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Title: Quality of life and clinical outcome comparison of semitendinosus and gracilis tendon versus patellar tendon autografts for anterior cruciate ligament reconstruction: an 11-year follow-up of a randomized controlled trial.
Author: Sajovic M, Strahovnik A, Dernovsek MZ, Skaza K.
Journal: Am J Sports Med; 2011 Oct; 39(10):2161-9. PubMed ID: 21712483.
Abstract:
BACKGROUND: There are still controversies about graft selection for primary anterior cruciate ligament reconstruction. Prospective, randomized long-term studies are needed to determine the differences between the graft materials. 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: Randomized controlled trial; Level of evidence, 2. METHODS: From June 1999 to March 2000, 64 patients were included in this prospective 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.

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