No abstract

BACKGROUND: There are no controlled, prospective studies comparing the 10-year outcomes of anterior cruciate ligament (ACL) reconstruction using patellar tendon (PT) and four-strand hamstring tendon (HT) autografts. HYPOTHE-SIS: Comparable results are possible with HT and PT autografts. STUDY DE-SIGN: Cohort study; Level of evidence, 2. METHODS: One hundred and eighty ACL-deficient knees that met inclusion criteria underwent ACL reconstruction (90 HT autograft, 90 PT autograft) by one surgeon and were treated with an accelerated rehabilitation program. All knees were observed in a prospective fashion with subjective, objective, and radiographic evaluation at 2-, 5-, 7-, and 10-year intervals. RESULTS: At 10 years, there were no differences in graft rupture rates (7/90 PT vs 12/90 HT, P 5 0.24). There were 20 contralateral ACL ruptures in the PT group, compared with nine in the HT group (P 5 0.02). In all patients, graft rupture was associated with instrumented laxity 42 mm at 2 years (P 5 0.001). Normal or near-normal function of the knee was reported in 97% of patients in both groups. In the PT group, harvest-site symptoms (P 5 0.001) and kneeling pain (P 5 0.01) were more common than in the HT group. More patients reported pain with strenuous activities in PT knees than in HT knees (P 5 0.05). Radiographic osteoarthritis was more common in PT knees than the HT-reconstructed knees (P 5 0.04). The difference, however, was composed of patients with mild osteoarthritis. Other predictors of radiographic osteoarthritis were o90% single-legged hop test at 1 year and the need for further knee surgery. An ''ideal'' outcome, defined as an overall International Knee Docu-

Repeat ACL injury after isolated ACL reconstruction is common, occurring in 1 in 3 over 20 years. In the absence of further injury, isolated ACL reconstruction using this technique was associated with good long-term outcomes with respect to patient-reported outcomes and return to sports, regardless of age. However, mild ligament laxity and ACL graft rupture after ACL reconstruction are significantly more common in adolescents, especially adolescent males, compared with adults. PTS of 12° or more is the strongest predictor of repeat ACL injury, and its negative effect is most pronounced in adolescents.