A 7-Year Follow-up of Patellar Tendon and Hamstring Tendon Grafts for Arthroscopic Anterior Cruciate Ligament Reconstruction

Abstract

Background For arthroscopic anterior cruciate ligament reconstruction, the most commonly used graft constructs are either the hamstring tendon or patellar tendon. Well-controlled, long-term studies are needed to determine the differences between the 2 materials. Hypothesis There is a difference between hamstring and patellar tendon grafts in the clinical results of anterior cruciate ligament reconstructions at 7 years. Study Design Cohort study; Level of evidence, 2. Methods Two groups of 90 patients each, consecutively treated with hamstring or patellar tendon grafts, were followed and assessed at 1, 2, 5, and 7 years after surgery. Results At the 7-year review, abnormal radiographic findings were seen in 45% (24/53) of the patellar tendon group and in 14% (7/51) of the hamstring tendon group (P = .002). Although there was no significant difference between the groups in extension deficit (P= .22), the percentage of patients with an extension deficit increased significantly in the patellar tendon group from 8% at 1 year to 25% at 7 years (P= .02). No significant change was seen in the hamstring tendon group over time (P= .20). There was no significant difference in laxity between the groups on Lachman (P= .44), pivot-shift (P= .39), or instrumented (P= .44) testing. Graft rupture occurred in 4 patients from the patellar tendon group and in 9 patients from the hamstring tendon group (P= .15). Both autografts gave excellent subjective results, as evidenced by the International Knee Documentation Committee evaluation and Lysholm knee scores at 7 years. Conclusions Both hamstring and patellar tendon grafts provided good subjective outcomes and objective stability at 7 years. No significant differences in the rate of graft rupture or contralateral anterior cruciate ligament rupture were identified. Patients with patellar tendon grafts had a greater prevalence of osteoarthritis at 7 years after surgery; therefore, the authors preferred hamstring tendons as the primary graft choice in anterior cruciate ligament reconstructions.