There is no difference between quadriceps- and hamstring tendon autografts in primary anterior cruciate ligament reconstruction: a 2-year patient-reported outcome study Is Quadriceps Tendon Autograft a Better Choice Than Hamstring Autograft for Anterior Cruciate Ligament Reconstruction? A Comparative Study With a Mean Follow-up of 3.6 Years A 10-year comparison of anterior cruciate ligament reconstructions with hamstring tendon and patellar tendon autograft: a controlled, prospective trial. Clinical Results and Risk Factors for Reinjury 15 Years After Anterior Cruciate Ligament Reconstruction Lower Risk of Revision With Patellar Tendon Autografts Compared With Hamstring Autografts Early post-operative morbidity following anterior cruciate ligament reconstruction: patellar tendon versus hamstring graft Functional capability is enhanced with semitendinosus than patellar tendon ACL repair. Knee extension and flexion muscle power after anterior cruciate ligament reconstruction with patellar tendon graft or hamstring tendons graft: a cross-sectional comparison 3 years post surgery Hip extension strength following hamstring tendon harvest for ACL reconstruction. Management of Injuries to the Anterior Cruciate Ligament: Results of a Survey of Orthopaedic Surgeons in Canada A Randomized Clinical Trial Comparing Patellar Tendon, Hamstring Tendon, and Double-Bundle ACL Reconstructions: Patient-Reported and Clinical Outcomes at a Minimal 2-Year Follow-up Strength recovery after anterior cruciate ligament reconstruction with quadriceps tendon versus hamstring tendon autografts in soccer players: A randomized controlled trial. Long-term Comparison of Semitendinosus and Gracilis Tendon Versus Patellar Tendon Autografts for Anterior Cruciate Ligament Reconstruction: A 17-Year Follow-up of a Randomized Controlled Trial Reruptures, Reinjuries, and Revisions at a Minimum 2-Year Follow-up: A Randomized Clinical Trial Comparing 3 Graft Types for ACL Reconstruction Knee proprioception following ACL reconstruction; a prospective trial comparing hamstrings with bone-patellar tendon-bone autograft. Bone tunnel enlargement following anterior cruciate ligament reconstruction: a randomised comparison of hamstring and patellar tendon grafts with 2-year follow-up Patellar tendon versus quadrupled bone-semitendinosus anterior cruciate ligament reconstruction: a prospective clinical investigation in athletes. Quality of Life and Clinical Outcome Comparison of Semitendinosus and Gracilis Tendon Versus Patellar Tendon Autografts for Anterior Cruciate Ligament Reconstruction Comparing 2-Year Outcomes of Anterior Cruciate Ligament Reconstruction Using Either Patella-Tendon or Semitendinosus-Tendon Autografts: A Non-Randomised Prospective Study Isokinetic evaluation of anterior cruciate ligament reconstruction: hamstring versus patellar tendon. Patellar tendon vs. doubled semitendinosus and gracilis tendon for anterior cruciate ligament reconstruction Single-bundle patellar tendon versus non-anatomical double-bundle hamstrings ACL reconstruction: a prospective randomized study at 8-year minimum follow-up The effect of graft tissue on anterior cruciate ligament outcomes: a multicenter, prospective, randomized controlled trial comparing autograft hamstrings with fresh-frozen anterior tibialis allograft.
Purpose Graft choice for anterior cruciate ligament ( ACL ) reconstruction is crucial , however the optimal graft source remains a topic of controversy . The purpose of this study is to compare subjective and functional patient-reported outcomes ( PRO ) after single-bundle ACL reconstruction using quadriceps tendon ( QT ) or hamstring tendon ( HT ) autografts for single-bundle ACL reconstruction . We hypothesize that there is no difference in patient-reported functional outcomes after ACL reconstruction using either HT- or QT autograft . Methods All data were extracted from a prospect ively collected ACL registry . A total of 80 patients with at least 2-year follow-up were included in this study . A total of 40 patients with primary ACL reconstruction using a QT autograft harvested via a minimally invasive technique were matched by sex , age and pre-injury Tegner and Lysholm score to 40 patients who received HT autografts .  Subjective and functional PRO scores including Lysholm score , Tegner activity level and visual analogue scale for pain were obtained at 6 , 12 and 24 months after index surgery . Results No significant difference between the QT and the HT group was seen at any follow-up in regard to any of the PRO scores for function or pain . 24 months post-surgery the mean Tegner activity score of the HT group was significantly ( p = 0.04 ) lower compared to the pre-injury status . At final follow-up , 27 patients ( 67.5 % ) in the QT group and 32 patients ( 80.0 % ) in the HT returned to their pre-injury activity level ( n.s . ) . A total of 37 patients ( 92.5 % ) of the QT cohort and 35 patients ( 87.5 % ) of the HT cohort reported “ good ” or “ excellent ” results according to the Lysholm score ( n.s . ) . “ No pain ” or “ slight pain ” during severe exertion was reported by 33 patients ( 82.5 % ) with QT autograft and 28 patients ( 82.4 % ) with HT autograft ( n.s . ) . Conclusion There is no significant difference between PRO 2 years post-operative using either QT or HT autografts . Both QT and HT grafts show acceptable and comparable PRO scores making the QT a reliable graft alternative to HT for primary ACL reconstruction . Level of evidence III Background : The quadriceps tendon ( QT ) autograft is known as an effective graft for anterior cruciate ligament ( ACL ) reconstruction and shows a similar functional outcome to the bone-patellar tendon-bone ( BPTB ) in r and omized controlled trials , with a lesser incidence of complications . Up until now , only 2 studies have compared QT to hamstring tendon ( HT ) autograft . Hypothesis : The functional outcomes of the QT technique are at least as good as those of the HT technique , with the same morbidity . Study Design : Cohort study ; Level of evidence , 3 . Methods : Ninety-five patients underwent isolated ACL reconstruction between January 1 and December 31 , 2012 . Fifty underwent ACL reconstruction with the QT and 45 with the HT .  