Prospective and Randomized Clinical Evaluation of Hamstring Versus Patellar Tendon Autograft for Anterior Cruciate Ligament Reconstruction in Soccer Players

Abstract

Background: Anterior cruciate ligament (ACL) reconstruction is usually performed with autologous bone–patellar tendon–bone (PT) or hamstring tendon (HT) graft. There has been only 1 randomized clinical trial examining ACL reconstruction with these grafts specifically in soccer players, and more studies comparing these graft types within a homogenous cohort such as soccer athletes may better highlight differences in outcomes. Purpose: To compare the results of ACL reconstruction with PT versus HT autograft in soccer players and to evaluate objective and subjective outcomes. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 62 professional or semiprofessional soccer players (mean age, 25.1 years) with ACL injury were randomized to undergo reconstruction with PT or HT autograft by a single orthopaedic surgeon (n = 31 in each group). Outcome measures were recorded preoperatively and at 2 years postoperatively. The primary outcome was the modified Cincinnati Knee Rating System, and secondary outcomes were the objective and subjective International Knee Documentation Committee scores, Lachman test, pivot-shift test, anterior drawer test, and Lysholm score. The following variables were also evaluated postoperatively: return to soccer, level at return, graft rerupture, postoperative complications, anterior knee pain, patellar tendinitis, difficulty sprinting, and loss of kicking power. Results: The PT and HT groups were homogenous in terms of age, sex distribution, injured side, and time from injury to surgery, and there was no difference between them on any preoperative outcome score. At 2 years postoperatively, there were no differences between the groups on any outcome score; however, there were significantly fewer patients with anterior knee pain in the HT group compared with the PT group (7 [22.6%] vs 15 [48.4%], respectively; P = .03). Two patients from each group (2/31; 6.5%) sustained rerupture. Conclusion: There were no differences between soccer players who underwent different types of ACL reconstruction with the exception of anterior knee pain, which was more frequent in players who underwent reconstruction with PT graft. Registration: NCT02642692 ( ClinicalTrials.gov ).

Effectiveness of Platelet‐Rich Plasma in Anterior Cruciate Ligament Reconstruction: A Systematic Review of Randomized Controlled Trials

“…It has been reported that the long period of healing in the interzone between bone tunnel and graft makes up one of the factors to delay the return to pre‐injury activity, and there is also an existent relationship between harvest site healing time and anterior knee pain. 4 , 5 , 6 Though the treatment role of PRP in ACL‐reconstructed patients has not been definitely identified, it has been applied with the anticipation of accelerating the recovering processes. In many former cytological, histological or biomechanical studies, PRP was shown to have positive effects on promoting tendon healing at the injured site by promote cell proliferation and tissue regeneration.…”

“… 4 , 5 Additionally, the slow healing process of defect at harvest site has been recognized as a cause of persistent anterior knee pain even after many years. 6 Although the treatment role of platelets‐rich plasma (PRP) remains unclear, it has been provided with the aim of accelerating the maturation of the graft and healing processes of bone tunnel and donor site. 7 Theoretically, after applying of PRP to the ACL‐reconstructed patients, a myriad of growth factors (GFs) and proteins would be released to the local environment, which could potentially accelerate the tissue regeneration.…”

“…However, one of the challenges of ACLR is the slow integration in the bone tunnel and ligamentization of intra‐articular part of graft, which is one of the factors causing long rehabilitation period before returning to full physical activity 4,5 . Additionally, the slow healing process of defect at harvest site has been recognized as a cause of persistent anterior knee pain even after many years 6 . Although the treatment role of platelets‐rich plasma (PRP) remains unclear, it has been provided with the aim of accelerating the maturation of the graft and healing processes of bone tunnel and donor site 7 .…”

The safety and effectiveness comparison of Delta Medical's PEEK interface screw and Endobutton and that of Smith & Nephew's in arthroscopic anterior cruciate ligament reconstruction: A multicenter prospective double-blind randomized controlled clinical trial

“…Guglielmetti reported the same result in his ACL reconstruction using metal interference screws. The mean Lysholm score of the patellar tendon group was 89.87 points (range, 65-100), and that of the hamstring tendon group was 91.26 points (range, 60-100) at 2 years post-operation ( 30 ).…”

The reverse fragility index: RCTs reporting non-significant differences in failure rates between hamstring and bone–patellar tendon–bone autografts have fragile results

“…In a recent survey study of members of the American Orthopaedic Society for Sports Medicine (AOSSM) and Arthroscopy Association of North America (AANA), the second most important factor for graft selection was graft failure rates reported in the literature [6]. However, the current evidence on re‐rupture/revision rates between two of the most frequently used grafts, hamstring (HT) autografts and bone–patellar tendon–bone (BTB) autografts, is conflicting [2, 3, 5, 9, 10, 12, 14, 16–18, 20, 22, 34–36, 39, 41, 43, 46]. For example, Samuelsen et al performed a meta‐analysis which demonstrated a significantly lower re‐rupture rate among BTB autografts ( P = 0.01), whereas a meta‐analysis from Mouarbes et al showed no significant difference in re‐rupture rates between these two graft types (n.s.)…”