Ipsilateral Versus Contralateral Hamstring Grafts in Anterior Cruciate Ligament Reconstruction
McRae S, Leiter J, McCormack R, Old J, & MacDonald P. American Journal of Sports Medicine. Epub ahead of print; doi:10.1177/0363546513499140
Take Home Message: An ACL hamstring autograft can be harvested from either the same or opposite leg without compromising quality of life, clinical signs and symptoms, or strength for at least 24 months after surgery.
Increasingly, patients receive anterior cruciate ligament (ACL) reconstructions with a hamstring autograft, specifically the semitendinosus autograft (STG). When using STG, a question remains whether it is better to take it from the ipsilateral or contralateral hamstring for optimal outcomes. Therefore, the purpose of this multicenter, single-blind, randomized study was to compare the outcomes (i.e., quality of life, strength, pain, IKDC [clinical assessment of signs and symptoms]) between contralateral and ipsilateral STG ACL reconstructions in 100 participants. The authors assessed participants preoperatively and post-operatively at 3, 6, 12, 18, and 24 months. There were no group differences for quality of life, strength, IKDC knee assessments, pain, and rerupture rate at 24 months postoperatively. Among patients that had the graft harvested from the same knee as the ACL reconstruction, the knee with both the reconstruction and graft harvest had less knee flexion strength – and possibly less extension strength – than the contralateral unaffected knee at 3 months. Both groups had comparable knee strength by the end of the follow-up period (24 months).
Clinically, it appears that there are no major advantages or disadvantages to STG site selection. This is a nice finding because it gives surgeons flexibility to consider which site to take the graft from. If a person has a history of repetitive hamstring issues on the involved side, a decision could be made to take it from the contralateral side with no apparent downside. While this study did not find any differences with graft re-rupture rates, it would be interesting to compare the incidence of other lower extremity pathologies. Of note, there were no major differences in pain nor analgesic use between the two groups. With the contralateral group having “2 surgical sites” one may have expected them to be in more pain, however, this was not the case. Theoretically, this allows for healthy hamstrings to serve as secondary stabilizers of the newly reconstructed ACL. It may also be interesting to compare participant-perceived outcome differences based on activity that they were returning back to. For instance, a participant returning back to sprinting activities compared with someone returning to activities of daily living may have very different perceptions of successful outcomes.
Questions for Discussion: When do you think that you might opt for a contralateral over an ipsilateral STG site? Has anyone seen a contralateral STG ACL reconstruction done clinically? What have your experiences been?
Written by: Nicole Cattano
Reviewed by: Jeffrey Driban
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