The same surgical technique , fixation method , and postoperative protocol were used in both groups . The following parameters were evaluated : surgical revisions , functional outcome ( Lysholm , Knee injury and Osteoarthritis Outcome Score [ KOOS ] , Tegner , subjective International Knee Documentation Committee ) , joint stability ( KT-1000 , Lachman , pivot shift ) , anterior knee pain ( Shelbourne-Trumper score ) , and isokinetic strength . Descriptive statistics are presented for these variables using the Student t test . Results : Eighty-six patients ( 45 QT , 41 HT ) were review ed with a mean follow-up of 3.6 ± 0.4 years ; minimum follow-up was 3 years . There were 4 reoperations in the QT group ( including 1 ACL revision ) and 3 in the HT group ( including 2 ACL revisions ) ( P > .05 ) . The Lysholm ( 89 ± 6.9 vs 83.1 ± 5.3 ) , KOOS Symptoms ( 90 ± 11.2 vs 81 ± 10.3 ) , and KOOS Sport ( 82 ± 11.3 vs 67 ± 12.4 ) scores were significantly better in the QT group than in the HT group . In terms of stability , the mean side-to-side difference was 1.1 ± 0.9 mm for the QT group and 3.1 ± 1.3 mm for the HT group based on KT-1000 measurements ( P < .005 ) . The negative Lachman component was higher in the QT group than in the HT group ( 90 % vs 46 % , P < .005 ) . There was a trend for the negative pivot-shift component to be higher in the QT group than in the HT group ( 90 % vs 64 % , P = .052 ) . The Shelbourne-Trumper score was the same in both groups . There was no difference between groups in terms of isokinetic strength . Conclusion : The use of a QT graft in ACL reconstruction leads to equal or better functional outcomes than does the use of an HT graft , without affecting morbidity BACKGROUND There are no controlled , prospect i ve studies comparing the 10-year outcomes of anterior cruciate ligament ( ACL ) reconstruction using patellar tendon ( PT ) and 4-str and hamstring tendon ( HT ) autografts . HYPOTHESIS Comparable results are possible with HT and PT autografts . STUDY DESIGN Cohort study ; Level of evidence , 2 . METHODS One hundred eighty ACL-deficient knees that met inclusion criteria underwent ACL reconstruction ( 90 HT autograft , 90 PT autograft ) by one surgeon and were treated with an accelerated rehabilitation program . All knees were observed in a prospect i ve fashion with subjective , objective , and radiographic evaluation at 2 , 5 , 7 , and 10-year intervals . RESULTS At 10 years , there were no differences in graft rupture rates ( 7/90 PT vs. 12/90 HT , P = .24 ) . There were 20 contralateral ACL ruptures in the PT group , compared with 9 in the HT group ( P = .02 ) . In all patients , graft rupture was associated with instrumented laxity > 2 mm at 2 years ( P = .001 ) . Normal or near-normal function of the knee was reported in 97 % of patients in both groups . In the PT group , harvest-site symptoms ( P = .001 ) and kneeling pain ( P = .01 ) were more common than in the HT group . More patients reported pain with strenuous activities in PT knees than in HT knees ( P = .05 ) . Radiographic osteoarthritis was more common in PT knees than the HT-reconstructed knees ( P = .04 ) . The difference , however , was composed of patients with mild osteoarthritis . Other predictors of radiographic osteoarthritis were < 90 % single-legged hop test at 1 year and the need for further knee surgery . An " ideal " outcome , defined as an overall International Knee Documentation Committee grade of A or B and a radiographic grade of A at 10 years after ACL reconstruction , was associated with <3 mm of instrumented laxity at 2 years , the absence of additional surgery in the knee , and HT grafts . CONCLUSIONS It is possible to obtain excellent results with both HT and PT autografts . We recommend HT reconstructions to our patients because of decreased harvest-site symptoms and radiographic osteoarthritis Background : There is a lack of prospect i ve studies comparing the long-term outcome of endoscopic  anterior cruciate ligament ( ACL ) reconstruction  with either a patellar tendon or hamstring tendon autograft . Purpose : This prospect i ve longitudinal study compared the results of isolated endoscopic ACL reconstruction utilizing a 4-str and hamstring tendon ( HT ) or patellar tendon ( PT ) autograft over a 15-year period with respect to reinjury , clinical outcomes , and the development of osteoarthritis . Study Design : Cohort study ; Level of evidence , 2 . Methods : Ninety consecutive patients with isolated ACL rupture were reconstructed  with a PT autograft , and 90 patients received an HT autograft  , with an identical surgical technique . Patients were assessed at 2 , 5 , 7 , 10 , and 15 years . Assessment included the International Knee Documentation Committee ( IKDC ) knee ligament evaluation including radiographic evaluation , KT-1000 arthrometer testing , and Lysholm knee score . Results : Patients who received the PT graft had significantly worse outcomes compared with those who received the HT graft at 15 years for the variables of radiologically detectable osteoarthritis ( grade A : 46 % in PT and 69 % in HT ; P = .04 ) , motion loss ( extension deficit < 3 ° : 79 % in PT and 94 % in HT ; P = .03 ) , single-legged hop test ( grade A : 65 % in PT and 92 % in HT ; P = .001 ) , participation in strenuous activity ( very strenuous or strenuous : 62 % of PT and 77 % of HT ; P = .04 ) , and kneeling pain ( moderate or greater pain : 42 % of PT and 26 % of HT ; P = .04 ) . There was no significant difference between the HT and PT groups in overall IKDC grade ( grade A : 47 % of PT and 57 % of HT ; P = .35 ) . An ACL graft rupture occurred in 17 % of the HT group and 8 % of the PT group ( P = .07 ) . An ACL graft rupture was associated with nonideal tunnel position ( odds ratio [ OR ] , 5.0 ) and male sex ( OR , 3.2 ) . Contralateral ACL rupture occurred in significantly more PT patients ( 26 % ) than HT patients ( 12 % ) ( P = .02 ) and was associated with age ≤18 years ( OR , 4.1 ) and the PT graft ( OR , 2.6 ) . Conclusion : Anterior cruciate ligament reconstruction using ipsilateral autograft continues to show excellent results in terms of patient satisfaction , symptoms , function , activity level , and stability . The use of HT autograft does , however , show better outcomes than the PT autograft in all of these outcome measures . Additionally , at 15 years , the HT graft – reconstructed ACLs have shown a lower rate of radiological osteoarthritis Background : A number of studies have found comparable results after  anterior cruciate ligament ( ACL ) reconstruction with patellar tendon autografts and hamstring autografts ; however , few studies have been large enough to reveal differences in risk of revision with regard to clinical and demographic factors . Purpose : To present the distribution of grafts for