Beynnon, J Bone Joint Surg Am 2002 - Anterior Cruciate Ligament Replacement: Comparison of Bone-Patellar Tendon-Bone Grafts with Two-Strand Hamstring Grafts. A Prospective, Randomized Study - Article Summary

Anterior Cruciate Ligament Replacement: Comparison of Bone-Patellar Tendon-Bone Grafts with Two-Strand Hamstring Grafts. A Prospective, Randomized Study

Beynnon, Renström, et al.·J Bone Joint Surg Am·2002·407 citations·RCT

Background

The purpose of this investigation was to evaluate replacement of a torn anterior cruciate ligament with either a bone-patellar tendon-bone autograft or a two-strand semitendinosus-gracilis autograft to compare the results of clinical testing, patient satisfaction, activity level, functional status, and muscle strength.

Methods

56 patients with a torn anterior cruciate ligament were enrolled in a prospective, randomized, controlled study.
28 underwent reconstruction with a bone-patellar tendon-bone autograft, and 28 were treated with a 2-strand semitendinosus-gracilis autograft.
Patients were followed for an average of 39 months (range, 36 to 57 months).
At the time of final follow-up, 22 patients in each group were evaluated in terms of clinical test findings, patient satisfaction, activity level, functional status, and isokinetic muscle strength.

Results

The objective outcome of replacement of the torn anterior cruciate ligament with a bone-patellar tendon-bone graft was superior to that obtained with a 2-strand semitendinosus-gracilis graft.
At the 3-year follow-up interval, the patients in whom a hamstring graft had been used had an average of 4.4 mm of increased anterior knee laxity compared with the laxity of the contralateral, normal knee, whereas the patients in whom a bone-patellar tendon-bone graft had been used had an average of 1.1 mm of increased knee laxity.
14 percent (3) of the 22 patients with a hamstring graft had a mild pivot shift, and 27% (6) had a moderate pivot shift.
Only 14% (3) of the 22 patients with a bone-patellar tendon-bone graft had a mild pivot shift, and none had a moderate pivot shift.
At the same follow-up interval, the patients in whom a hamstring graft had been used had significantly lower peak knee-flexion strength than those who had a bone-patellar tendon-bone graft (p = 0.039).
In contrast, the 2 treatments produced similar outcomes in terms of patient satisfaction, activity level, and knee function (ability to perform a one-legged hop, bear weight, squat, climb stairs, run in place, and duckwalk).

Conclusions

After three years of follow-up, the objective results of anterior cruciate ligament replacement with a bone-patellar tendon-bone autograft were superior to those of replacement with a two-strand semitendinosus-gracilis graft with regard to knee laxity, pivot-shift grade, and strength of the knee flexor muscles. However, the two groups had comparable results in terms of patient satisfaction, activity level, and knee function.

Supplemental

Anterior Cruciate Ligament Replacement: Comparison of Bone-Patellar Tendon-Bone Grafts with Two-Strand Hamstring Grafts. A Prospective, Randomized Study.

Beynnon, Renström, et al.J Bone Joint Surg Am2002407 citationsRCT