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Document Title: Matsumoto-AJSM-Feb06.shtml
Article Title: A Comparison of Bone–Patellar Tendon–Bone and Bone–Hamstring Tendon–Bone Autografts for Anterior Cruciate Ligament Reconstruction
Authors: Akio Matsumoto, MD, Shinichi Yoshiya, MD, Hirotsugu Muratsu, MD, Masayoshi Yagi, MD, Yasunobu Iwasaki, MD, Masahiro Kurosaka, MD and Ryosuke Kuroda, MD
Publication: American Journal of Sports Medicine, Baltimore, Maryland
Date: February 2006
Volume 34, pages 213-219
Keywords: ACL reconstruction, patellar-tendon autograft, hamstring-tendon autograft, DLSTG, comparison, strength, biomechanics.
(Reference-denoting numbers appear in the same font and point size as the document text. As with all Knee Library documents, this article is provided in full-text form, complete with all figures and tables. This article also includes two letters to the editor.)
Comments: These authors looked at 72 patients who had either hamstring (BHB) or patellar-tendon (BPTB or simply BTB) grafting for ACL reconstruction. All reconstructions used the same fixation devices, thus controlling for this potential source of variation. They found that using the hamstring tendon as ACL-graft source avoids the problem of pain while kneeling (which is sometimes a problem with the patellar-tendon graft). But they also note that the hamstring graft brings problems such as persistent hamstring-group weakness. The authors additionally note that some of the problems noted with hamstring grafting can be attributed to the previously common use of outside-the-tunnel fixation devices, which led to the "bungee-cord" effect (i.e. the graft would move slightly inside the tunnel as it stretched elastically with each loading, thus preventing proper healing of graft to tunnel). The use of interference screws, as done for all patients in this study, addresses this concern. The minimum 5-year follow-up is good.
ABSTRACT
Background: Most of the previous comparative studies between patellar tendon and hamstring tendon anterior cruciate ligament grafts compared grafts of different constructs fixed with different methods.
Purpose: To compare patellar tendon and hamstring tendon grafts with the same fixation method used to reconstruct the anterior cruciate ligament.
Study Design: Randomized controlled trial; Level of evidence, 1.
Methods: During the reconstructive procedure, the hamstring tendon graft was prepared as a bone-hamstring-bone graft; both bone–patellar tendon–bone and bone-hamstring-bone grafts were fixed with interference screws. Eighty consecutive patients who underwent anterior cruciate ligament reconstruction were randomly assigned to either bone–patellar tendon–bone or bone-hamstring-bone groups. Follow-up examinations were performed for at least 5 years postoperatively. Seventy-two of the 80 patients (37 patients in the bone–patellar tendon–bone group and 35 in the bone-hamstring-bone group) were evaluated, with a mean follow-up period of 87.0 and 80.8 months, respectively. Follow-up examinations were performed using the International Knee Documentation Committee knee ligament standard and subjective knee forms.
Results: The mean KT-1000 arthrometer evaluation results showed no significant difference between the bone–patellar tendon–bone and bone-hamstring-bone groups (1.2 ± 2.1 mm and 1.7 ± 1.4 mm, respectively; P = .24). However, symptoms related to graft harvest (anterior kneeling pain) were more frequently observed in the bone–patellar tendon–bone group, and unsatisfactory results were correlated with severe kneeling pain in 3 patients from this group (P = .0056). Significant hamstring muscle weakness without complaint of functional deficit was found in the bone-hamstring-bone group (P = .0045).
Conclusion: Bone-hamstring-bone grafts were shown to reduce the risk of problems at the graft harvest site compared to bone–patellar tendon–bone grafts, with comparable results in the remaining clinical parameters tested.
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