ACL reconstruction based on data in the Sc and inavian ACL registries and to compare the risk of revision between patellar tendon autografts and hamstring autografts . Potential associations with other clinical and demographic factors were also explored . Study design : Cohort study ; Level of evidence , 2 . Methods : A total of 45,998 primary ACL reconstructions , including 6736 patellar tendon autografts and 38,666 hamstring autografts , were identified in the Sc and inavian ACL registries . The overall median follow-up time was 3 years ( range , 0 - 8 years ) . To compare the risk of revision between groups of patients , univariate Kaplan-Meier analysis ( with log-rank test ) and the Cox proportional hazard regression model were applied . The hazard rate ratio with 95 % CI was reported as a measure of effect . Results : Patellar tendon and hamstring autografts were used in 14.6 % and 84.1 % of the patients , respectively . The remaining patients received  allografts , direct sutures , or other graft types  ( 1.3 % ) . The primary ACL injury occurred during soccer , team h and ball , or alpine activities in 67.5 % of the patients in the patellar tendon group and 66.2 % in the hamstring group . A total of 156 patients in the patellar tendon group and 1042 patients in the hamstring group underwent revision . The overall risk of revision was significantly lower in the patellar tendon group versus the hamstring group ( hazard rate ratio = 0.63 ; 95 % CI , 0.53 - 0.74 ) , and it decreased with increasing age at surgery , although not strictly linearly . The lower risk of revision in the patellar tendon group was consistently observed across subgroups of patient sex , age , and concomitant cartilage injury ( P > .05 , test for interaction ) but seemed to be slightly more pronounced for patients injured during certain pivoting activities ( soccer , team h and ball , and alpine activities ) compared with other activities ( hazard rate ratio = 0.57 vs 0.81 ; P = .058 , test for interaction ) . Conclusion : The majority of primary  ACL reconstructions in Sc and inavia are performed with hamstring autografts . Results from the present large prospect i ve study show that patients receiving patellar tendon autografts  have a statistically significantly lower risk of revision compared with patients receiving hamstring autografts Abstract . This study documented postoperative morbidity during the first 4 months following  anterior cruciate ligament ( ACL ) reconstruction  using either patellar tendon or hamstring tendon autograft .  Sixty-five patients undergoing primary arthroscopically assisted single-incision ACL reconstruction  were r and omized to have a central third bone patellar tendon bone autograft ( PT ) or a doubled semitendinosus/doubled gracilis autograft ( HS ) . Postoperatively patients undertook a st and ard ' accelerated ' rehabilitation protocol . Patients were review ed after 2 weeks , 8 weeks , and 4 months . At each review the location and severity of general knee pain and the presence and severity of anterior knee pain ( AKP ) were recorded as were the presence and size of an effusion as well as the active and passive flexion and passive extension deficits compared to the contralateral limb . Pain on kneeling , KT-1000 measured side to side difference in anterior tibial displacement , isokinetic assessment of quadriceps and hamstring peak torque deficits , IKDC score and Cincinnati sports activity level were also recorded after 4 months . After 2 weeks more patients in the PT group complained of AKP and reported that the pain was more severe . After 8 weeks there was no significant difference between the groups for any variable . After 4 months the severity of general pain experienced and the incidence of pain on kneeling were greater in the PT group . The PT group also demonstrated a significantly greater quadriceps peak torque deficit at 240 ° /s . IKDC scores were higher in the HS group , but Cincinnati sports activity scores were higher in the PT group . Although we observed a lower morbidity in the HS group , primarily related to pain , the severity of pain in both groups was relatively low and , in light of the higher mean sports activity level observed in the PT group at 4 months the clinical impact of the difference may not be significant UNLABELLED The patellar and semitendinosus tendon autograft are the two most common techniques that orthopedic surgeons use to reconstruct the anterior cruciate ligament ( ACL ) . It has not been established , however , whether either of these techniques provides a greater functional advantage to the patient . PURPOSE To identify patients ' functional capabilities after reconstruction of the ACL with a patellar or semitendinosus tendon autograft . METHODS Forty male soccer players volunteered for the study and were assigned to three homogeneous groups : individuals who had patellar tendon reconstruction ( N = 15 ) , individuals who had semitendinosus tendon reconstruction ( N = 15 ) , and a control group ( N = 10 ) . All patients had undergone surgery 2 yr before this study and received the same  rehabilitation training . The testing procedures included measurement of thigh circumference , maximal isometric strength of quadriceps and hamstrings , two- and one-legged jump , squat and gait analysis . Kinetic , kinematic , and electromyographic data were collected . RESULTS The patellar tendon group exhibited lower ( P < 0.05 ) coactivation of the agonist and antagonist muscles around the knee joint during the squat movement and lower stabilization- and l and ing degrees during the jumps . Furthermore , the patellar tendon group had a shorter stance phase and reached the first vertical maximum later with the impaired leg while walking ( 720.2 + /- 15.6 ms vs 740.3 + /- 14.3 ms , and 24.3 + /- 0.64 % vs 22.9 + /- 0.74 % of stance phase ) , which was not observed in the semitendinosus tendon and control groups . CONCLUSION Functional performance is compromised in patients who undergo a patellar tendon graft compared with a semitendinosus graft , possibly due to an altered activation of the quadriceps and hamstring muscles Hamstring muscles play a major role in knee-joint stabilization after anterior cruciate ligament ( ACL ) injury . Weakness of the knee extensors after ACL reconstruction with patellar tendon ( PT ) graft , and in the knee flexors after reconstruction with hamstring tendons ( HT ) graft has been observed up to 2 years post surgery , but not later . In these studies , isokinetic muscle