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The Journal of Bone and Joint Surgery (American) 84:1503-1513 (2002)
© 2002 The Journal of Bone and Joint Surgery, Inc.

Scientific Article

Anterior Cruciate Ligament Replacement: Comparison of Bone-Patellar Tendon-Bone Grafts with Two-Strand Hamstring Grafts

A Prospective, Randomized Study

Bruce D. Beynnon, PhD, Robert J. Johnson, MD, Braden C. Fleming, PhD, Pekka Kannus, MD, PhD, Michael Kaplan, MD, John Samani, MD and Per Renström, MD, PhD

Investigation performed at the Department of Orthopaedics and Rehabilitation, University of Vermont, McClure Musculoskeletal Research Center, Burlington, Vermont

Bruce D. Beynnon, PhD
Robert J. Johnson, MD
Braden C. Fleming, PhD
Department of Orthopaedics and Rehabilitation, University of Vermont, McClure Musculoskeletal Research Center, Burlington, VT 05405-0084. E-mail address for B.D. Beynnon: bruce.beynnon{at}uvm.edu

Pekka Kannus, MD, PhD
Department of Surgery, Tampere University Medical School and University Hospital, FIN-33500 Tampere, Finland
Michael Kaplan, MD
Active Orthopaedics, 1201 West Main Street, Waterbury, CT 06708

John Samani, MD
Michigan Knee and Shoulder Institute, 3252 University Drive, Suite 140, Auburn Hills, MI 48326

Per Renström, MD, PhD
Section of Sports Medicine, Department of Orthopedics, Karolinska Hospital, S-171 76, Stockholm, Sweden

In support of their research or preparation of this manuscript, one or more of the authors received grants or outside funding from the Orthopaedic Research and Education Foundation. None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

A video supplement to this article is available from the Video Journal of Orthopaedics. A video clip is available at the JBJS web site, www.jbjs.org. The Video Journal of Orthopaedics can be contacted at (805) 962-3410, web site: www.vjortho.com.

Background: The purpose of this investigation was to evaluate replacement of a torn anterior cruciate ligament with either a bone-patellar tendon-bone autograft or a two-strand semitendinosus-gracilis autograft to compare the results of clinical testing, patient satisfaction, activity level, functional status, and muscle strength.

Methods: Fifty-six patients with a torn anterior cruciate ligament were enrolled in a prospective, randomized, controlled study. Twenty-eight underwent reconstruction with a bone-patellar tendon-bone autograft, and twenty-eight were treated with a two-strand semitendinosus-gracilis autograft. Patients were followed for an average of thirty-nine months (range, thirty-six to fifty-seven months). At the time of final follow-up, twenty-two patients in each group were evaluated in terms of clinical test findings, patient satisfaction, activity level, functional status, and isokinetic muscle strength.

Results: The objective outcome of replacement of the torn anterior cruciate ligament with a bone-patellar tendon-bone graft was superior to that obtained with a two-strand semitendinosus-gracilis graft. At the three-year follow-up interval, the patients in whom a hamstring graft had been used had an average of 4.4 mm of increased anterior knee laxity compared with the laxity of the contralateral, normal knee, whereas the patients in whom a bone-patellar tendon-bone graft had been used had an average of 1.1 mm of increased knee laxity. Fourteen percent (three) of the twenty-two patients with a hamstring graft had a mild pivot shift, and 27% (six) had a moderate pivot shift. Only 14% (three) of the twenty-two patients with a bone-patellar tendon-bone graft had a mild pivot shift, and none had a moderate pivot shift. At the same follow-up interval, the patients in whom a hamstring graft had been used had significantly lower peak knee-flexion strength than those who had a bone-patellar tendon-bone graft (p = 0.039). In contrast, the two treatments produced similar outcomes in terms of patient satisfaction, activity level, and knee function (ability to perform a one-legged hop, bear weight, squat, climb stairs, run in place, and duckwalk).

Conclusions: After three years of follow-up, the objective results of anterior cruciate ligament replacement with a bone-patellar tendon-bone autograft were superior to those of replacement with a two-strand semitendinosus-gracilis graft with regard to knee laxity, pivot-shift grade, and strength of the knee flexor muscles. However, the two groups had comparable results in terms of patient satisfaction, activity level, and knee function.


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Letters to the Editor:

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Longer term results May be more Significant
Chatenya Chauhan
JBJS Online, 5 Sep 2002 [Full text]