Intrinsic Healing of a Patellar Tendon Donor Site Defect After Anterior Cruciate Ligament Reconstruction

Background Although there is a tendency toward gait normalization after anterior cruciate ligament reconstruction, altered moments about the knee flexion-extension axis have been reported. It is possible that these gait alterations relate to donor site morbidity associated with the graft harvest. Hypothesis There is a relationship between graft type and external knee moments during walking. Study Design Controlled laboratory study. Methods Three groups were compared: 17 patellar tendon anterior cruciate ligament reconstruction patients (mean, 11 months after surgery), 17 hamstring tendon anterior cruciate ligament reconstruction patients (mean, 9.3 months after surgery), and 17 matched controls. A 3-dimensional motion analysis and force plate system was used to determine sagittal plane kinematics and kinetics of the lower limb during comfortable-speed walking. Results There were significant differences in the moments about the knee that related to graft type. The external knee flexion moment at midstance was significantly smaller than that in the control knees in 65% of patients in the patellar tendon group and 29% of patients in the hamstring tendon group. In contrast, the external knee extension moment at terminal stance was significantly smaller than that in the control knees in 53% of subjects in the hamstring tendon group and 23% of subjects in the patellar tendon group. Conclusions There are graft-specific differences in knee biomechanics after anterior cruciate ligament reconstruction that appear to relate to the donor site. Clinical Relevance Considerable debate continues as to whether the patellar tendon or the hamstring tendon graft is preferable for anterior cruciate ligament reconstruction. It is therefore clinically relevant to understand the biomechanical differences in knee function associated with both graft types.

Download Full-text

Patellar Tendon or Semitendinosus Tendon Autografts for Anterior Cruciate Ligament Reconstruction?

The American Journal of Sports Medicine ◽

10.1177/03635465030310011401 ◽

2003 ◽

Vol 31 (1) ◽

pp. 19-25 ◽

Cited By ~ 276

Author(s):

Lars Ejerhed ◽

Jüri Kartus ◽

Ninni Sernert ◽

Kristina Köhler ◽

Jon Karlsson

Keyword(s):

Anterior Cruciate Ligament ◽

Anterior Cruciate Ligament Reconstruction ◽

Patellar Tendon ◽

Ligament Reconstruction ◽

Cruciate Ligament ◽

Donor Site ◽

Semitendinosus Tendon ◽

Cruciate Ligament Reconstruction ◽

Anterior Cruciate ◽

Bone Patellar Tendon

Background There are well-known problems with the use of bone-patellar tendon-bone autografts for anterior cruciate ligament reconstruction, especially in terms of donor site morbidity. Hamstring tendon grafts have been increasingly used as an alternative, but there are very few controlled studies comparing the methods. Hypothesis Use of semitendinosus tendon grafts will cause less donor site morbidity and result in better knee-walking ability. Study Design Prospective randomized clinical trial. Methods Seventy-one patients who had a unilateral anterior cruciate ligament rupture underwent arthroscopic reconstruction with interference screw fixation and use of either bone-patellar tendon-bone or semitendinosus tendon graft. Outcome assessment was performed by physiotherapists not involved in the patients' care. Results At the 2-year follow-up, no differences were found in terms of the Lysholm score, Tegner activity level, KT-1000 arthrometer side-to-side laxity measurement, single-legged hop test, or International Knee Documentation Committee classification results. The knee-walking test was rated difficult or impossible to perform by 53% of the bone-patellar tendon-bone group and by only 23% of the semitendinosus graft patients, a significant difference. Conclusions The semitendinosus tendon graft is at least an equivalent option to the bone-patellar tendon-bone graft for anterior cruciate ligament reconstruction, and we recommend its use.

Download Full-text