A Comparison of Long Term Stability Outcomes Between Hamstring Tendon and Patella Tendon Grafts for ACL Reconstruction
Robert Fakler
University of Alabama, Physician Assistant Program
Birmingham, 2016
A Comparison of Long Term Stability Outcomes Between Hamstring Tendon and Patella Tendon Grafts for ACL Reconstruction
Abstract
Background: The purpose of this systematic review is to compare the long term outcomes the two most commonly used treatment methods for Anterior Cruciate Ligament (ACL) reconstruction. The anterior cruciate ligament of each knee is a structure that attaches between the tibia and femur and prevents hyperextension of the knee. Reconstructing an injury to this ligament is done by either using Hamstring Tendon (HT) or Patellar Bone Tendon Bone (PBTB) autografts. An ACL tear is one of the most common injuries among athletic individuals that participate in recreational to sanctioned athletics. Three prospective cohort studies were used for this systematic review.
Methods: All studies were selected from a database search of PubMed and Google Scholar, utilizing a keyword search containing, hamstring versus patella tendon for ACL reconstruction. Studies were further screened to include only long term studies with a minimum of 7 years. All meta-analysis studies were then excluded and three of the four articles left were selected based on assessment testing and reporting.
Results: All three studies compared knee stability outcomes for a minimum of seven years by assessing knee laxity, range of motion deficit and knee function using standardized assessment methods by orthopedic surgeons internationally and anterior knee pain. Results for knee laxity, range of motion deficit and knee function showed no statistical significance (P > 0.05), between the two surgical treatment methods in all three studies. However, the assessment of anterior knee pain with kneeling, showed a statistical significant difference (P=0.01) between the Hamstring Tendon (HT) and Patella Bone Tendon Bone (PBTB) treatment groups, with increasing pain in the PBTB group.
Discussion/Conclusion: All three studies demonstrated no significant difference between the two treatment methods when assessing stability outcomes. However, there was a significant difference between the HT and PBTB group for anterior kneeling pain. All three studies concluded that both treatments can provide excellent outcomes for knee function, range of motion deficit and knee laxity in regards to post-surgical knee stability. The post-study research recommendation selected HT graft as the treatment of choice from all the studies used in this systematic review. The reason for this conclusion was due to the significant difference in anterior knee pain with activity.
Key Words: ACL reconstruction, patella tendon, hamstring tendon, long-term outcomes, versus.
A Comparison of Long Term Stability Outcomes Between Hamstring Tendon and Patella Tendon Grafts for ACL Reconstruction
Introduction
A common knee injury among athletes or individuals that participate in recreational sporting activities is damage to the to the anterior cruciate ligament (ACL). The ACL is one of the three major ligaments located in the knee joint, providing most of the stability for the lower leg and rotational stability to the knee. This is accomplished by the ligament preventing the tibial joint component from sliding in front of the femoral joint component. An ACL injury can range between a mild sprain to complete tear, however the majority of ACL injuries are either a mild sprain or complete rupture. Injuries to the ligament occur from changing direction or stopping suddenly, slowing down while running, landing incorrectly from a jump, a collision or contact with another person.
Ligament injuries are graded based on the extent of damage it has undergone and placed into three different categories. Grade 1 Sprains: There is mild damage to the ligament which involves a slight stretching and stability is not compromised. Grade 2 Sprains: This is incomplete tear of the ligament which causes the ligament to stretch and become loose. Grade 3 Sprains: Grade 3 is a full tear of the ligament which renders the knee joint immobile and is considered unstable.
A torn or grade 3 sprain ACL injury will not heal on its own and must be replaced completely by surgical reconstruction using a graft and placing it into the original site in the knee joint. The majority of replacements are an autologous graft and the two primary sources to obtain them by surgeons are the Bone Patellar Tendon Bone (BPTB) and the Hamstring Tendon (HT). The replacement grafts are harvested from the individual at the beginning of surgery and prepared for implantation while the remnants of the torn graft are removed. Surgeons will usually specialize in one treatment technique, based on the graft they believe has the best outcomes for patients and selection is made by preference despite discrepancies in choice. The desired outcome of ACL reconstruction is to restore adequate function and stability, protect the knee from developing cartilage damage, osteoarthritis and meniscus tears.1