torque was used . However , muscle power has been suggested to be a more sensitive and sport-specific measures of strength . The aim was to study quadriceps and hamstring muscle power in patients with ACL injury treated with surgical reconstruction with PT or HT grafts at a mean of 3 years after surgery . Twenty subjects with PT and 16 subjects with HT grafts ( mean age at follow up 30 years , range 20–39 , 25 % women ) , who were all included in a prospect i ve study and followed the same goal -based rehabilitation protocol for at least 4 months , were assessed with reliable , valid , and responsive tests of quadriceps and hamstring muscle power at 3 years ( SD 0.9 , range 2–5 ) after surgery . The mean difference between legs ( injured minus uninjured ) , the hamstring to quadriceps ( H : Q , hamstring divided by quadriceps ) ratio , and the limb symmetry index ( LSI , injured leg divided by uninjured and multiplied by 100 ) value , were used for comparisons between the groups ( analysis of variance ) . The mean difference between the injured and uninjured legs was greater in the HT than in the PT group for knee flexion power ( –21.3 vs. 7.7 W , p = 0.001 ) . Patients with  HT graft had lower H : Q ratio in the injured leg than the patients with PT graft ( 0.63 vs. 0.77 , p = 0.012 ) . They also had lower LSI for knee flexion power than those in the PT group ( 88 vs. 106 % , p < 0.001 ) . No differences were found between the groups for knee extension power . The lower hamstring muscle power , and the lower hamstring to quadriceps ratio in the HT graft group than in the PT graft group 3 years ( range 2–5 ) after ACL reconstruction , reflect imbalance of knee muscles after reconstruction with HT graft that may have a negative effect on dynamic knee-joint stabilization Hamstring autograft harvest for ACL reconstruction may have an effect on hip extension strength and this may be important especially in sports that involve high speed running such as soccer , rugby , American football and the sprint disciplines of track and field . This aspect of hamstring tendon harvesting has not been looked at before . We have performed a non-r and omised prospect i ve case control study comparing isokinetic hip extension strength following four str and semitendinosus and gracilis tendons ( 4SHS ) and bone-patellar tendon-bone ( BPTB ) autografts in ACL reconstruction .  Isokinetic hip extension was assessed at 3 and 12 months post-operatively using a Kin-Com machine at a speed of 30 degrees per second . Three months post-operatively there was a significant decrease ( p<0.05 ) in the peak force of concentric hip extension in the 4SHS group . There was no evidence that hip extension is weaker following ACL reconstruction with 4SHS tendon autograft than ACL reconstruction with BPTB autograft at 12 months post-operatively . We find no contra-indication to the use of 4SHS tendon autografts in ACL reconstruction in patients who wish to preserve hip extension strength for their sporting activities Objective To identify the approaches to management of anterior cruciate ligament ( ACL ) injury by Canadian orthopedic surgeons . Methods A question naire was mailed to 234 physicians r and omly chosen from the Canadian Orthopaedic Association directory to obtain the following information : 1 ) how orthopaedic surgeons diagnose acute hemarthroses ; 2 ) how patients in any of three common ACL injury scenarios would be managed ; 3 ) what variations exist in surgical technique ; and 4 ) how patient variables such as age , gender , and alignment influence the decision-making process . Results The return rate was 72 % , and 56 % of respondents were from academic centers . Patients such as those described in the protocol are routinely managed by 80 % of the respondents . The diagnosis of acute hemarthrosis is predominantly made by means of clinical examination and radiographs . Magnetic resonance imaging ( MRI ) is used occasionally by 43 % and routinely by 6 % of those who responded ; arthroscopy is used routinely by 24 % . For the competitive athlete with a complete ACL tear , 64 % would recommend reconstruction and 33 % would recommend bracing and rehabilitation . For reconstruction , 59 % would use bone – patellar tendon – bone ( B-PT-B ) autograft and 32 % would use hamstring tendon autograft ; 40 % would incorporate the ACL stump during reconstruction . Of the respondents , 77 % would advocate ACL reconstruction for competitive athletes with chronic ACL injury . Of these , 63 % would use B-PT-B autograft and 27 % would use  hamstring tendons .  If bracing and rehabilitation failed , 98 % would recommend  ACL reconstruction . In ACL reconstruction , synthetic augmentation would be used by 12 % in chronic cases and by 16 % in acute cases . In making the decision to perform ACL reconstruction , 53 % consider limb alignment to be important and 67 % consider moderate patellofemoral pain to be important . Seventy-one percent are influenced by patellofemoral pain when choosing a surgical technique , with a trend toward semitendinosis autograft rather than B-PT-B autograft reconstruction . For the 8-year-old child with an acute ACL injury , 63 % of the respondents would recommend rehabilitation and bracing . For the 14-year-old , 45 % would recommend rehabilitation and bracing and 37 % would recommend ACL reconstruction after physeal closure . Conclusion The results of the survey indicate that , with respect to some of the issues , there is a wide variation in management of acute and chronic ACL injuries among Canadian orthopedic surgeons . Future research and r and omized , controlled clinical trials should be directed toward these areas Objective : To compare 3 anatomically positioned autografts for anterior cruciate ligament ( ACL ) reconstruction , by measuring patient-reported disease-specific quality of life at 2 years postoperatively . Design : Double-blinded , r and omized clinical trial with intraoperative computer-generated treatment allocation . Patients and an independent trained evaluator were blinded . Setting : University-based orthopedic referral practice . Patients : Three hundred thirty patients ( 14 - 50 years ; 183 male patients ) with isolated ACL deficiency were equally r and omized to : ( 1 ) patellar tendon , PT : 28.7 years ( SD = 9.7 ) ; ( 2 ) quadruple-str and ed hamstring tendon , HT : 28.5 years ( SD = 9.9 ) ; and ( 3 ) double bundle using HT , DB : 28.3 years ( SD = 9.8 ) ; 322 patients completed 2-year follow-up . Intervention : Anterior cruciate