Comparison
of Hamstring Tendon and Patellar Tendon Grafts in Anterior Cruciate Ligament
Reconstruction in a Nationwide Population-Based Cohort Study: Results From the
Danish Registry of Knee Ligament Reconstruction
of Hamstring Tendon and Patellar Tendon Grafts in Anterior Cruciate Ligament
Reconstruction in a Nationwide Population-Based Cohort Study: Results From the
Danish Registry of Knee Ligament Reconstruction
Rahr-Wagner L, Thillemann TM, Pederson
AB, & Lind M. American Journal of
Sports Medicine. 2014 42: 278 doi:10.1177/0363546513509220
AB, & Lind M. American Journal of
Sports Medicine. 2014 42: 278 doi:10.1177/0363546513509220
Increased Risk of Revision With
Hamstring Tendon Grafts Compared With Patellar Tendon Grafts After Anterior
Cruciate Ligament Reconstruction: A Study of 12,643 Patients From the Norwegian
Cruciate Ligament Registry, 2004-2012
Hamstring Tendon Grafts Compared With Patellar Tendon Grafts After Anterior
Cruciate Ligament Reconstruction: A Study of 12,643 Patients From the Norwegian
Cruciate Ligament Registry, 2004-2012
Persson
A, Fjeldsgaard K, Gjertsen JE, Kjellsen AB, Engebretsen L, Hole RM, &
Fevang JM. American Journal of Sports Medicine.
2014 42:285 doi:10.1177/0363546513511419
A, Fjeldsgaard K, Gjertsen JE, Kjellsen AB, Engebretsen L, Hole RM, &
Fevang JM. American Journal of Sports Medicine.
2014 42:285 doi:10.1177/0363546513511419
Take Home Message: The risk of anterior cruciate
ligament (ACL) revision is relatively low after an autograft
reconstruction. Revision rates may be
slightly lower for patellar autografts compared with hamstring autografts.
ligament (ACL) revision is relatively low after an autograft
reconstruction. Revision rates may be
slightly lower for patellar autografts compared with hamstring autografts.
There has been little consensus
amongst healthcare professionals regarding ACL graft selection. While some physicians favor the autograft,
debates still remain about whether a hamstring (HT) or patellar tendon (PT)
autograft yields better results. The
purpose of these two studies was to investigate the revision rates between
these two grafts. Rahr-Wagner and
colleagues explored the Danish Knee Ligament Reconstruction Registry (13,647
primary ACL reconstructions, 2005-2011) while Persson and colleagues used the
Norwegian Knee Ligament Registry (12,643 primary ACL reconstructions,
2004-2012). In both studies, the HT autograft was more commonly selected for
ACL reconstruction. Also, in both
studies, an individual with a HT graft had a greater risk of revision surgery in
comparison with a PT graft. The Danish
study revealed that the revision rates at 1 year were 0.7% (HT) and 0.2% (PT)
and at 5 years were 4.5% (HT) compared with 3.0% (PT). The Norwegian study findings were similar
with revision rates at 1 year being 1.1% (HT) and 0.3% (PT) and at 5 years were
5.1% (HT) compared to 2.1% (PT). While
both studies analyzed information on age at time of surgery, only the Norwegian
study reported that risk of revision was increased the younger a person was at
the time of surgery.
amongst healthcare professionals regarding ACL graft selection. While some physicians favor the autograft,
debates still remain about whether a hamstring (HT) or patellar tendon (PT)
autograft yields better results. The
purpose of these two studies was to investigate the revision rates between
these two grafts. Rahr-Wagner and
colleagues explored the Danish Knee Ligament Reconstruction Registry (13,647
primary ACL reconstructions, 2005-2011) while Persson and colleagues used the
Norwegian Knee Ligament Registry (12,643 primary ACL reconstructions,
2004-2012). In both studies, the HT autograft was more commonly selected for
ACL reconstruction. Also, in both
studies, an individual with a HT graft had a greater risk of revision surgery in
comparison with a PT graft. The Danish
study revealed that the revision rates at 1 year were 0.7% (HT) and 0.2% (PT)
and at 5 years were 4.5% (HT) compared with 3.0% (PT). The Norwegian study findings were similar
with revision rates at 1 year being 1.1% (HT) and 0.3% (PT) and at 5 years were
5.1% (HT) compared to 2.1% (PT). While
both studies analyzed information on age at time of surgery, only the Norwegian
study reported that risk of revision was increased the younger a person was at
the time of surgery.
