Bone-patellar tendon-bone autograft could be recommended as a superior graft to hamstring autograft for ACL reconstruction in patients with generalized joint laxity: 2- and 5-year follow-up study

Knee Surg Sports Traumatol Arthrosc. 2018 Sep;26(9):2568-2579. doi: 10.1007/s00167-018-4881-y. Epub 2018 Mar 3.


Purpose: The present study aimed to compare 2- and 5-year outcomes of ACL reconstruction between patients with and without generalized joint laxity and to perform comparative evaluation between two types of grafts used for ACL reconstruction in patients with generalized joint laxity.

Methods: Two hundred and thirty-seven patients who underwent ACL reconstruction from 2001 to 2008 were included. Patients were classified into two groups according to the presence or the absence of generalized joint laxity, and further subdivided into two subgroups based on the type of graft used: bone-patellar tendon-bone (BPTB) or hamstring. Generalized joint laxity was assessed with the Beighton and Horan criteria using a point scoring system. Stability reflected by the Lachman test, pivot-shift test, and anterior translation measured with KT-2000, and functional outcomes reflected by Lysholm knee score, and International Knee Documentation Committee (IKDC) subjective score were investigated. IKDC objective grade and radiographic grade were also assessed. Clinical assessments were conducted preoperatively and at 2 and 5 years after operation.

Results: Two-year follow-up results showed that patients with generalized joint laxity receiving hamstring grafts had poorer outcomes than those without generalized joint laxity. Five-year follow-up results showed that patients with generalized joint laxity experienced poorer outcomes than patients without generalized joint laxity, irrespective of the type of graft. Comparison of grafts used showed that, in patients with generalized joint laxity, BPTB graft provided significantly better stability and functional outcomes than hamstring graft at both 2- and 5-year follow-ups. Comparisons between serial outcomes measured at 2 and 5 years demonstrated that stability and functional outcomes deteriorated over time in patients with generalized joint laxity.

Conclusions: Less satisfactory stability and functional outcomes were noted in patients with generalized joint laxity, compared to patients without generalized joint laxity. Comparisons of stability and functional outcomes after ACL reconstruction in patients with generalized joint laxity between two different grafts demonstrated that BPTB graft achieves better results than hamstring graft.

Level of evidence: III, a retrospective cohort study.

Keywords: Anterior cruciate ligament reconstruction; Bone–patellar tendon–bone; Generalized joint laxity; Graft; Hamstring; Risk factor.

Publication types

  • Comparative Study

MeSH terms

  • Anterior Cruciate Ligament / surgery
  • Anterior Cruciate Ligament Injuries / complications*
  • Anterior Cruciate Ligament Injuries / surgery
  • Anterior Cruciate Ligament Reconstruction / methods
  • Autografts
  • Bone Transplantation
  • Bone-Patellar Tendon-Bone Grafting / statistics & numerical data*
  • Follow-Up Studies
  • Hamstring Muscles / transplantation*
  • Humans
  • Joint Instability / complications*
  • Knee / surgery
  • Knee Joint / surgery
  • Lysholm Knee Score
  • Patellar Ligament / surgery
  • Retrospective Studies
  • Tendons / transplantation
  • Transplantation, Autologous
  • Treatment Outcome