ligament reconstruction using PT , HT , or DB autografts . Main Outcome Measures : Measured at baseline , 1 and 2 years postoperatively— primary : anterior cruciate ligament quality -of-life scores ; secondary : International Knee Documentation Committee ( IKDC ) scores , KT-1000 arthrometer , pivot shift , range of motion , Tegner activity , Cincinnati Occupational Scale , and single-leg hop . Proportions of correct graft type guesses by the patients and evaluator assessed blinding effectiveness . Results : Baseline characteristics were not different . Anterior cruciate ligament quality -of-life scores increased over time for all groups ( P = 0.001 ) but were not different at 2 years ( P = 0.591 ) : PT = 84.6 ( SD = 16.6 , 95 % confidence interval [ CI ] = 81.4 - 87.8 ) , HT = 82.5 ( SD = 17.7 , 95 % CI = 79.2 - 85.9 ) , and DB = 82.4 ( SD = 17.5 , 95 % CI = 79.1 - 85.7 ) . Two-year KT-1000 side-to-side differences ( PT = 1.86 mm ; HT = 2.97 mm ; DB = 2.65 mm ) were statistically significant between PT – HT ( P = 0.002 ) and PT – DB ( P = 0.044 ) . The remaining secondary outcomes were not statistically different . Correct graft type guesses occurred 51 % of the time for patients and 46 % for the evaluator . Conclusions : Two-year disease-specific quality -of-life outcome was not different between the ACL reconstruction techniques . The PT reconstructions had significantly lower side-to-side differences on static stability measures . Patient and evaluator blinding was achieved . Level of Evidence : Level 1 ( Therapeutic Studies ) . Clinical Relevance : This high- quality , large , double-blind r and omized clinical trial ( RCT ) addresses the insufficient evidence in the literature comparing PT , single-bundle hamstring , and DB hamstring reconstructions for ACL rupture in adults . In addition to the clinical and functional results , this RCT uniquely reports on the disease-specific , patient-reported quality -of-life outcome at 2 years postoperatively BACKGROUND The comparison between HT and QT grafts in strength recovery and function  after an ACLR is scarce in the literature . METHODS A total of 56 participants were enrolled in this r and omized controlled trial and placed into two groups : HT or QT .  The hamstring/quadriceps ( H/Q ) ratio was the primary end-point measured with a Genu-3 dynamometer . Peak torque , functional assessment ( Lysholm knee scoring scale and Cincinnati Knee Rating System ) , and anteroposterior laxity ( KT-2000 ™ arthrometer ) were also assessed . An intention-to-treat analysis was performed . RESULTS The results of the H/Q ratio analysis of the participants over time revealed significant differences at 60 , 180 , and 300 ° /s at three , six , and 12months of follow-up ( 60 ° /s : F=5.3 , p=0.005 ; 180 ° /s : F=5.5 , p=0.004 ; 300 ° /s : F=5.1 , p=0.005 ) . Furthermore , they revealed significant differences at 60 ° /s , 180 ° /s , and 300 ° /s in the participants over time for peak torque in the extensor muscle strength at three and six months of follow-up , with higher values in the hamstring tendon group but not at 12months of follow-up . There were no significant differences in functional endpoints or arthrometer assessment s at 24months of follow-up . CONCLUSION An ACLR with a QT graft showed similar functional results with a better isokinetic H/Q ratio compared to an ACLR with the HT at 12months of follow-up in soccer players . This higher H/Q ratio observed with the QT could be an advantage of this graft over the HT for an ACLR Background : Short-term and mid-term differences between hamstring and patellar tendon autografts for anterior cruciate ligament ( ACL ) reconstruction are well documented . Systematic review s highlight the lack of long-term results between the two grafts . Hypothesis : Seventeen years after ACL reconstruction , no difference will be found in functional outcome , quality of life , and graft failure between patients with patellar tendon ( PT ) or semitendinosus and gracilis tendon ( STG ) autografts ;  however , a significant difference will be seen in the prevalence of osteoarthritis . Study Design : R and omized controlled trial ; Level of evidence , 2 . Methods : Sixty-four patients were included in this prospect i ve study ( 32 in each group ) . A single surgeon performed primary ACL reconstruction in alternating sequence . Forty-eight patients ( 24 in each group ) were evaluated 17 years after ACL reconstruction :  A clinical assessment was made based on the International Knee Documentation Committee ( IKDC ) form , instrumented laxity was measured with KT-1000 arthrometer , and radiography of the operated knee was conducted and assessed for degenerative disease . The Lysholm question naire and the Short Form–36 version 2 question naire were filled out by the patients . Results : At the 17-year follow-up , no statistically significant differences were seen with respect to graft failure ( 2 reruptures in the semitendinosus and gracilis tendon [ STG ] group [ 6.3 % ] and 3 reruptures in the PT group [ 9.4 % ] ) and functional outcome . Increased instrumented laxity ( > 3 mm ) measured with KT-1000 arthrometer was seen in significantly more patients in the STG group ( 8 in the STG group compared with 2 in the PT group ; P = .03 ) with a mean side-to-side difference of 2.17 ± 1.86 mm in the STG group compared with 1.33 ± 1.93 mm in the PT group . A significant difference was found in frequency of knee osteoarthritis (OA)—100 % in the PT group compared with 71 % in the STG group ( P = .004 ) . Patients in the PT group tended to have higher grade OA according to the IKDC grading system , with an average grade of 1.46 in the PT group compared with 1 in the STG group ( P = .055 ) . The degenerative changes in the PT group were more common in the medial and patellofemoral compartments ( P = .003 and P = .04 , respectively ) . Conclusion : Both autografts provided good to excellent subjective outcomes . No significant differences were noted in graft failure and clinical instability . However , significantly more patients in the STG group had increased instrumented anteroposterior translation measured with KT-1000 arthrometer , and there was a greater prevalence of knee OA at 17 years after surgery in the PT group Objective : To evaluate the predictive factors for traumatic rerupture , reinjury , and atraumatic graft failure of anterior cruciate ligament ( ACL ) reconstruction at a minimum 2-year follow-up . Design : Double-blind r and omized clinical trial ( RCT ) with intraoperative