High school and college female athletes: intermediate-term comparison of bone-patellar tendon-bone versus hamstring anterior cruciate ligament reconstruction (SS-12)

Abstract

Female athletes are at greater risk for anterior cruciate ligament (ACL) injury than males. Recently, hamstrings (HT) have been a more popular graft choice for this gender and age population. This is in part due to improved cosmesis and potentially less harvest site morbidity. We hypothesize there is no difference in outcome between hamstring versus bone patellar tendon bone (BPTB) ACL reconstruction. Methods: A case-control study of athletic related ACL reconstructions in female high school and college athletes was performed. Participants underwent either HT or BPTB ACL reconstruction and were matched on age at injury, pre-injury activity level, time from injury to surgery (chronicity), and number of giving way episodes prior to surgery. Participating patients completed the IKDC Subjective Knee Form; the Activities of Daily Living (ADLs) and Sports Activity Scale (SAS) of the Knee Outcome Survey; and the SF-36 general health status questionnaire. Patients were seen in follow-up for X-ray evaluation, physical examination, KT-1000 testing, quadriceps torque using Biodex testing, and assessment of functional strength using one-legged hop and vertical jump tests. Paired t tests and Bowker’s test for correlated proportions were used to compare the HT versus BPTB. Results: Twenty-four matched pairs were included. Average length of follow-up was 5.5 for BPTB and 3.9 years for HT. The side-to-side difference in passive extension was significantly greater in the BPTB (3°) compared to the HT (0°) group. There was a trend for an increased maximal manual KT-1000 in the BPTB group (2.4 vs. 1.2 mm, P = .08). The BPTB group had significantly greater avoidance of kneeling and numbness/dysesthesia. There were no significant differences on IKDC, ADLS, or SAS. However, there was a trend for the BPTB group to have higher SF-36 physical component summary scores (56.8 vs. 54.6, P = .06). Conclusions: HT grafts for ACL reconstruction in the high school female athlete appear to be at least as effective as BPTB graft reconstructions. This study reinforces that HT is an acceptable alternative with less numbness/dysesthesia, kneeling pain, and loss of extension compared to BPTB.