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

A Prospective, Randomized Study

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

The Journal of Bone & Joint Surgery: September 2002 - Volume 84 - Issue 9 - p 1503-1513
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Supplementary Content

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.

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@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

Copyright © 2002 by The Journal of Bone and Joint Surgery, Incorporated
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