computer-generated allocation . Setting : University-based orthopedic referral practice . Patients : Three hundred thirty patients with isolated ACL deficiency were equally r and omized to ( 1 ) patellar tendon ( PT ; mean , 29.2 years ) , ( 2 ) quadruple-str and ed hamstring tendon ( HT ; mean , 29.0 years ) , and ( 3 ) double bundle using HT ( DB ; mean , 28.8 years ) . Three hundred twenty-two patients completed 2-year follow-up . Interventions : Anatomically positioned primary ACL reconstruction with PT , HT , and DB autografts . Main Outcome Measures : Proportions of complete traumatic reruptures , traumatic reinjuries ( complete reruptures and partial tears ) , atraumatic graft failures , and contralateral ACL tears . Logistic regression assessed 5 a priori determined independent predictors : chronicity , graft type , age , sex , and Tegner level . Results : More complete traumatic reruptures occurred in the HT and DB groups : PT = 3 ; HT = 7 ; DB = 7 ( P = 0.37 ) . Traumatic reinjuries statistically favored PT reconstructions : ( PT = 3 ; HT = 12 ; DB = 11 ; P = 0.05 ) . Atraumatic graft failures were not different : PT = 16 ; HT = 17 ; DB = 20 ( P = 0.75 ) . Younger age was a significant predictor of complete traumatic reruptures and traumatic reinjuries ( P < 0.01 ) . Higher activity level , males , and patients with HT , DB , and acute reconstructions had greater odds of reinjury . None of these factors reached statistical significance . Contralateral ACL tears were not different between groups , but trends suggested that younger females were more likely to have a contralateral ACL tear . Conclusions : More traumatic reinjuries occurred with HT and DB grafts . Younger age was a predictor of complete traumatic rerupture and traumatic reinjury , irrespective of graft type . Level of Evidence : Level 1 ( Therapeutic Studies ) . Clinical Relevance : This article describes the complete traumatic graft rerupture , partial traumatic ACL tear , atraumatic graft failure , and contralateral ACL tear rates observed at 2 years postoperatively in a large double-blind RCT comparing PT , single-bundle hamstring , and double-bundle hamstring ACL reconstructions . The odds and predictive factors of traumatic rerupture and reinjury are also evaluated We prospect ively studied knee proprioception  following ACL reconstruction in 40 patients ( 34 men and six women ; mean age 31 years ) . The patients were allocated into two equal groups ; group A underwent reconstruction using hamstrings autograft , and group B underwent reconstruction using bone-patellar tendon-bone autograft . Proprioception was assessed in flexion and extension by the  joint position sense ( JPS )  at 15 ° , 45 ° and 75 ° , and  time threshold to detection of passive motion ( TTDPM ) at 15 ° and 45 ° , preoperatively and at 3 , 6 and 12 months postoperatively . The contralateral healthy knee was used as internal control . No statistical difference was found between the ACL-operated and the contralateral knees in JPS 15 ° , 45 ° and 75 ° at 6 and 12 months , in both study groups . No statistical difference was found between the ACL-operated and the contralateral knees in TTDPM 15 ° at 6 and 12 months , nor regarding TTDPM 45 ° at 3 , 6 and 12 months , in group A. No statistical difference was found in JPS and TTDPM between the two grafts , at any time period . Knee proprioception returned to normal with ACL reconstruction at 6 months postoperatively , without any statistically significant difference between the autografts used Radiographic tibial and femoral bone tunnel enlargement has been demonstrated following anterior cruciate ligament ( ACL ) reconstruction . This study investigated whether bone tunnel enlargement differs between  four-str and hamstring ( HS ) and patellar tendon ( PT ) ACL reconstructions  over the course of a 2-year follow-up . Patients undergoing primary ACL reconstruction ( n=65 ) were r and omised to receive either a  PT or HS autograft .  Femoral fixation in both groups was by means of an Endobutton . On the tibial side the PT grafts were fixed using a metallic interference screw , and the HS tendons by sutures tied to a fixation post . The PT grafts were inserted such that the proximal end of the distal bone block was within 10 mm of the tibial articular surface , result ing in a portion of free patellar tendon in the femoral tunnel immediately proximal to the articular surface . Patients were review ed after 4 months and 1 and 2 years . Tunnel enlargement was determined by measuring the widths of the femoral and tibial tunnels with a digital caliper in both lateral and anteroposterior radiographs . Because of the presence of the interference screw and the proximity of the bone block to the tibial articular surface , the tibial tunnel could not be reliably measured in the PT group . Measurements were corrected for magnification , and changes in tunnel width were recorded relative to the diameters drilled at surgery . St and ard clinical measures were also noted . In 32 % of patients in the PT group there was femoral tunnel obliteration from 4 months onwards . For the other patients there was a significantly greater increase in femoral tunnel width in the HS group than in the PT group at each follow-up , but no significant change with time . There was also a marked increase in tibial tunnel width in the HS group at 4 months but not thereafter . There was no relationship between tunnel enlargement and clinical measurements . Although tunnel enlargement is more common and greater with HS grafts , it does not appear to affect the clinical outcome in the first 2 postoperative years . Femoral suspensory fixation does not in itself appear to be the principal cause of femoral tunnel enlargement , at least for PT grafts PURPOSE Patellar tendon and hamstrings are both used in anterior cruciate ligament ( ACL ) reconstruction , and comparisons have been reported with different results . The purpose of this clinical study was to compare the results of  ACL reconstruction in athletes with 2 different graft types , both using bone-to-bone healing : bone-patellar tendon-bone graft and a quadrupled bone-semitendinosus graft . TYPE OF STUDY Outcomes study . METHODS From 1994 to 1997 , 2 groups of 40 athletes who underwent ACL replacement with patellar tendon and quadrupled bone-semitendinosus grafts were prospect ively evaluated . Preinjury activity level , age , and gender were comparable in both groups . All patients were operated on by the same surgeon within 5 months from injury