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No major differences seen with two types of ACL grafts 16 years after reconstruction
Less laxity was found in patients with hamstring grafts, however, patients who received patellar tendons had more difficulty with the knee walking test.
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BARCELONA — Patellar tendon autografts showed minor and mostly insignificant differences when used in ACL reconstruction compared with hamstring tendon autografts at long-term follow-up, according to results presented at the European Society of Sports Traumatology, Knee Surgery and Arthroscopy Congress, here.
“[It] is our opinion that the graft choice facing reconstruction should be based on preference of the patient and the surgeon rather than any possible minor differences in the short-, medium- or long-term,” Kristian Samuelsson, MD, PhD, MSC, associate professor of orthopaedic surgery at Sahlgrenska Hospital in Gothenburg, Sweden, said. This study won the Theo van Rans Best Paper Award at the meeting.
Patellar tendon vs hamstring grafts
Samuelsson and his colleagues originally performed a 2-year follow-up of 193 patients from two previous randomized cohorts who underwent arthroscopic unilateral primary ACL reconstruction using patellar tendon (PT) or hamstring (HS) tendon autograft. Researchers performed a complete clinical assessment that included knee laxity measurements, functional outcomes, patient-reported outcomes, activity scales and bilateral standing radiographs.
At a mean follow-up of 16.5 years, 147 patients were available with 61 patients in the PT group and 86 patients in the HS group. Results showed no significant difference in range of motion of the reconstructed knee between the two groups at that time.
“The pivot shift test revealed less laxity in the HT group when we removed the reinjured patients and patients with contralateral ACL injury,” Samuelsson said. “However, it was almost nonsignificant. Otherwise, no difference was found in terms of Lachman, pivot-shift test and KT-1000.”
During the knee walking test, patients in the PT group experienced significantly more difficulties and had a larger area of disturbed anterior knee sensitivity, according to study results. Researchers noted the two groups showed no significant differences in terms of Lysholm knee scoring scale, Tegner activity scale and IKDC score results.
“The radiographic evaluation showed that both groups had significantly more postoperative radiographic changes,” Samuelsson said. “Their results were consistent regardless of classification system we used or whether patients with new ACL injury or contralateral injury were excluded, and there were no differences between the two groups.”
Follow-up
According to Samuelsson, future research related to type of graft used for ACL reconstruction will focus on combining data from long-term follow-up and performing a meta-analysis of individual populations to provide a more stable analysis of patellar tendon and hamstring grafts.
“[One] of those steps is increasing the sample size, so what we do with this is maybe get a [narrower] and a [truer] estimate on our results,” Samuelsson told Orthopaedics Today Europe. “Hopefully, we will show the same thing, that there is no difference and that we know that we have good evidence that there is no difference between the grafts.” – by Casey Tingle
- Reference:
- Samuelsson K, et al. Paper #AW01-1603. Presented at: European Society of Sports Traumatology, Knee Surgery and Arthroscopy Congress; May 4-7, 2016; Barcelona.
- For more information:
- Kristian Samuelsson, MD, PhD, MSC, can be reached at Sahlgrenska Hospital, SE-413 45 Gothenburg, Sweden; email: kristian@samuelsson.cc.
Disclosure: Samuelsson reports no relevant financial disclosures.
Perspective
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Freddie H. Fu, MD, DSc(Hon), DPs(Hon)
The awarded paper, A randomized controlled trial with 16-year follow-up after anterior cruciate ligament reconstruction, by Kristian Samuelsson and colleagues investigated the influence of graft choice on long-term outcomes after an ACL reconstruction.
Despite a long-term follow-up, there was little attrition and the research group was able to follow 76% of their original patients. In contrast to many recent studies, the present paper did not find any significant differences regarding re-rupture rate between hamstring tendon and patellar tendon grafts. The authors found those who underwent ACL reconstruction with a patellar tendon graft had higher incidence of anterior knee problems, even after 16 years.
Such studies are important for the orthopaedic community since most of our evidence is based on short-term outcomes. However, when interpreting these data, one has to account for the surgical technique and the postoperative rehabilitation protocol. Nowadays, surgeons have to individualize treatment depending on the patients unique anatomy and specific demands to further improve outcomes.
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