Quality of life and clinical outcome comparison of semitendinosus and gracilis tendon versus patellar tendon autografts for anterior cruciate ligament reconstruction: an 11-year follow-up of a randomized controlled trial

Am J Sports Med. 2011 Oct;39(10):2161-9. doi: 10.1177/0363546511411702. Epub 2011 Jun 28.


Background: There are still controversies about graft selection for primary anterior cruciate ligament reconstruction. Prospective, randomized long-term studies are needed to determine the differences between the graft materials.

Hypothesis: Eleven years after anterior cruciate ligament reconstruction there is no difference in functional outcome and quality of life between patients with patellar tendon or hamstring tendon autografts; however, the patients with patellar tendon autograft would have a higher prevalence of osteoarthritis.

Study design: Randomized controlled trial; Level of evidence, 2.

Methods: From June 1999 to March 2000, 64 patients were included in this prospective study. A single surgeon performed primary arthroscopically assisted anterior cruciate ligament reconstruction in an alternating sequence. In 32 patients, anterior cruciate ligament reconstruction was performed with hamstring tendon autograft (semitendinosus and gracilis [STG] group) while in the other 32 patients the reconstruction was performed with patellar tendon autograft (PT group).

Results: At the 11-year follow-up, no statistically significant differences were seen with respect to the Lysholm score and Short Form-36, KT-1000 arthrometer laxity testing, anterior knee pain, single-legged hop test, or International Knee Documentation Committee (IKDC) classification results. Positive pivot-shift test (1+) was significantly more frequent in the PT group (P = .036). Twenty-two patients (81%) in the STG group and 18 patients (72%) in the PT group were still at their preinjury level of activity. Graft rupture occurred in 2 patients from the STG group (6%) and in 4 patients from the PT (12%). Grade B and C abnormal radiographic findings were seen in 84% (21 of 25) of patients in the PT group and in 63% (17 of 27) of patients in the STG group (P = .008).

Conclusion: Both hamstring and patellar tendon autografts provided good subjective outcomes and objective stability at 11 years. Positive pivot-shift test (1+) was significantly more frequent in the PT group. No significant differences in the rate of graft failure were identified. Patients with patellar tendon graft had a greater prevalence of osteoarthritis at 11 years after surgery.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Anterior Cruciate Ligament Reconstruction / adverse effects
  • Anterior Cruciate Ligament Reconstruction / methods*
  • Arthroscopy / methods
  • Female
  • Follow-Up Studies
  • Humans
  • Joint Instability / diagnostic imaging
  • Joint Instability / surgery
  • Knee Injuries / complications
  • Knee Injuries / diagnostic imaging
  • Knee Injuries / surgery
  • Male
  • Middle Aged
  • Osteoarthritis / epidemiology
  • Osteoarthritis / etiology
  • Quality of Life*
  • Radiography
  • Rupture / diagnostic imaging
  • Rupture / surgery
  • Tendons / diagnostic imaging
  • Tendons / transplantation*
  • Transplantation, Autologous
  • Treatment Outcome