Abstract
PurposeTo compare muscle strength and patient reported outcomes following ACLR using a semitendinosus (ST) graft from the ipsilateral (IL) leg compared to a graft from the contralateral (CL) leg.MethodsOne-hundred and forty patients with an ACL injury were randomized to IL or CL ACLR. Patients were assessed at 6, 12 and 24 months with isokinetic and isometric muscle strength measured using Biodex. Patient-reported outcomes and manual stability measurements were also recorded.ResultsPatient-related outcomes improved over time for both groups with no significant differences between groups at any time point. No differences between groups in objective knee assessment scores or rerupture rates were found. The IL group was significantly weaker in knee flexion strength at all time points compared to the CL group, additionally the IL group did not recover flexor strength within 2 years.ConclusionThis study demonstrated that utilizing an ST graft harvested from the uninjured limb for ACLR facilitates early isokinetic and isometric strength recovery, with no significant adverse outcomes demonstrated in other measurements and therefore be performed to reduce the risk of long-term strength deficits in the injured legLevel of evidenceII.
Highlights
In Sweden, approximately 8000 ACL injuries are reported each year, with approximately 4000 ACL reconstructions performed annually [2]
There were no significant differences in age, sex or additional injuries
The most important finding of the present study was that the use of a contralateral ST graft facilitates earlier isokinetic and isometric strength recovery after ACLR
Summary
In Sweden, approximately 8000 ACL injuries are reported each year, with approximately 4000 ACL reconstructions performed annually [2]. The most widely used grafts for reconstruction of the ACL include the patellar tendon (BPTB), hamstring tendon (HS), and quadriceps tendon (QT). In Sweden, a hamstring graft using semitendinosus (ST) is utilized in 95% of ACLRs, mainly to minimize donor site morbidity [2]. It is fair to say that the perfect graft for ACLR does not exist. There have been studies using BTPB graft from the contralateral noninjured leg for primary ACLR, and in the context of revision surgery, with good results [24, 25]. Yasuda [33] performed a study using contralateral semitendinosus-gracilis (ST-G) grafts to distinguish morbidity attributable to graft harvest from the ACLR, and McRae et al [16] have performed a randomized controlled trial using contralateral ST-G hamstring graft.
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