scholarly journals Comparison of the outcomes of anterior cruciate ligament reconstruction by using patellar tendon or hamstring tendon autografts that have been fixed with cross-pin system at femoral side

Author(s):  
Omer UNAL ◽  
Ülkü SUR ◽  
Mirza Zafer DAĞTAŞ ◽  
Burak DEMİRAĞ
2003 ◽  
Vol 31 (4) ◽  
pp. 564-573 ◽  
Author(s):  
Julian A. Feller ◽  
Kate E. Webster

Background Patellar and hamstring tendon autografts are the most frequently used graft types for anterior cruciate ligament reconstruction, but few direct comparisons of outcomes have been published. Hypothesis There is no difference in outcome between the two types of reconstruction. Study Design Prospective randomized clinical trial. Methods After isolated anterior cruciate ligament rupture, 65 patients were randomized to receive either a patellar tendon or a four-strand hamstring tendon graft reconstruction, and results were reviewed at 4, 8, 12, 24, and 36 months. Results Pain on kneeling was more common and extension deficits were greater in the patellar tendon group. There were greater quadriceps peak torque deficits in the patellar tendon group at 4 and 8 months but not thereafter. In the hamstring tendon group, active flexion deficits were greater from 8 to 24 months, and KT-1000 arthrometer side-to-side differences in anterior knee laxity at 134 N were greater. Cincinnati knee scores, International Knee Documentation Committee ratings, and rates of return to preinjury activity levels were not significantly different between the two groups. Conclusions Both grafts resulted in satisfactory functional outcomes but with increased morbidity in the patellar tendon group and increased knee laxity and radiographic femoral tunnel widening in the hamstring tendon group.


2005 ◽  
Vol 33 (2) ◽  
pp. 247-254 ◽  
Author(s):  
Kate E. Webster ◽  
Joanne E. Wittwer ◽  
Jason O'Brien ◽  
Julian A. Feller

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.


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