and underwent group-specific rehabilitation programs . An independent examiner performed the final evaluations at 36 months . Review included clinical examination , radiographs , computed analysis , isokinetic and functional strength tests , and subjective and objective evaluation with st and ard knee scores . Additional procedures were recorded . Statistical analysis was performed with both parametric and nonparametric tests . RESULTS Average surgical time was longer with the semitendinosus graft , and postoperative pain was higher in the patellar tendon group . St and ard knee evaluation scores and subjective assessment revealed no significant differences . Isokinetic testing of flexion-extension and internal-external rotation showed lower quadriceps strength and a mild deficit of external rotation in the patellar tendon group and slightly lower flexor strength in the semitendinosus group at 12 months . Computerized laxity analysis showed no difference between the 2 groups with 90 % of patients having less than 3 mm side-to-side difference , with a gender difference in the semitendinosus group . Kneeling pain was higher in patellar tendon group . CONCLUSIONS The bone-patellar tendon-bone and quadrupled bone-semitendinosus autograft provide excellent grafts for ACL reconstruction . Both techniques are comparable regarding final stability , but in patients with extensor mechanism problems or those who engage in sports with a high incidence of patellar tendonitis , the semitendinosus graft should be considered Background : There are still controversies about graft selection for  primary anterior cruciate ligament reconstruction .  Prospect i ve , r and omized long-term studies are needed to determine the differences between the graft material s. Hypothesis : Eleven years after anterior cruciate ligament reconstruction  there is no difference in functional outcome and quality of life between patients with patellar tendon or hamstring tendon autografts ; however , the patients with patellar tendon autograft would have a higher prevalence of osteoarthritis . Study Design : R and omized controlled trial ; Level of evidence , 2 . Methods : From June 1999 to March 2000 , 64 patients were included in this prospect i ve study . A single surgeon performed primary arthroscopically assisted anterior cruciate ligament reconstruction  in an alternating sequence . In 32 patients ,  anterior cruciate ligament reconstruction was performed with hamstring tendon autograft ( semitendinosus and gracilis [ STG ] group ) while in the other 32 patients the reconstruction was performed with patellar tendon autograft ( PT group ) . Results : At the 11-year follow-up , no statistically significant differences were seen with respect to the Lysholm score and Short Form-36 , KT-1000 arthrometer laxity testing , anterior knee pain , single-legged hop test , or International Knee Documentation Committee ( IKDC ) classification results . Positive pivot-shift test ( 1 + ) was significantly more frequent in the PT group ( P = .036 ) . Twenty-two patients ( 81 % ) in the STG group and 18 patients ( 72 % ) in the PT group were still at their preinjury level of activity . Graft rupture occurred in 2 patients from the STG group ( 6 % ) and in 4 patients from the PT ( 12 % ) . Grade B and C abnormal radiographic findings were seen in 84 % ( 21 of 25 ) of patients in the PT group and in 63 % ( 17 of 27 ) of patients in the STG group ( P = .008 ) . Conclusion : Both hamstring and patellar tendon autografts provided good subjective outcomes and objective stability at 11 years . Positive pivot-shift test ( 1 + ) was significantly more frequent in the PT group . No significant differences in the rate of graft failure were identified . Patients with patellar tendon graft had a greater prevalence of osteoarthritis at 11 years after surgery Purpose . To compare the results of  anterior cruciate ligament ( ACL ) reconstructions  using either a patella-tendon autograft or a semitendinosus-tendon autograft . Methods . Based on surgeon experience and preference , 68 patients underwent ACL reconstruction using either a quadruple-str and semitendinosus autograft  ( n=34 )  or a central one-third bone-patella tendon-bone autograft  ( n=34 ) . Each patient was assessed preoperatively and postoperatively at 3 , 6 , and 24 months using the International Knee Documentation Committee ( IKDC ) knee score , Biodex muscle strength and endurance testing , and the KT1000 instrumented arthrometer test of knee laxity to anterior translation . All assessment s at the 2-year follow-up were performed by the same physician and physiotherapist . Results . While ACL reconstruction improved knee stability and IKDC knee scores significantly , there was no statistically significant difference between semitendinosus- and patella-tendon autograft reconstructions in terms of long-term knee score or laxity to anterior translation .  Semitendinosus graft reconstruction was associated with less donor-site morbidity and hamstring weakness . Meniscectomy was associated with poorer long-term knee scores . Conclusion . ACL reconstruction is associated with a significantly better IKDC knee score and laxity measurement at 2-year follow-up . However , we were unable to demonstrate a significantly better long-term outcome in knee score or laxity to anterior translation with either a patella-tendon autograft or a semitendinosus-tendon autograft The purpose of the study was to compare the hamstring and quadriceps isokinetic results 6 months postoperatively in patients having patellar tendon or hamstring anterior cruciate ligament ( ACL ) reconstruction . The study group was comprised of 106 r and omly selected patients who had ACL reconstruction with either autogenous patellar tendon ( PT ) , semitendinosus ( ST ) , or semitendinosus and gracilis ( ST/G ) .  