A Prospective Comparison Of Bone-patellar Tendon-bone And Hamstring Grafts For ACL Reconstruction In Female Patients

Abstract

For many years, the BTB autograft has been advocated as the golden standard but disadvantages such as donor-site morbidity, patellar fractures, remaining patello- femoral pain and, in the worst case scenario, patellar tendon rupture has led to an increased interest in using ST/G autografts An increase in knee laxity in the ST/G group is the most common post-operative difference to be reported when comparing the two methods. However, in terms of objective and functional outcomes, the two methods have been comparable in many studies. The incidence of ACL ruptures among females is three to five times higher compared with males. Explanations that have been put forward are a combination of hormonal influences, a narrow intercondylar notch, increased ligamentous laxity and increased knee valgus compared with males. PURPOSE The aim of the study was to compare the results after arthroscopic anterior cruciate ligament (ACL) reconstruction using central-third, bone-patellar tendon-bone (BTB group) (n=28) and four-strand semitendinosus/gracilis (ST/G group) (n=31) autografts in female patients. METHODS A consecutive series of 61 female patients, all with unilateral ACL ruptures, was included in the study. In both groups, interference screw fixation of the graft was used at both ends and 59/61 (97%) of the patients returned for the follow-up examination after a period of 26 (23–31) months. The pre-operative assessments in both groups were similar in terms of the Lysholm score, KT-1000 measurements, one-leg-hop test and knee-walking test. RESULTS At the two-year follow-up, the knee-walking test was significantly worse in the BTB group than in the ST/G group (p=0.003). Furthermore, the knee-walking test was significantly worse at follow-up than pre-operatively in the BTB group (p<0.005). The corresponding finding was not made in the ST/G group. A reduction in knee laxity compared with the pre-operative assessments was found in both groups. A significant increase in activity level and subjective scores was found in both groups compared with pre-operative values, without any significant differences between the groups. CONCLUSIONS Two years after ACL reconstruction, the groups displayed no significant differences in terms of functional outcome and knee laxity. However, the use of ST/G autografts rendered significantly less discomfort during the knee-walking test than the use of BTB autografts.