Background: The choice of graft for anterior cruciate ligament
reconstruction is a matter of debate, with patellar and hamstring tendons
being the two most popular autologous graft options. The objective of this
study was to determine in a prospective, randomized clinical trial whether two
grafts (bone-patellar tendon-bone or doubled hamstring tendons) fixed with
modern devices affect the two-year minimum clinical and radiographic outcomes
of anterior cruciate ligament reconstruction.
Methods: One hundred and twenty patients with a chronic unilateral
rupture of the anterior cruciate ligament underwent arthroscopically assisted
reconstruction with use of either autologous bone-patellar tendon-bone or
doubled hamstring tendon grafts, in a strictly alternating manner. Both groups
were comparable with regard to demographic data, preoperative activity level,
mechanism of injury, interval between the injury and the operation, and the
amount of knee laxity present preoperatively. The same well-proven surgical
technique and aggressive controlled rehabilitation was used. An independent
observer, who was blinded with regard to the involved leg and the type of
graft, performed the outcome assessment with use of a visual analog scale, the
new International Knee Documentation Committee form, the Knee Injury and
Osteoarthritis Outcome Score, the Functional Knee Score for Anterior Knee
Pain, and an arthrometric and an isokinetic dynamometric evaluation.
Radiographs were also made.
Results: At the two-year follow-up evaluation, no differences were
found in terms of the visual analog score, the Knee Injury and Osteoarthritis
Outcome Score, the new International Knee Documentation Committee subjective
and objective evaluation scores, the KT-1000 side-to-side laxity measurements,
the Functional Knee Score for Anterior Knee Pain, muscle strength recovery, or
return to sports activities. In the bone-patellar tendon-bone group, we found
a higher prevalence of postoperative kneeling discomfort (p < 0.01) and an
increased area of decreased skin sensitivity (p < 0.001). In the hamstring
tendon group, we recorded a higher prevalence of femoral tunnel widening (p
< 0.01). In this group, a correlation was also found between medial
meniscectomy and an increased prevalence of pivot-shift glide (p = 0.035).
Conclusions: We believe that, with use of accurate and proven
surgical and rehabilitation techniques, both grafts are an equivalent option
for anterior cruciate ligament reconstruction.
Level of Evidence: Therapeutic study, Level I-1b
(randomized controlled trial [no significant difference but narrow confidence
intervals]). See Instructions to Authors for a complete description of levels