Comparative study between bone patellar tendon bone and quadrupled hamstring autografts in arthroscopic anterior cruciate ligament reconstruction with aperture fixation

Authors

  • Dilip S. Shaktawat Department of Orthopaedics, Military Hospital Kirkee, Pune, Maharashtra, India
  • Anil Kumar Mishra Department of Orthopaedics, Military Hospital Kirkee, Pune, Maharashtra, India
  • Manoj R. Kashid Department of Orthopaedics, Military Hospital Kirkee, Pune, Maharashtra, India
  • Amit Chaudhry Department of Orthopaedics, Military Hospital Kirkee, Pune, Maharashtra, India
  • Rajshekhar . Department of Orthopaedics, Military Hospital Kirkee, Pune, Maharashtra, India
  • Abin Stanely Department of Orthopaedics, Military Hospital Kirkee, Pune, Maharashtra, India

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20170091

Keywords:

Hamstring autograft (HT), Bone patellar tendon bone graft (BPTB), ACL reconstruction

Abstract

Background: Bone patellar tendon bone (BPTB) and hamstring (HT) auto grafts have been used routinely in reconstruction of ACL over past two decades. Controversy still remains as to which graft is superior over other. Many studies have compared these graft options using different implants and different methods of fixation. Continuation of efforts in the same direction; purpose of the study is to compare these two graft options utilizing identical implants and similar method of fixation.

Methods: 40 patients of clinically and radiologically diagnosed ACL tear fulfilling the inclusion and exclusion criteria were randomized into two groups to undergo arthroscopic ACL reconstruction using quadrupled hamstring graft (n=20) and bone patellar tendon bone auto graft (n=20) utilizing bioscrew by aperture fixation method in both the groups. They were compared post operatively for symptomatic improvement, clinical and rolimeter laxity tests and Lysholm functional knee scoring at 02 year.

Results: At the end of 02 years laxity measurement by rolimeter showed slightly better results in BPTB group; however it was not statistically significant (p value= 0.362). Knee pain at the end of 02 year was slightly more in HT groups (45%) as compared to BPTB group (35%) but not significant (p value =0.748). Instability symptoms are comparable in both the groups (sense of giving away on exertion). Manual laxity testing by Lachman and Pivot shift tests were comparable in both the groups with p value of 0.695 and 0.999 respectively. Lysholm functional knee score also showed no statistical significance (p value =0.957).

Conclusions: There is no significant difference between HT and BPTB auto grafts in terms of clinical and functional outcome at the end of 02 years. 

Author Biography

Dilip S. Shaktawat, Department of Orthopaedics, Military Hospital Kirkee, Pune, Maharashtra, India

Dept of Orthopaedics

Major

References

Bartlett R, Clatworthy M, Nguyen T. Graft selection in reconstruction of the anterior cruciate ligament. J Bone Joint Surg Br. 2001;83:625-34.

Frank CB, Jackson DW. The science of re-construction of the anterior cruciate ligament. J Bone Joint Surg Am. 1997;79:1556-76.

O’Neill DB. Arthroscopically assisted re-construction of the anterior cruciate ligament: a follow-up report. J Bone Joint Surg Am. 2001;83:1329-32.

Shelbourne KD, Gray T. Anterior cruciate ligament reconstruction with autogenous patellar tendon graft followed by accelerated rehabilitation: a two- to nine-year followup. Am J Sports Med. 1997;25:786-95.

Yunes M, Richmond JC, Engels EA, Pinczewski LA. Patellar versus hamstring tendons in anterior cruciate ligament reconstruction: a meta-analysis. Arthroscopy. 2001;17:248-57.

Brown CH Jr, Steiner ME, Carson EW. The use of hamstring tendons for anterior cruciate ligament reconstruction: technique and results. Clin Sports Med. 1993;12:723-56.

Aune AK, Holm I, Risberg MA, Jensen HK, Steen H. Four-strand hamstring tendon autograft compared with patellar tendon–bone autograft for anterior cruciate ligament reconstruction: a randomized study with two-year follow-up. Am J Sports Med. 2001;29:722-8.

Beard DJ, Anderson JL, Davies S, Price AJ, Dodd CA. Hamstrings vs. patella tendon for anterior cruciate ligament reconstruction: a randomized controlled trial. Knee. 2001;8:45-50.

Beynnon BD, Johnson RJ, Fleming BC, Kannus P, Kaplan M, Samani J, et al. Anterior cruciate ligament replacement: comparison of bone–patellar tendon–bone grafts with two-strand hamstring grafts: a prospective, randomized study. J Bone Joint Surg Am. 2002;84:1503-13.

Ejerhed L, Kartus J, Sernert N, Kohler K, Karlsson J. Patellar tendon or semitendinosus tendon autografts for anterior cruciate ligament reconstruction? A prospective randomized study with a two-year follow- up. Am J Sports Med. 2003;31:19-25.

Feller JA, Webster KE. A randomized comparison of patellar tendon and hamstring tendon anterior cruciate ligament reconstruction. Am J Sports Med. 2003;31:564-73.

Brand J, Weiler A, Caborn DN, Brown CH Jr, Johnson DL. Graft fixation in cruciate ligament surgery: current concepts. Am J Sports Med. 2000;28:761-74.

Gulotta LV, Rodeo SA. Biology of autograft and allograft healing in anterior cruciate ligament reconstruction. Clin Sports Med. 2007;26:509-24.

Tomita F, Yasuda K, Mikami S, Sakai T, Yamazaki S, Tohyama H. Comparisons of intraosseous graft healing between the doubled flexor tendon graft and the bone-patellar tendonbone graft in anterior cruciate ligament reconstruction. Arthroscopy. 2001;17:461-76.

Park MJ, Lee MC, Seong SC. A comparative study of the healing of tendon autograft and tendon-bone autograft using patellar tendon in rabbits. Int Orthop. 2001;25:35-9.

L'Insalata JC, Klatt B, Fu FH, Harner CD. Tunnel expansion following anterior cruciate ligament reconstruction: a comparison of hamstring and patellar tendon autografts. Knee Surg Sports Traumatol Arthrosc. 1997;5:234-8.

Fauno P, Kaalund S. Tunnel widening after hamstring anterior cruciate ligament reconstruction is influenced by the type of graft fixation used: a prospective randomized study. Arthroscopy. 2005;21:1337-41.

Landes S, Nyland J, Elmlinger B, Tillett E, Caborn D. Knee flexor strength after ACL reconstruction: comparison between hamstring autograft, tibialis anterior allograft, and non-injured controls. Knee Surg Sports Traumatol Arthrosc. 2010;18:317-24.

Corry IS, Webb JM, Clingeleffer AJ, Pinczewski LA. Arthroscopic reconstruction of the anterior cruciate ligament: a comparison of patellar tendon autograft and four-strand hamstring tendon autograft. Am J Sports Med. 1999;27:444-54.

Downloads

Published

2017-02-22

Issue

Section

Original Research Articles