Reconstruction of the anterior cruciate ligament:a comparison between bone-patellar tendon-bone grafts and four-strand hamstring grafts

  Background :Disruption of anterior cruciate ligament (ACL) is a common ligamentous injury of the knee. The choice of graft for (ACL) reconstruction remains controversial. This prospective, randomized clinical trial aimed to compare clinical results of bone-patellar tendon-bone (BPTB) grafts and four-strand semitendinosus-gracilis (ST) grafts for ACL reconstruction over a 3-year follow-up interval.   Methods :Seventy-one patients with an average age of 29± 4.5yearswere treated for torn ACL between 2008 and 2009. Forty-sixpatients underwent reconstruction with BPTBautograft, and 41 were treated with STautograft.At the time of final follow-up, 37 patients in patella group and 34 patients in hamstring group were evaluated in terms of return to pre-injury activity level, pain, knee stability, range of motion,IKDC (International Knee Documentation Committee) score and complications.   Results : At 36thmonth of follow-up, 34 (92%) and 28 (82%) patients in BPTB and ST group, respectively had good-to-excellent IKDC score (p > 0.05). Theactivity levelswerehigher in BPTB group(p> 0.05). At 3rd yearof follow up, the Lachman test was graded normal, for 23 (62%) and 11 (32%) patientsin BPTB and ST group, respectively(p=0.019).Regarding the pivot-shift test, 29 (79%) and 15 (44%) patients in patella and hamstring group, respectively had normal test at the latest follow-up (p=0.021).There were no significant differences in terms of thigh circumference difference, effusion, knee range of motion, pain and complications.   Conclusion : Theresults indicate a trend toward increased graft laxityand pivot-shift grades in patients undergoing reconstruction with hamstring autograft compared with patella tendon. However, the two groups had comparable results in terms of activity level and knee function.