Randomized prospective study of ACL reconstruction with interference screw fixation in patellar tendon autografts versus femoral metal plate suspension and tibial post fixation in hamstring tendon autografts: 5-year clinical and radiological follow-up results

Abstract

Patellar tendon graft has been the most frequently used material in anterior cruciate ligament (ACL) reconstruction, but the hamstring tendons have been increasingly used as well; however, which graft is to be preferred is not adequately supported by existing clinical studies. In this prospective randomized clinical trial, the study hypothesis was that the hamstring tendons are equally good graft material as the patellar tendon in ACL reconstruction. Ninety-nine patients with laxity due to a torn ACL underwent arthroscopically assisted reconstruction with graft randomization according to their birth year to either patellar tendon with metal interference screw fixation or double looped semitendinosus and gracilis tendons with fixation similar to the Endobutton technique using a titanium metal plate suspension proximally and screw-washer postdistally. Excluding preoperative Lysholm knee score, there were no significant differences between the two groups in the preoperative and operative data. A standard rehabilitation regimen was used for all the patients, including immediate postoperative mobilization without a knee brace, protected weight bearing for 2 weeks, and return to full activity at 6-12 months postoperatively. Forty patients in the patellar tendon group and 39 patients in the hamstring tendon group were available for clinical evaluation at median 5 years after surgery (ranges 3 years 11 months-6 years 7 months). The results revealed no statistically significant differences with respect to clinical and instrumented laxity testing, isokinetic muscle torque measurements, International Knee Documentation Committee ratings, Lysholm (knee score), Tegner (activity level) and Kujala patellofemoral knee scores. There was an enlargement of the drill tunnels, statistically more in the hamstring tendon group, but no increase from 2 to 5 years in either group. Narrowing of the joint spaces (IKDC measurement method) from 2 to 5 years postoperatively was seen in both the groups, however, without difference between the two groups.

Estudo comparativo da reconstrução do LCA com o posicionamento anatômico dos túneis entre o tendão patelar e os tendões flexores

“…Although our study was not randomized or homogenous, its findings were in agreement with previous studies (8,18,25,26) . Persistent anterior pain has been considered by some authors to be a consequence of harvesting the patellar tendon (8,19,27) . However, we only found one patient in the patellar tendon group who presented this complaint, which was not significant.…”

“…Some studies have shown that using the flexor tendons produced cases of slackness, in comparison with using the patellar tendon, because of the fixation methods (8,20) . Evolution of these cases made the results similar.…”

“…This tendon and the flexor tendons are currently the graft materials that are used most (7,8) , and each has its advantages and disadvantages (9,10) .…”

Influence of Different Tibial Fixation Techniques on Initial Stability in Single-Stage Anterior Cruciate Ligament Revision With Confluent Tibial Tunnels: A Biomechanical Laboratory Study

“…[1][2][3][4][5][6][7][8] In general, recurrent instability can be traumatic or atraumatic. Cases with significant widening of the tibial and femoral bone tunnels can be distinguished from those without relevant tunnel widening.…”

A prospective comparison of double- and single-bundle anterior cruciate ligament reconstructions

“…Nepaisant didelio skaièiaus klinikiniø tyrimø, kuriø metu buvo tiriamos priekinio kryþminio raiðèio traumos ir rekonstrukcijos, vis dar neaiðkios prieþastys, lemianèios sugráþimà á buvusá aktyvumo lygá. Beje, kitø tyrimø autoriai nenurodo tikslaus pacientø sugráþimo á buvusá fizinio aktyvumo lygá laiko, bet tik pageidautinà sugráþimo laikà (1,4,7,9,10,(12)(13)(14)(15)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30). Visi tyrimai, deja, buvo sukoncentruoti tik á sugráþimo faktà, bet ne sugráþimo laikà (1,4,7,9,10,(12)(13)(14)(15)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30).…”