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Comparative Study
, 27 (2), 381-388

Increased Knee Laxity With Hamstring Tendon Autograft Compared to Patellar Tendon Autograft: A Cohort Study of 5462 Patients With Primary Anterior Cruciate Ligament Reconstruction

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Comparative Study

Increased Knee Laxity With Hamstring Tendon Autograft Compared to Patellar Tendon Autograft: A Cohort Study of 5462 Patients With Primary Anterior Cruciate Ligament Reconstruction

Riccardo Cristiani et al. Knee Surg Sports Traumatol Arthrosc.

Abstract

Purpose: To compare anterior knee laxity and patient-reported outcome measures (PROMs) between anterior cruciate ligament reconstruction (ACLR) performed with bone-patellar tendon-bone (BPTB) and hamstring tendon (HT) autografts and, moreover, to study any correlation between postoperative anterior knee laxity and PROMs.

Methods: Patients who underwent primary ACLR at Capio Artro Clinic, Stockholm, Sweden, from January 2000 to October 2015, were identified in our local database. Instrumented laxity measurements and PROMs were reviewed. The KT-1000 arthrometer, with an anterior tibial load of 134-N, was used to evaluate knee laxity preoperatively and at the 6-month follow-up. The Lysholm score was collected preoperatively and at 6 months postoperatively. The Knee injury and Osteoarthritis Outcome Score (KOOS) was collected preoperatively and at the 1-year follow-up.

Results: A total of 5462 primary ACLRs, 692 BPTBs and 4770 HT autografts were included in the study. All the patients showed a significant reduction in knee laxity from preoperatively to postoperatively (BPTB group: from 3.8 ± 2.6 to 1.2 ± 2.1 mm; HT group: from 3.6 ± 3.1 to 1.8 ± 2.2 mm; P < 0.001 for both). The HT group showed a significantly increased postoperative knee laxity compared with the BPTB group (1.8 ± 2.2 vs 1.2 ± 2.1 mm; P < 0.001). The mean anterior tibial translation (ATT) reduction from preoperative to postoperative was significantly larger for the BPTB graft compared with the HT graft (2.7 ± 2.2 vs 1.7 ± 2.6 mm; P < 0.001). A significantly higher rate of "surgical failures", defined as a postoperative side-to-side (STS) difference > 5 mm, was found in the HT group compared with the BPTB group at follow-up (4.3 vs 2.4%; P < 0.001). A significantly larger improvement was found in the HT group compared with the BPTB group for the KOOS Pain (9.5 vs 8.0; P = 0.02), Activities of Daily Living (7.2 vs 5.7; P = 0.006), Sports (24.2 vs 15.3; P < 0.001) and Quality of Life (25.8 vs 22.1; P = 0.001) subscales. No significant difference regarding the mean improvement in the Lysholm knee score was found between the two grafts (BPTB group: 14.5, HT group: 14.0; n.s.). No correlation between postoperative anterior knee laxity and PROMs was found in either graft group.

Conclusion: Primary ACLR performed with HT autograft resulted in greater postoperative anterior knee laxity and significantly more surgical failures (STS > 5 mm) compared with BPTB autograft. The BPTB autograft showed a larger anterior knee laxity reduction (ATT reduction) in conjunction with primary ACLR. The HT autograft led to a significantly larger improvement in four of five KOOS subscales from preoperatively to the 1-year follow-up, compared with BPTB autograft. There was no association between postoperative anterior knee laxity and PROMs for either graft. The findings of the present study provide clinicians with valuable information regarding differences in knee laxity and subjective knee function between BPTB and HT autograft after primary ACLR. The use of BPTB autograft should be considered for patients with high knee stability demands.

Level of evidence: Retrospective cohort study, Level III.

Keywords: ACL reconstruction; Anterior cruciate ligament; Graft; Hamstring; KOOS; Laxity; Lysholm; Outcome; Patellar tendon.

Conflict of interest statement

Conflict of Interest

Each author declares that no possible conflict of interest (financial or non-financial) exist in connection with this study.

Ethical approval

The study was approved by the Regional Ethics Committee, Karolinska Institutet, Diarie number: 2016/1613-31/2

Figures

Fig. 1
Fig. 1
Mean ± SD preoperative and postoperative side-to-side KT-1000 arthrometer measurements. A significantly greater laxity was found for the HT graft postoperatively. Covariates applied to the model are age, gender and meniscal injuries. STS side-to-side, BPTB bone–patellar-tendon–bone, HT hamstring tendons
Fig. 2
Fig. 2
Mean ± SD ATT reduction from preoperatively to postoperatively measured with the KT-1000 arthrometer. A significantly greater reduction was found for the BPTB graft. Covariates applied to the model are age, gender and meniscal injuries. ATT anterior tibial translation, BPTB bone–patellar tendon–bone, HT hamstring tendons
Fig. 3
Fig. 3
Knee injury and Osteoarthritis Outcome Score (KOOS) in each stratified side-to-side laxity group, for both grafts, at the 1-year follow-up. BPTB bone–patellar tendon–bone, HT hamstring tendons, ADL Activities of Daily Living, QOL Quality of Life
Fig. 4
Fig. 4
Lysholm score in each stratified side-to-side laxity group, for both grafts, at the 6-month follow-up. BPTB bone–patellar tendon–bone, HT hamstring tendons

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