Objective: Graft choices for athletes undergoing anterior cruciate ligament reconstruction (ACLR) include bone-patellar tendon-bone (BPTB) and hamstring tendon (HT) autografts and soft tissue allografts. The objective was to assess time to meet clinical milestones by graft type in athletes who completed a return-to-sport (RTS) program after ACLR.
Design: Retrospective cohort study.
Methods: Seventy-nine athletes enrolled after ACLR (allograft, n = 18; BPTB, n = 24; HT, n = 37). Time from surgery to meet (1) enrollment criteria (12 or more weeks post surgery, 80% or greater isometric quadriceps strength index, minimal effusion, and full knee range of motion), and (2) RTS criteria (90% or greater quadriceps strength index, hop testing limb symmetry, and patient-reported outcomes) was calculated. Quadriceps strength, hop performance, and patient-reported outcomes were measured before and after training, and at 1 year post surgery. Descriptive statistics, chi-square tests, and 1-way analyses of variance (α = .05) were used to analyze differences among graft types.
Results: On average, the BPTB group (28.5 ± 7.6 weeks) took longer to meet enrollment milestones than the HT (22.5 ± 7.6 weeks, P = .007) and allograft (18.9 ± 5.8 weeks, P<.001) groups. The BPTB group (44.7 ± 15.8 weeks) took longer from surgery to meet RTS criteria than the HT (32.5 ± 9.9 weeks, P = .001) and allograft (29.3 ± 9.0 weeks, P<.001) groups. After training, the quadriceps strength index was lower in the BPTB group (86.1% ± 11.4%) than it was in the HT (96.1% ± 12.9%, P = .004) and allograft (96.9% ± 5.9%, P = .009) groups.
Conclusion: Athletes with a BPTB autograft may take longer than athletes with an HT autograft or a soft tissue allograft to complete postoperative rehabilitation, recover quadriceps strength, and meet RTS criteria. J Orthop Sports Phys Ther 2020;50(5):259-266. Epub 27 Nov 2019. doi:10.2519/jospt.2020.9111.
Keywords: ACL reconstruction; knee; outcome measures; rehabilitation; return to sport.