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Better results seen with hamstring autografts than patellar tendon grafts 15 years after ACL reconstruction

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SAN DIEGO — Patients who underwent ACL reconstruction with patellar tendon autograft displayed significantly worse outcomes at 15 years postoperative than those reconstructed with four-strand hamstring tendon, according to results of a study presented here.

Leo A. Pinczewski, MBBS, FRACS, presented the findings at the 2011 American Orthopaedic Society for Sports Medicine Specialty Day Meeting.

Pinczewski and colleagues compared the results of 90 consecutive patients with isolated ACL ruptures who underwent hamstring tendon repair with a cohort of 90 patients who had the same injury and underwent patellar tendon repair using the same surgical technique.

The investigators assessed the groups at 2, 5, 7, 10 and 15 years. These assessments included the IKDC Knee Ligament Evaluation, KT-1000, Lysholm Knee Score, kneeling pain, radiographic evaluation and other clinical outcomes.

“After 15 years, significant differences emerge,” Pinczewski said. At the 15-year mark, he noted that patients who received the patellar tendon graft displayed significantly worse outcomes than those who received hamstring tendon repair regarding radiologically-detectable osteoarthritis, motion loss, the single-leg hop test, participation in strenuous activity and kneeling pain.

No significant differences were reported between the groups regarding laxity and overall IKDC grade.

ACL graft rupture occurred in 16% of patients in the hamstring tendon group and 8% of patients in the patellar tendon group. In the study, these ruptures were associated with male patients and non-ideal tunnel position.

Pinczewski also noted that contralateral ACL rupture occurred in more patellar tendon patients than hamstring tendon patients (24% vs. 12%), and these occurrences were associated with patients younger than 18 years old.

Reference:

• Pinczewski LA, et al. Clinical results and risk factors for reinjury 15 years after ACL reconstruction. A prospective study of hamstring and patellar tendon graphs. Paper 9584. Presented at the 2011 American Orthopaedic Society for Sports Medicine Specialty Day. Feb. 19, 2011.

Disclosure: Pinczewski receives royalties from and is a paid consultant for Smith & Nephew.

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