reconstructions: Patient-reported outcomes at a minimal 2-year follow up.
Chan D, Barker R, Paolucci EO. Clin J
Sports Med. [Epub Ahead of Print]. 2014
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.
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.
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.
for Discussion: Which graft type do you
feel your patients have had the best outcomes with?
Mohtadi, N., Chan, D., Barber, R., & Oddone Paolucci, E. (2014). A Randomized Clinical Trial Comparing Patellar Tendon, Hamstring Tendon, and Double-Bundle ACL Reconstructions Clinical Journal of Sport Medicine DOI: 10.1097/JSM.0000000000000165