Published May 30, 2020 | Version 4.1
Journal article Open

Kneeling Assessment after Anterior Cruciate Ligament Reconstruction Using Bone-Patellar Tendon-Bone Autograft versus Hamstring Autograft

Authors/Creators

  • 1. Orthopedic Surgery Department, Dammam medical complex, Dammam, Saudi Arabia
  • 2. Orthopedic Surgery Department, King Fahd Hospital Hofuf, Ahsa, Saudi Arabia
  • 3. Orthopedic Surgery Department, King Faisal University, Ahsa, Saudi Arabia

Description

Background: ACL reconstruction surgeries is a common surgery that aim to provide stability and return functionality post ACL injury. Commonly, bone patellar tendon-bone (BPTB) and hamstring tendon autografts are used for the reconstruction. The choice of optimal autograft remains debatable to achieve satisfactory outcomes for various activities after reconstruction, including kneeling as widely needed, especially in prayers among Muslims. Kneeling with considerable ranges of motion and the minimum level of pain is still under rigorous investigations to choose proper autograft.

Purpose: Hereby, we compare kneeling outcomes post-operatively using bone-patellar tendon-bone autografts with hamstring autografts for ACL reconstruction.

Methods: A retrospective cohort study; Level of evidence (III) has enrolled. Adult patients underwent primary ACL reconstruction using either BPTB or HS autografts after they consented at a single institution with a minimum of 1-year as follow-up post-operatively were reviewed for assessment of the surgery’s outcomes in regards of kneeling pain and subjective assessment measures using International Knee Documentation Committee (IKDC) evaluation system.

Results: A total of Thirty-two males were met our inclusion criteria. Analysis of data provided that 12 patients were in the BPTB group and 20 patients in the HS group. All patients show ACL rupture was sustained during participation in the athletic activity. After a follow-up of 1-year, there was no statistically significant difference between scores of two groups when comparing patient-reported outcome measures, with mean IKDC scores of 68.5 and 62.55 in the BPTB and HS groups, respectively. Interestingly, insignificant statistical differences observed in both groups regarding kneeling pain in the BPTB group when compared with the HS group.

Conclusion: The findings of our study have shown that Arthroscopic ACL reconstruction using either hamstring autograft or bone patellar tendon autograft ends with equally reasonable satisfactory outcomes, with an insignificant difference in kneeling pain between both groups.

Files

SRORTR-04-0075.pdf

Files (307.8 kB)

