No Difference in Knee Function or Prevalence of Osteoarthritis after Reconstruction of the Anterior Cruciate Ligament with 4-Strand Hamstring Autograft versus Patellar Tendon—Bone Autograft

Abstract

Background The choice of different graft types and surgical techniques used when reconstructing a torn anterior cruciate ligament may influence the long-term prevalence of osteoarthritis and functional outcomes. Hypothesis There are no differences in the prevalence of knee osteoarthritis or knee function in patients undergoing reconstruction of a torn anterior cruciate ligament with 4-strand hamstring autograft versus patellar tendon—bone autograft. Study Design Randomized controlled trial; Level of evidence, 1. Methods Seventy-two patients with subacute or chronic rupture of the anterior cruciate ligament were randomly assigned to autograft reconstruction with 4-strand gracilis and semitendinosus tendon (HAM) (N = 37) or with patellar tendon—bone (PTB) (N = 35) from the ipsilateral side. Outcome measurements were the Cincinnati knee score, single-legged hop tests, isokinetic muscle strength tests, pain, knee joint laxity test (KT-1000 arthrometer), and a radiologic evaluation (Kellgren and Lawrence) at 10-year follow-up. Results At 10 years, 57 patients (79%) were eligible for evaluation—29 in the HAM group and 28 in the PTB group. No differences were found between the 2 graft groups with respect to the Cincinnati knee score, the single-legged hop tests, pain, muscle strength measurements, or knee joint laxity. Fifty-five percent and 64% of the patients had osteoarthritis corresponding to Kellgren and Lawrence grade 2 or more in the HAM and the PTB groups, respectively (P = .27). For the uninvolved knee, the corresponding numbers were 28% and 22% (P = .62). Conclusion At 10 years postoperatively, no statistically significant differences in clinical outcome between the 2 graft types were found. The prevalence of osteoarthritis was significantly higher in the operated leg than in the contralateral leg, but there were no significant differences between the 2 groups. The results indicate that the choice of graft type after an anterior cruciate ligament injury has minimal influence on the prevalence of osteoarthritis 10 years after surgery.