Abstract
Purpose: The most frequently used grafts for intra-articular anterior cruciate ligament (ACL) reconstruction are the autologous patellar tendon (PT) or doubled semitendinosus and gracilis tendons (STG) autografts. There are still controversies about graft selection for primary ACL reconstruction. Methods: A prospective, randomized study was conducted on 57 patients who underwent arthroscopically assisted ACL reconstruction between January 2010 and February 2011. In 29 patients ACL reconstruction was performed with hamstring tendon autograft (STG group), and in 28 patients the ACL reconstruction was performed with patellar tendon autograft (PT group). At 6 months follow-up, all patients have performed the isokinetic extensor and flexor muscles strength and KT-1000 measurements. Results: At 6 months after surgery, we found significantly lower average isokinetic quadriceps peak torque in the PT group compared to the STG group at angular velocity of 60°/s. However, at the same time we did not find significant difference in flexor muscle power comparing both groups. The manual maximum KT-1000 arthrometer side-to-side difference was 1.7 ± 1.7 mm for the PT group and 1.9 ± 1.6 mm for the STG group (P=0.398). No significant correlation was found between the knee objective stability (KT-1000 measurements) and the isokinetic thigh muscle strength (extensors, Spearman’s rho=0.057, P=0.671; flexors, Spearman’s rho=0.094, P=0.489). Conclusions: Both hamstring and patellar tendon autografts provided good objective stability at 6 months after surgery In addition, regardless of which graft was used, a considerable percentage of patients continue to have strength deficits. In our opinion, the ACL-reconstructed leg should have 85% or greater return to the strength of the normal leg as one criterion before release to full sports activities. We were particularly intrigued to find only half of the competitive athletes achieved this goal at 6 months after surgery.
Highlights
The anterior cruciate ligament (ACL) rupture is the most common serious injury of the knee
No significant correlation was found between the knee objective stability (KT-1000 measurements) and the isokinetic thigh muscle strength
The results of our study substantiate the similarities found in previous reports that document that good or excellent results may be obtained in the majority of ACL reconstructions when using either patellar tendon (PT) or semitendinosus and gracilis tendon (STG) autografts [4,11,13]
Summary
The anterior cruciate ligament (ACL) rupture is the most common serious injury of the knee. It is widely believed that knee injury with associated ACL tear may lead to functional instability. In the active sporting population, such instability has been found to be associated with muscle weakness, meniscal and chondral injuries as well as with the development of degenerative disease within the joint [1,2,3]. The goals of ACL reconstruction are to decrease symptoms, improve function, and return patients to their pre-injury level of activity in the short term. ACL reconstruction is a common procedure that usually allows predictable and timely return to function for the patient [2]. It is customary to allow return to full activities 6 months after the procedure, with some surgeons advocating return to sports as early as 4 months [4]
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