) Results of anterior cruciate ligament reconstruction with patellar tendon autografts: objective factors associated with the development of osteoarthritis at 20 to 33 years after surgery. Am J Sports Med 45:2730–2738

    Article  Google Scholar 

  22. Filbay SR, Ackerman IN, Russell TG, Macri EM, Crossley KM (2014) Health-related quality of life after anterior cruciate ligament reconstruction: a systematic review. Am J Sports Med 42:1247–1255

    Article  Google Scholar 

  23. Möller E, Weidenhielm L, Werner S (2009) Outcome and knee-related quality of life after anterior cruciate ligament reconstruction: a long-term follow-up. Knee Surg Sports Traumatol Arthrosc 17:786–794

    Article  Google Scholar 

  24. Sajovic M, Strahovnik A, Dernovsek MZ, Skaza K (2011) Quality of life and clinical outcome comparison of semitendinosus and gracilis tendon versus patellar tendon autografts for anterior cruciate ligament reconstruction: an 11-year follow-up of a randomized controlled trial. Am J Sports Med 39:2161–2169

    Article  Google Scholar 

  25. Oiestad BE, Holm I, Engebretsen L, Risberg MA (2011) The association between radiographic knee osteoarthritis and knee symptoms, function and quality of life 10–15 years after anterior cruciate ligament reconstruction. Br J Sports Med 45:583–588

    Article  CAS  Google Scholar 

  26. Holm I, Øiestad BE, Risberg MA, Aune AK (2010) No difference in knee function or prevalence of osteoarthritis after reconstruction of the anterior cruciate ligament with 4-strand hamstring autograft versus patellar tendon—bone autograft: a randomized study with 10-year follow-up. Am J Sports Med 38:448–454

    Article  Google Scholar 

  27. Wren TAL, Mueske NM, Brophy CH, Pace JL, Katzel MJ, Edison BR, Vandenberg CD, Zaslow TL (2018) Hop distance symmetry does not indicate normal landing biomechanics in adolescent athletes with recent anterior cruciate ligament reconstruction. J Orthop Sports Phys Ther 48:622–629

    Article  Google Scholar 

  28. Nagai T, Schilaty ND, Laskowski ER, Hewett TE (2020) Hop tests can result in higher limb symmetry index values than isokinetic strength and leg press tests in patients following ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 28:816–822

    Article  Google Scholar 

  29. Tengman E, Brax Olofsson L, Stensdotter AK, Nilsson KG, Häger CK (2014) Anterior cruciate ligament injury after more than 20 years. II. Concentric and eccentric knee muscle strength: knee muscle strength 23 years after ACL injury. Scand J Med Sci Sports 24:e501-509

    Article  CAS  Google Scholar 

  30. ØIestad BE, Holm I, Gunderson R, Myklebust G, Risberg MA (2010) Quadriceps muscle weakness after anterior cruciate ligament reconstruction: a risk factor for knee osteoarthritis? Arthrit Care Res (Hoboken) 62:1706–1714

    Article  Google Scholar 

  31. von Essen C, McCallum S, Eriksson K, Barenius B (2021) Minimal graft site morbidity using autogenous semitendinosus graft from the uninjured leg: a randomised controlled trial. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-021-06686-6

    Article  Google Scholar 

  32. Koutras G, Bernard M, Terzidis IP, Papadopoulos P, Georgoulis A, Pappas E (2016) Comparison of knee flexion isokinetic deficits between seated and prone positions after ACL reconstruction with hamstrings graft: Implications for rehabilitation and return to sports decisions. J Sci Med Sport 19:559–562

    Article  Google Scholar 

  33. Lee DW, Shim JC, Yang SJ, Cho SI, Kim JG (2019) Functional effects of single semitendinosus tendon harvesting in anatomic anterior cruciate ligament reconstruction: comparison of single versus dual hamstring harvesting. Clin Orthop Surg 11:60–72

    Article  Google Scholar 

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Funding

No funding was received for this study.

Author information

Authors and Affiliations

  1. Pan Am Clinic Foundation, Winnipeg, MB, Canada

    Dan Ogborn, Sheila McRae, Holly Brown & Peter MacDonald

  2. Department of Surgery, Orthopedic Section, University of Manitoba, Winnipeg, MB, Canada

    Dan Ogborn, Sheila McRae, Gabriel Larose & Peter MacDonald

  3. Department of Physical Therapy, University of Manitoba, Winnipeg, MB, Canada

    Dan Ogborn & Sheila McRae

  4. Max Rady College of Medicine, University of Manitoba, 75 Poseidon Bay, Winnipeg, MB, R3M 3E4, Canada

    Alisha Beaudoin

  5. Department of Orthopaedic Surgery, University of British Columbia, Vancouver, BC, Canada

    Robert McCormack

Authors
  1. Alisha Beaudoin
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  2. Dan Ogborn
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  3. Sheila McRae
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  4. Gabriel Larose
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  5. Holly Brown
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  7. Peter MacDonald
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Contributions

AB: data acquisition, manuscript preparation. DO: data analysis, manuscript preparation. SM: protocol development, data acquisition, manuscript preparation. GL: protocol development, data acquisition, manuscript preparation. HB: data acquisition, manuscript preparation. RM: data acquisition, manuscript preparation. PM: protocol development, data acquisition, manuscript preparation.

Corresponding author

Correspondence to Alisha Beaudoin.

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Conflict of interest

Alisha Beaudoin, Dan Ogborn, Sheila McRae, Gabriel Larose, Holly Brown, Robert McCormack, and Peter MacDonald declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Patients gave written informed consent.

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Beaudoin, A., Ogborn, D., McRae, S. et al. No differences found in long-term outcomes of a randomized controlled trial comparing ipsilateral versus contralateral hamstring graft in ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 30, 3718–3725 (2022). https://doi.org/10.1007/s00167-022-06980-x

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  • DOI: https://doi.org/10.1007/s00167-022-06980-x

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