Quality of life and clinical outcome comparison of semitendinosus and gracilis tendon versus patellar tendon autografts for anterior cruciate ligament reconstruction: An 11-year follow-up of a randomized controlled trial

Sajovic M, Strahovnik A, Dernovsek MZ, Skaza K. Am J Sports Med. 2011 Oct;39(10):2161-9.

The goals of anterior cruciate ligament (ACL) reconstruction surgery are to decrease symptoms, increase function, and to return to pre-injury activity status.  There are numerous techniques and grafts utilized for ACL reconstruction, including autografts or allografts.  Autografts are frequently selected, and can consist of patellar tendon (PT) or semitendinosus and gracilis (STG) tendons.  Currently, there is no consensus as to which graft is the best option for optimal outcomes.  Therefore, this group conducted a prospective, randomized controlled trial to compare the surgical outcomes of PT and STG autografts among 64 patients (32 receiving each graft).  In this article the authors report the 11-year follow-up data for 52 patients that were available for evaluation (27 patients with STG autograft and 25 patients with PT autograft). During the follow-up visit, patients were assessed on multiple outcome and quality of life measures.  Outcomes included the Lysholm knee (patient-reported knee evaluation), Short Form-36 (general health questionnaire), and International Knee Documentation Committee (IKDC) scores (clinician-reported functional outcome), as well as single-legged hop test.  Clinical measures included a Lachman’s, anterior drawer, pivot shift, and KT-1000 tests, as well as radiographs.  There were no significant differences between the PT and STG groups in graft ruptures, number of patients participating at their preinjury level of activity, Lysholm, Short Form-36, IKDC, single-legged hop test, Lachman’s, or KT-1000 scores.  The PT group had significantly greater positive pivot shift tests, as well as a possibly greater incidence of osteoarthritis on radiograph (84% versus 63% with knee osteoarthritis).

As clinicians, this study demonstrates that ACL reconstruction utilizing either the PT or STG has comparable and favorable patient outcomes in function and quality of life.  Each choice has negative consequences (e.g., tendinitis, weakness) but with similar outcomes.  Functional demands of patients should be taken into consideration when making this decision.  It is also important to note that a large number of knees in both groups had osteoarthritis, despite no apparent link to poorer quality of life or function.  It will take a larger sample size to determine if knees with PT grafts are at a greater risk for osteoarthritis compared to knees with STG grafts.  Future studies should also assess biomechanics and joint biochemistry to determine how these factors influence the risk of osteoarthritis with both graft types.  This study provides additional evidence that knee injuries place the joint at an increased risk for developing osteoarthritis.  What are your clinical experiences with the long-term performance of different ACL grafts?

Written by: Nicole Cattano
Reviewed by: Jeffrey Driban

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Sajovic M, Strahovnik A, Dernovsek MZ, & Skaza K (2011). Quality of Life and Clinical Outcome Comparison of Semitendinosus and Gracilis Tendon Versus Patellar Tendon Autografts for Anterior Cruciate Ligament Reconstruction: An 11-Year Follow-up of a Randomized Controlled Trial. The American Journal of Sports Medicine, 39 (10), 2161-9 PMID: 21712483