Name Size
md5:eb4abffecd46cf47dfde0c827ae728f3
307.8 kB Preview Download

Additional details

References

  • 1. Miyasaka KC. et al. "The incidence of knee ligament injuries in the general population". The American journal of knee surgery 4 [1991]: 3-8.
  • 2. Fithian DC. et al. "Fate of the anterior cruciate ligament-injured knee". Orthopedic Clinics of North America 33.4 [2002]: 621-36.
  • 3. P Chambat., et al. "The evolution of ACL reconstruction over the last fifty years". International Orthopaedics 37.2 [2013]: 181-186.
  • 4. Poehling KL., et al. "Long-Term Outcomes in Anterior Cruciate Ligament Reconstruction: A Systematic Review of Patellar Tendon Versus Hamstring Autografts". Orthopaedic Journal of Sports Medicine 5.6 [2017]: 2325967117709735.
  • 5. Pinczewski LA., et al. "A 10-year comparison of anterior cruciate ligament reconstructions with hamstring tendon and patellar tendon autograft: A controlled, prospective trial". American Journal of Sports Medicine 35.4 [2007]: 564-574.
  • 6. KP Spindler., et al. "Anterior cruciate ligament reconstruction autograft choice: bone-tendon-bone versus hamstring: does it really matter? A systematic review". American Journal of Sports Medicine 32.8 [2004]:1986-1995.
  • 7. Lidén M., et al. "Patellar tendon or semitendinosus tendon autografts for anterior cruciate ligament reconstruction: a prospective, randomized study with a 7-Year follow-up". The American Journal of Sports Medicine 35.5 [2007]: 740-748.
  • 8. Thompson S., et al. "Twenty-year outcomes of a longitudinal prospective evaluation of isolated endoscopic anterior cruciate ligament reconstruction with patellar tendon autografts". The American Journal of Sports Medicine 43.9 [2015]: 2164-2174.
  • 9. Boonstra AM., et al. "Cut-off points for mild, moderate, and severe pain on the visual analogue scale for pain in patients with chronic musculoskeletal pain". Pain 155.12 [2014]: 2545e2550.
  • 10. Vaishya R., et al. "Current trends in anterior cruciate ligament reconstruction: a review". Cureus 7.11 [2015] : e378.
  • 11. Katabi M., et al. "Anterior cruciate ligament reconstruction: patellar tendon autograft versus four-strand hamstring tendon autografts. A comparative study at one-year follow-up". Rev Chir Orthop Reparatrice Appar Mot 88.2 [2002]: 139-148.
  • 12. Persson A., et al. "Increased risk of revision with hamstring tendon grafts compared with patellar tendon grafts after anterior cruciate ligament reconstruction: a study of 12,643 patients from the Norwegian Cruciate Ligament Registry, 2004- 2012". American Journal of Sports Medicine 42 [2014]: 285-291.
  • 13. Magnussen RA., et al. "Does autograft choice determine intermediate-term outcome of ACL reconstruction?" Knee Surgery, Sports Traumatology, Arthroscopy 19.3 [2011]: 462-472.
  • 14. Maletis GB., et al. "A prospective randomized study of anterior cruciate ligament reconstruction: a comparison of patellar tendon and quadruple-strand semitendinosus/gracilis tendons fixed with bioabsorbable interference screws". American Journal of Sports Medicine 35.3 [2007]: 384-394.
  • 15. Romanini E., et al. "Graft selection in arthroscopic anterior cruciate ligament reconstruction". Journal of Orthopaedics and Traumatology 11.4 [2010]: 211-219.
  • 16. West RV and Harner CD. "Graft selection in anterior cruciate ligament reconstruction". The Journal of the American Academy of Orthopaedic Surgeons 13.3 [2015]: 197-207.
  • 17. Xie X., et al. "A meta-analysis of bonepatellar tendon-bone autograft versus four-strand hamstring tendon autograft for anterior cruciate ligament reconstruction". Knee 22.2 [2015]:100-110.
  • 18. Li S., et al. "A systematic review of randomized controlled clinical trials comparing hamstring autografts versus bone-patellar tendon-bone autografts for the reconstruction of the anterior cruciate ligament". Archives of Orthopaedic and Trauma Surgery 132.9 [2012]: 1287-1297.
  • 19. Greco NJ., et al. "Responsiveness of the International Knee Documentation Committee subjective knee form in comparison to the Western Ontario and McMaster Universities Osteoarthritis Index, modified Cincinnati Knee Rating System, and Short Form 36 in patients with focal articular cartilage defects". The American journal of sports medicine 38.5 [2010]: 891-902.
  • 20. ErikssonK., et al. "A comparison of quadruple semitendinosus and patellar tendon grafts in reconstruction of the anterior cruciate ligament". The Journal of bone and joint surgery 83.3 [2001]: 348 354.
  • 21. Beynnon BD., et al. "Anterior cruciate ligament replacement. Comparison of bone-patellar tendon-bone grafts with two-strand hamstring grafts; a prospective randomized study". Journal of Bone and Joint Surgery 84.9 [2002]: 1503-1513.
  • 22. Laxdal G., et al. "A prospective comparison of bone-patellar tendon-bone and hamstring tendon grafts for anterior cruciate ligament reconstruction in male patients". Knee Surgery, Sports Traumatology, Arthroscopy 15.2 [2007]:115-125.
  • 23. Good L., et al. "Sagittal knee stability after anterior cruciate ligament reconstruction with a patellar tendon strip. A two-year follow-up study". American Journal of Sports Medicine 22.4 [1994]: 518-523.
  • 24. Biau DJ., et al. "Bone-patellar tendon-bone autografts versus hamstring autografts for reconstruction of anterior cruciate ligament: Meta-analysis". The BMJ 332.7548 [2006]: 995-1001.
  • 25. Biau DJ., et al. Patellar tendon versus hamstring tendon autografts for reconstructing the anterior cruciate ligament: A meta analysis based on individual patient data. American Journal of Sports Medicine 37.12 [2009]: 2470 2478.
  • 26. Norimasa Nakamura., et al. "Evaluation of Active Knee Flexion and Hamstring Strength After Anterior Cruciate Ligament Reconstruction Using Hamstring Tendons". The Journal of Arthroscopic and Related Surgery 18.6 [2002]: 598-602.
  • 27. Chee MY., et al. "Outcome of patellar tendon versus 4-strand hamstring tendon autografts for anterior cruciate ligament reconstruction: a systematic review and meta-analysis of prospective randomized trials". Arthroscopy 33.2 [2017]: 450-463.
  • 28. Erickson BJ., et al. "Anterior cruciate ligament reconstruction practice patterns by NFL and NCAA football team physicians". Arthroscopy 30.6[2014]: 731-738.
  • 29. Hui., et al. "Fifteen-Year Outcome of Endoscopic Anterior Cruciate Ligament Reconstruction With Patellar Tendon Autograft for 'Isolated' Anterior Cruciate Ligament Tear." The American Journal of Sports Medicine 39.1[2011]: 89-98.
  • 30. Okoroha KR., et al. "Pain Assessment After Anterior Cruciate Ligament Reconstruction: Bone-Patellar Tendon-Bone Versus Hamstring Tendon Autograft". Orthopaedic Journal of Sports Medicine 4.12 [2016]: 2325967116674924.
  • 31. Pinczewski Leo A., et al. "A 10-Year Comparison of Anterior Cruciate Ligament Reconstructions with Hamstring Tendon and Patellar Tendon Autograft: A Controlled, Prospective Trial." The American Journal of Sports Medicine 35.4 [2007]: 564–574.
  • 32. Kartus J., et al. "Comparison of traditional and subcutaneous patellar tendon harvest: a prospec- tive study of donor site–related problems after anterior cruciate lign- ment reconstruction using different graft harvesting techniques". The American Journal of Sports Medicine 28.3 [2000]: 328-335.