Overall, the risk of revision was low
for both grafts, with new trauma being the primary reason for revision. It appears that a PT autograft has a lower
risk of revision than a HT autograft.
However, we should interpret these results with caution. Previous literature has sometimes indicated
that PT autograft may increase the risk of contralateral ACL tear. Related Sports Med Res posts (see below) have
discussed studies that demonstrated patients who receive PT autografts have
poor outcomes with some clinical measures; such as, the pivot-shift,
radiographic changes, and functional outcome scores. In contrast, other studies
showed that patients with HT autografts have higher risk of infection or no
differences at all. Both studies
reported that surgeons are increasingly using the HT autograft. Based on the mixed outcomes in many research
studies, we may need to individualize graft selection based on patient’s
needs. It may be beneficial if future
research explored which patients respond best to certain graft choices. We may
need to consider comorbidity (for example, obesity, occupation, activity) when
discussing graft selection with our patients. As we talk with our patients
about graft selection these studies may help us reassure patients that both
graft types have low failure rates and that the increased risk among PT
autografts is small.
for both grafts, with new trauma being the primary reason for revision. It appears that a PT autograft has a lower
risk of revision than a HT autograft.
However, we should interpret these results with caution. Previous literature has sometimes indicated
that PT autograft may increase the risk of contralateral ACL tear. Related Sports Med Res posts (see below) have
discussed studies that demonstrated patients who receive PT autografts have
poor outcomes with some clinical measures; such as, the pivot-shift,
radiographic changes, and functional outcome scores. In contrast, other studies
showed that patients with HT autografts have higher risk of infection or no
differences at all. Both studies
reported that surgeons are increasingly using the HT autograft. Based on the mixed outcomes in many research
studies, we may need to individualize graft selection based on patient’s
needs. It may be beneficial if future
research explored which patients respond best to certain graft choices. We may
need to consider comorbidity (for example, obesity, occupation, activity) when
discussing graft selection with our patients. As we talk with our patients
about graft selection these studies may help us reassure patients that both
graft types have low failure rates and that the increased risk among PT
autografts is small.
Questions for Discussion: What
autografts are you seeing used? What
things do you take into consideration when discussing autograft selection with
a patient?
autografts are you seeing used? What
things do you take into consideration when discussing autograft selection with
a patient?
Written
by: Nicole Cattano
by: Nicole Cattano
Reviewed
by: Jeffrey Driban
by: Jeffrey Driban
Related Posts:
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Rahr-Wagner, L., Thillemann, T., Pedersen, A., & Lind, M. (2013). Comparison of Hamstring Tendon and Patellar Tendon Grafts in Anterior Cruciate Ligament Reconstruction in a Nationwide Population-Based Cohort Study: Results From the Danish Registry of Knee Ligament Reconstruction The American Journal of Sports Medicine, 42 (2), 278-284 DOI: 10.1177/0363546513509220
Persson, A., Fjeldsgaard, K., Gjertsen, J., Kjellsen, A., Engebretsen, L., Hole, R., & Fevang, J. (2013). Increased Risk of Revision With Hamstring Tendon Grafts Compared With Patellar Tendon Grafts After Anterior Cruciate Ligament Reconstruction: A Study of 12,643 Patients From the Norwegian Cruciate Ligament Registry, 2004-2012 The American Journal of Sports Medicine, 42 (2), 285-291 DOI: 10.1177/0363546513511419