Versus Contralateral Hamstring Grafts in Anterior Cruciate Ligament

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?
by: Nicole Cattano
by: Jeffrey Driban

Related Posts:

Patellar Tendon versus Hamstring Autografts: 15 Years After Reconstruction

McRae S, Leiter J, McCormack R, Old J, & Macdonald P (2013). Ipsilateral Versus Contralateral Hamstring Grafts in Anterior Cruciate Ligament Reconstruction: A Prospective Randomized Trial. The American Journal of Sports Medicine PMID: 24001575