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.

An increased posterior tibial slope is associated with increased odds of a further ACL injury after ACL reconstruction. The increased risk is most pronounced in those with a posterior tibial slope of ≥12°.

It is possible to obtain excellent results with both HT and PT autografts. We recommend HT reconstructions to our patients because of decreased harvest-site symptoms and radiographic osteoarthritis.

Anterior cruciate ligament reconstruction using ipsilateral autograft continues to show excellent results in terms of patient satisfaction, symptoms, function, activity level, and stability. The use of HT autograft does, however, show better outcomes than the PT autograft in all of these outcome measures. Additionally, at 15 years, the HT graft-reconstructed ACLs have shown a lower rate of radiological osteoarthritis.

Arthroscopic reconstruction with either graft results in a similar surgical outcome, reliably restoring knee stability over a 5-year period; however, patients with patellar tendon grafts are at greater risk of developing early signs of osteoarthritis.

Fifteen years after ACL reconstruction, expected survival of the ACL graft was 89% and expected survival of the CACL was 86%. Graft choice did not affect ACL graft rupture, but using BPTB increased the risk of CACL rupture compared with HT. Men had a less favorable survival rate of the ACL graft than did women, and a family history of ACL rupture increased the risk of both ACL graft and CACL rupture.