A 10‐year comparison of anterior cruciate ligament reconstructions with hamstring tendon and patellar tendon autograft: a controlled, prospective trial

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-

The Relationship Between Pre-Operative and Twelve-Week Post-Operative Y-Balance and Quadriceps Strength in Athletes With an Anterior Cruciate Ligament Tear

“…This finding may point to the fact that the YBT-LQ is a trainable skill in which quadriceps strength plays a role in improvements following ACL-R, in addition to neuromuscular control, hip strength and range of motion of the entire lower extremity. Garrison et al 24 found that gluteal strengthening contributes to YBT-LQ ANT. Individuals that scored higher on the YBT-LQ at 12-weeks, but had decreased quadriceps strength may have had an increase in gluteal strength between the preoperative assessment and assessment at 12-weeks.…”

Muscle strength and hop performance criteria prior to return to sports after ACL reconstruction

“…Several risk factors for the development of knee OA after ACL injury are reported in the literature [75,41,84,85,24]. A systematic review discussed whether the risk of developing knee OA might be somewhat exaggerated in the literature [64].…”

“…Strong evidence identifying meniscal injury and meniscectomy as risk factors for 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 the development of knee OA after ACL injury was found [64]. However, the results in a single-leg hop test one year after the ACL injury have been stated as a predictor of future development of knee OA [75] and muscle weakness is commonly suggested to be a risk factor [24]. It has further been suggested that neuromuscular function may be of importance in preventing knee OA [81,100,71,40] and that poor muscle function might be a predictor of OA development [92,93,75].…”

“…However, the results in a single-leg hop test one year after the ACL injury have been stated as a predictor of future development of knee OA [75] and muscle weakness is commonly suggested to be a risk factor [24]. It has further been suggested that neuromuscular function may be of importance in preventing knee OA [81,100,71,40] and that poor muscle function might be a predictor of OA development [92,93,75]. It is possible that early neuromuscular rehabilitation resulting in good knee function and a modification of physical activity could reduce the risk of developing knee OA in the long run after ACL injury [42].…”

Recent advances following anterior cruciate ligament reconstruction: rehabilitation perspectives

“…Most of these standard objective measures such as these are temporal based measures and therefore are quit variable and may have limitations if used in isolation to determine return to full activity. This is concerning since as many as one in four patients undergoing an ACL reconstruction will suffer a second tear within 10 years of their first [101]. Furthermore recent biomechanical data has shown that altered neuromuscular control of the hip and knee during a dynamic landing task as well as postural stability deficits after ACL reconstruction are predictors of a second ACL injury after an athlete has returned to sports [102•].…”