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Effectiveness of Reconstruction of the Anterior Cruciate Ligament With Quadrupled Hamstrings and Bone-Patellar Tendon-Bone Autografts

An In Vivo Study Comparing Tibial Internal-External Rotation

Vasileios Chouliaras, MD^*, Stavros Ristanis, MD^*, Constantina Moraiti, MD^*, Nicholas Stergiou, PhD and Anastasios D. Georgoulis, MD^*,

From the ^* Orthopaedic Sports Medicine Center of Ioannina, Department of Orthopaedic Surgery, University of Ioannina, Ioannina, Greece, and HPER Biomechanics Laboratory, University of Nebraska at Omaha, Omaha, Nebraska

Address correspondence to Anastasios D. Georgoulis, MD, Methodiou Anthrakitou 1, Ioannina 45221, Greece (e-mail: oaki{at}cc.uoi.gr).

Background: The 2 most frequently used autografts for anterior cruciate ligament reconstruction are the bone-patellar tendon-bone and the quadrupled hamstrings tendon.

Hypothesis: Hamstring tendon graft is superior to patellar tendon graft in restoring tibial rotation during highly demanding activities because of its superiority in strength and linear stiffness and because it is closer morphologically to the anatomy of the natural anterior cruciate ligament.

Study Design: Case control study; Level of evidence, 3.

Methods: Eleven patients with patellar tendon graft anterior cruciate ligament reconstruction, 11 patients with hamstring tendon graft anterior cruciate ligament reconstruction, and 11 controls were assessed. Kinematic data were collected (50 Hz) with a 6-camera optoelectronic system while the subjects descended stairs and, immediately after, pivoted on their landing leg. The dependent variable examined was the tibial internal-external rotation during pivoting. All patients in both groups were also assessed clinically and with the use of a KT-1000 arthrometer to evaluate anterior tibial translation.

Results: The results demonstrated that reconstructions with either graft successfully restored anterior tibial translation. However, both anterior cruciate ligament reconstruction groups had significantly increased tibial rotation when compared with the controls, whereas no differences were found between the 2 reconstructed groups.

Conclusion: The 2 most frequently used autografts for anterior cruciate ligament reconstruction cannot restore tibial rotation to normal levels.

Clinical Relevance: New surgical techniques are needed that can better approximate the actual anatomy and function of the anterior cruciate ligament.

Key Words: anterior cruciate ligament reconstruction • gait analysis • tibial rotation • quadrupled hamstrings autograft • bone-patellar tendon-bone autograft

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