Hamstring and quadriceps isokinetic strength  were assessed at 180 degrees/sec and 300 degrees/sec with the results of the operatively treated leg expressed as a percent compared with the nonoperative leg . The mean results for knee extension at 180 degrees/sec were 68.3 % , 74.3 % , and 78.1 % ; and at 300 degrees/sec were 70.7 % , 76.7 % , and 81.7 % for PT , ST , and ST/G , respectively . The mean results for knee flexion at 180 degrees/sec were 86.1 % , 80.6 % , and 81.7 % ; and at 300 degrees/sec were 77.6 % , 79.1 % , and 75.6 % for PT , ST , and ST/G , respectively . No statistically significant differences were found in regard to knee extension or flexion strength when evaluating the different tissue sources . The results show that selection of autogenous hamstring or PT used for ACL reconstruction should not be based solely on the assumption of the tissue source altering the recovery of quadriceps and /or hamstring strength . In addition , a majority of the patients had not achieved adequate strength to safely partake in unlimited activities at 6 months postoperatively Abstract In a prospect i ve study on ACL reconstruction we treated 17 patients with a " central third-bone-patellar tendon-bone " autograft ( PT group ) and 32 patients with a doubled semitendinosus/doubled gracilis autograft ( HS group ) . Patients were review ed at 6 weeks , and at 3 , 6 , and 12 months postoperatively and the groups compared . Up till 6 months , the KT-1000 side-to-side difference was significantly greater in the HS group ( P<0.05 ) and at 6 and 12 months isokinetic hamstrings strength was lower ( P<0.05 ) . No significant differences were noted at any stage with respect to quadriceps strength , functional scores , range of motion , or swelling . Résumé . Dans une étude prospect i ve de la reconstruction du ligament croisé antérieur nous avons traité 17 patients avec un transplant rotulien os-tendon-os ( PT Groupe ) et 32 patients avec une autogreffe de tendon gracilis doublé et semitendineux doublé ( HS Groupe ) . Les Patients ont été examinés à 6 semaines , et à 3 , 6 , et 12 mois postopératoires . Jusqu'à 6 mois , les KT-1000 comparatifs des deux cotés étaient significativement plus gr and s dans le groupe HS ( P<0.05 ) et à 6 et 12 mois la force isocinetique des tendons ischio jambiers était inférieure ( P<0.05 ) . Aucune différence notable n'a été notée en ce qui concerne la force du quadriceps , les scores fonctionnels , la mobilité ou les épanchements articulaires Purpose The purpose of this study was to compare subjective , objective and radiographic outcome of the lateralized single-bundle bone-patellar tendon-bone autograft with a non-anatomical double-bundle hamstring tendons autograft anterior cruciate ligament ( ACL ) reconstruction technique at long-term follow-up . Methods Seventy-nine non-consecutive r and omized patients ( 42 men ; 37 women ) with unilateral ACL insufficiency were prospect ively evaluated , before and after ACL reconstruction by means of the above-mentioned techniques , with a minimum follow-up of 8 years ( range 8–10 years ; mean 8.6 years ) . In the double-bundle hamstrings technique , we used one tibial and one femoral tunnel combined with one “ over-the-top ” passage , cortical staple ’s fixation and we left intact hamstrings ’ tibial insertion . Patients were evaluated subjectively and objective ly , using IKDC score , Tegner level , manual maximum displacement test with KT-2000 ™ arthrometer . Radiographic evaluation was performed according to IKDC grading system , and re-intervention rate for meniscal lesions was also recorded . Results The subjective and objective IKDC were similar in both groups while double-bundle hamstrings group showed significantly higher Tegner level ( P = 0.0007 ) , higher passive range of motion recovery ( P = 0.0014 ) , faster sport resumption ( P = 0.0052 ) , lower glide pivot-shift phenomenon ( P = 0.0302 ) and lower re-intervention rate ( P = 0.0116 ) compared with patellar tendon group . Radiographic evaluation showed significant lower objective degenerative changes in double-bundle hamstrings group at final follow-up ( P = 0.0056 ) . Conclusion Although both techniques provide satisfactory results , double-bundle ACL reconstruction shows better functional results , with a faster return to sport activity , a lower re-operation rate and lower degenerative knee changes PURPOSE To compare the results and outcome of  anterior cruciate ligament ( ACL ) reconstruction  using autogenous hamstring tendon versus fresh-frozen allograft anterior tibialis tendon . METHODS A prospect i ve r and omized study was conducted from September 2002 to October 2006 . We r and omized 147 patients to undergo ACL reconstruction with either autogenous hamstring or fresh-frozen allograft anterior tibialis tendon .  Of these patients , 102 ( 69 % ) completed a minimum of 2 years ' follow-up . There were 54 patients in the hamstring group ( 73 % of those originally enrolled in the group ) and 48 patients in the allograft group ( 66 % ) . All patients underwent st and ardized subjective and objective evaluation with functional outcome assessment s ( International Knee Documentation Committee [ IKDC ] ) , and st and ardized radiographs were also obtained . RESULTS The mean age was 32.0 years for the autograft group and 33.3 years for the allograft group . There was no difference in stability between the 2 groups ( P > .05 ) . The mean IKDC subjective score was 91.0 for the autograft group and 90.9 for the allograft group ( P > .05 ) . The functional IKDC scores for the autograft group were normal in 46 patients ( 85 % ) , nearly normal in 7 patients ( 13 % ) , and severely abnormal in 1 patient . For the allograft group , the functional IKDC scores were normal in 43 patients ( 90 % ) and nearly normal in 5 ( 10 % ) ( P > .05 ) . There were 4 reoperations in the allograft group and 3 reoperations in the autograft group . No patient underwent revision ACL surgery or planned to undergo revision surgery because of instability in either group during the study period despite the 1 patient in the autograft group with a pivot shift and a maximum manual KT measurement ( MEDmetric , San Diego , CA ) of 5 mm . CONCLUSIONS The use of fresh-frozen anterior tibialis allograft ( non-treated ) for ACL reconstruction produced similar subjective and functional outcomes at 24 months ' minimal follow-up compared with patients undergoing ACL reconstruction with autograft hamstring tendon . LEVEL OF EVIDENCE Level II , prospect i ve comparative study
The QT autograft detected comparable rate of Lachman test > 3 mm , Pivot shift test > 3 m and instrumental laxity > 3 mm .
The QT autograft showed a lower rate of autograft failure above all .
The QT autograft detected the reduced rate of AKP than the PT .
Quadriceps tendon autograft may represent a feasible option for primary ACL reconstruction .
The purpose of the current study was to clarify the role of the quadriceps tendon ( QT ) autograft for primary ACL reconstruction .
Thus , a Bayesian network meta- analysis comparing patients undergoing a primary ACL reconstruction with QT versus patellar tendon ( PT ) and hamstring tendon ( HT ) autografts  was conducted .