Contralateral hamstring graft offers quality of life scores comparable to ipsilateral graft for ACL reconstruction

Issue: May 2011

SAN FRANCISCO — A level 1 study revealed no significant differences in quality of life scores during 2-year follow-up and immediate postoperative pain comparing contralateral hamstring autograft with ipsilateral autograft for ACL reconstructions.

Jeff Leiter, MSc, PhD, shared his group’s findings at the 2011 Annual Meeting of the Arthroscopy Association of North America.

The investigators also found that contralateral graft harvest could potentially normalize the hamstrings/quadriceps ratio in reconstructed limbs, which may have some impact on function and the potential risk of re-injury.

Leiter noted the purposes for performing the study included a shift toward using semitendinosus gracilis graft in ACL reconstructions performed in the United States and Canada.

“The primary hypothesis of our research was that contralateral hamstring graft harvest would significantly improve quality of life scores compared to those undergoing ipsilateral graft harvest for use in ACL reconstruction,” he said.

Strength, flexion

Leiter’s group intraoperatively randomized 100 patients to undergo ACL reconstruction using either an ipsilateral or contralateral hamstring autograft. In addition to studying patients’ ACL quality of life scores, the investigators analyzed concentric isovelocity knee flexion and extension strength. They collected data preoperatively and at 3, 6, 12, and 24 months postoperatively.

Leiter reported ACL quality of life scores improved significantly from baseline to postoperative measurements in both groups, and investigators observed with no significant differences in scores between the groups during follow-up.

Knee flexion strength in the reconstructed limb was found to be greater in the contralateral group rather than the ipsilateral group at 12 months when measured at higher velocities. Additionally, flexion was greater in the ipsilateral non-reconstructed knees 3 months postoperatively, but not at any other times.

Hamstring/quadriceps ratios were highest in the reconstructed limb of the contralateral group, Leiter added.

No disadvantages

Leiter noted that the study did not support the investigators’ hypothesis. “There was no notable difference between groups in reported pain up to 3 days post-surgery … there was no clinically significant difference in strength,” he said.

“No drawbacks were identified using contralateral hamstring graft harvest based on quality of life, pain, medication use or strength,” he concluded. “Contralateral hamstring graft harvest may show promise as a new option in ACL reconstruction.”

Reference:
Leiter J, et al. Prospective randomized trial of ipsilateral vs. contralateral hamstring graft in ACL reconstruction. Paper SS-59. Presented at the 2011 Annual Meeting of the Arthroscopy Association of North America. April 14-16. San Francisco.
Disclosure: Leiter has no relevant financial disclosures.

This group has presented a well-done prospective randomized controlled trial. Interestingly — and this was in the paper but not their presentation — they found the contralateral harvest did not result in the weakness of the contralateral side, and actually they had higher hamstring-to-quad ratios on their harvest side in the contralateral vs. the ipsilateral side. Outcomes were obviously not different.

- John C. Richmond, MD
Moderator

Disclosure: He is a paid consultant for Mitek, Stryker, Lifenet, Serica, Carmell Therapeutics, and Entopica Therapeutics, he receives publisher royalties from Arthroscopy, Springer, Wolters Kluwer Health, Lippincott and Williams & Wilkins. He is on the editorial/governing board of Arthroscopy and Sports Medicine & Arthroscopy Review, and he is a board member or committee appointment for the Arthroscopy Association of North America, the American Academy of Orthopaedic Surgeons and New England Baptist Hospital.

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