Osteoarthritis After ACL Reconstruction. A Comparison of Patellar Tendon and Hamstring Tendon Graft for ACL Reconstruction Over 7 years (SS-03)

Abstract

Aim: The aim of this study is to compare the clinical outcomes of endoscopic ACL reconstruction utilizing ipsilateral 4-strand hamstring tendon or patellar tendon autograft over a 7-year period. Methods: 90 consecutive patients with isolated ACL rupture received PT autograft and 90 who received HT autograft were studied annually for 7 years. Assessment included the IKDC Knee Ligament Evaluation, KT1000, Lysholm Knee Score, thigh atrophy, kneeling pain, hamstring pain, radiographs and clinical outcomes. Results: The mean age at time of surgery was 28 years. At 7 years the median Lysholm Knee Score was 95 for both groups. No significant difference was found for graft rupture, contralateral ACL rupture, subjective knee function and overall IKDC. At 2 years, 8% of the PT group had a fixed flexion deformity, increasing to 31% at 5 and 7 years. The HT group showed no significant change with time. Forty-four percent of the PT group and 27% of the HT experienced kneeling pain at 5-year review, this figure increased significantly to 55% for the PT group at 7 years. Lachman, pivot shift and instrumented testing demonstrated a significant increase in laxity in the PT group between 5 and 7 years. HT laxity remained unchanged with time. Radiological assessment at 5 years displayed early osteoarthritic changes in 4% of the HT group and 18% of the PT group. At 7 years a significant increase to 31% of HT and 70% of PT was seen. Conclusion: Radiological early osteoarthritic changes are seen after ACL reconstruction in few patients up to 5 years, but the number of patients demonstrating such changes increases markedly by 7 years. PT grafts demonstrate a significant increase in laxity with time and kneeling pain remains a persistent problem that is worsening with time.