A randomized clinical trial comparing patellar tendon, hamstring tendon, and double-bundle ACL reconstructions: Patient-reported outcomes at a minimal 2-year follow up.
Mohtadi N, Chan D, Barker R, Paolucci EO. Clin J Sports Med. [Epub Ahead of Print]. 2014
Take Home Message: Three anterior cruciate ligament (ACL) reconstruction techniques yield similar patient-reported and objective outcomes for up to 2 years after surgery. The one exception was joint laxity, which was better among patients who received a patellar tendon autograft instead of one of two hamstring techniques.
Anterior cruciate ligament (ACL) surgery is often performed with the aim of restoring joint biomechanics and allowing an athlete to return to participation with no limitations. Despite numerous surgical techniques it remains debated if one approach is superior to another. Therefore, Mohtadi and colleagues completed a prospective, double-blind randomized control trial to compare the patient-reported outcomes of 3 anatomically positioned autograft options 2 years after surgery. A total of 330 (183 male, 139 female, 14-50 years of age) ACL-deficient patients met the inclusion/exclusion criteria. The authors randomized the patients to 1 of 3 treatment groups: patellar tendon, quadruple-stranded hamstring tendon, and double-stranded hamstring tendon. At baseline and 3 months, 6 months, 1 year, and 2 years post-surgery the patients underwent a comprehensive exam that included the ACL quality-of-life questionnaire, visual analogue scale for quality of life, KT-1000 arthrometer, pivot shift test, effusion (none/mild/moderate/severe), passive range of motion, IKDC scores, Tegner activity level, and single-leg hop. Overall, all groups improved significantly in quality of life scores from baseline to 2-year follow-up but there was no difference between groups. Patients who received the patellar tendon had less side-to-side differences in KT-1000 measurements (anterior tibial translation) than those who received either hamstring technique. All other outcomes were consistent among the 3 groups.
Overall, the authors found that outcomes were not different among the 3 surgical techniques with the exception of side-to-side differences in anterior translation, which favored the patellar tendon graft. This should be helpful to clinicians with regards to counseling patients who wish to return to high-level competition after surgery. These findings reinforce pervious literature, which has shown that bone-patellar tendon-bone grafts provided superior joint laxity results primarily due to the bone-to-bone fixation. Clinicians should also be cautious as the current study only followed patients for 2 years, which may be inadequate to completely understand the long-term effects of these techniques on a knee joint. Until more long-term studies can be completed clinicians should be aware of the current results and advise patients about the results over the first two years after surgery but also note that we don’t know how surgical technique may influence long-term outcomes.
Question for Discussion: Which graft type do you feel your patients have had the best outcomes with?
Written by: Kyle Harris
Reviewed by: Jeffrey Driban