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Hamstring Tendon Versus Patellar Tendon Anterior Cruciate Ligament Reconstruction Using Biodegradable Interference Fit Fixation

A Prospective Matched-Group Analysis

From Sports Traumatology and Arthroscopy Service, Center for Musculoskeletal Surgery, Charité, Campus Virchow-Clinic, Humboldt and Free University of Berlin, Berlin, Germany

^* Address correspondence to Andreas Weiler, MD, PhD, Centrum für Muskuloskeletale Chirurgie, Charité, Campus Virchow-Klinikum, Humboldt- und Freie Universität zu Berlin, Augustenburger Platz 1, D-13353 Berlin, Germany (e-mail: andreas.weiler{at}charite.de).

Background: There are still controversies about graft selection for primary anterior cruciate ligament reconstruction, especially with respect to knee stability and functional outcome.

Hypothesis: Biodegradable interference screw fixation of hamstring tendon grafts provides clinical results similar to those achieved with identical fixation of bone–patellar tendon–bone grafts.

Study Design: Cohort study; Level of evidence, 2.

Methods: In 1996 and 1997, primary isolated anterior cruciate ligament reconstruction using a bone–patellar tendon–bone autograft was performed in 72 patients. Since 1998, hamstring tendons were used as routine grafts. Matched patients with a hamstring tendon graft were selected from a database (n = 284). All patients were followed prospectively for a minimum of 2 years with KT-1000 arthrometer testing, International Knee Documentation Committee score, and Lysholm score.

Results: In the bone–patellar tendon–bone group, 9 patients were excluded because of bilateral rupture of the anterior cruciate ligament, 3 patients (4.2%) had a graft rupture, and 4 patients were lost to follow-up (follow-up rate, 92.1%), leaving 56 patients for a matched-group analysis. In the hamstring tendon database, the graft rupture rate was 5.6% (P = .698). The Lysholm score was 89.7 in the patellar tendon group and 94 in the hamstring tendon group (P = .003). The KT-1000 arthrometer side-to-side difference was 2.6 mm for the patellar tendon group and 2.1 mm for the hamstring tendon group (P = .041). There were significantly less positive pivot-shift test results in the hamstring tendon group (P = .005), and hamstring tendon patients showed lower thigh atrophy (P = .024) and patellofemoral crepitus (P = .003). Overall International Knee Documentation Committee scores were better (P = .001) in the hamstring tendon group (hamstring tendon: 34 x A, 21 x B, 0 x C, 0 x D; bone–patellar tendon–bone: 17 x A, 32 x B, 6 x C, 0 x D).

Conclusions: In this comparison of anterior cruciate ligament reconstruction with bone–patellar tendon–bone and anatomical hamstring tendon grafts, the hamstring tendon graft was superior in knee stability and function. These findings are partially contrary to previous studies and might be attributable to the use of an anatomical joint line fixation for hamstring tendon grafts. Thus, hamstring tendons are the authors’ primary graft choice for anterior cruciate ligament reconstruction, even in high-level athletes.

Key Words: anterior cruciate ligament (ACL) • hamstring tendons • patellar tendon • biodegradable interference screw • clinical study

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