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Anterior cruciate ligament reconstruction (transtibial hamstring versus anatomical patellar tendon technique). A 2 year follow-up study.
Author(s):
Huurman Suzanne (Netherlands)
,
Huurman Suzanne (Netherlands)
Affiliations:
van Grinsven Susan
,
van Grinsven Susan
Affiliations:
Kok D.
,
Kok D.
Affiliations:
van Loon C.
van Loon C.
Affiliations:
ESSKA Academy. HUURMAN S. May 9, 2018; 209463; P06-1550 Topic: Arthroscopic Surgery
Dr. Suzanne HUURMAN
Dr. Suzanne HUURMAN
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Abstract
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Objectives: In spite of all the publications about anterior cruciate ligament reconstruction (ACLR), the graft choice is still controversial. Anterior cruciate ligament (ACL) injury is a serious knee injury that often prevents young and active people to perform heavy physical work or to engage in sport at recreational or elite level without satisfactory treatment. The incidence rate of ACL injury per 100,000 person-years is 80, whereof 50-60% of are treated with ACLR surgery. Because the mean age at primary ACLR is young, the highest direct and indirect medical cost of sport injuries are found after ACL injury. ALCR is, however, considered a cost-effective knee stabilizing treatment.
In terms of graft choice for ACLR there has been a shift from patellar tendon to hamstring tendon usage over the past few years because of donor site morbidity issues such as anterior knee pain and extension deficits. However, the use of hamstring tendon grafts in ACLR seem associated with an increased risk of revision compared to patellar tendon grafts, in particular during the first year after surgery. This high re-rupture rate was also noticed at our centre. For this reason, some of our orthopaedic surgeons switched from quadruple-strand semitendinosus/gracilis tendon (4SGT) ACLR to iso-anatomical bone-patellar tendon-bone single-bundle (PT) ACLR.
The purpose of this study was to evaluate differences in objective and subjective outcomes after PT or 4GST ACLR. We hypothesised that there would be no differences in outcome at a minimum of 2-year follow-up.

Methods: Ultimately, 47 patients with a PT and 36 with a 4GST ACLR completed a questionnaire (patients' characteristics, International-Knee-Documentation-Committee-subjective-score (IKDC), Visual-Analogue-Scale (VAS-pain and VAS-satisfaction), Tegner-activity-scale, 12-Item-Short-Form-Health-Survey (MCS -12 and PCS-12)) and were included in this study. 69 patients also visited our hospital for a physical examination (range-of-motion (ROM), Lachman-test, anterior-drawer-test, pivot-shift-test, hop-test-battery). Differences in outcome were calculated with the Pearson-chi-squared-test, Fischer's-exact-test, unpaired-t-test or Mann-Whitney-U-test. The significance level was set at P<0.05.

Results: Although there was more injury (p=0.045) and more concomitant repair (p=0.001) in the PT-group, these patients ultimately achieved a significant higher sports level (p=0.044) and reported a significant superior state (p=0.012) of mental health (MCS-12 score). Patients who's ACLR re-ruptured had significant lower function scores (IKDC: p=0.036, Tegner-activity-scale: p=0.005, PCS-12: p=0.025) and were less satisfied (p=0.019).

Conclusions: As hypothesized we were not able to find differences in the vast majority of the reported primary and secondary outcomes. Both surgical techniques provide good patient outcomes. The results of our study indicate, however, that a PT-ACLR should be considered if a good mental state and a high sports activity level are major patient goals.

Keywords:
anterior cruciate ligament (ACL); reconstruction; patellar tendon; hamstring tendon; subjective outcome
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