Outcomes Improved After ACL Repair With Three Tendon Graft Types

Patients who received patellar tendon, hamstring tendon, or "double-bundle" hamstring tendon grafts for anterior cruciate ligament (ACL) repair had no significant difference in quality of life at five years postsurgery, according to a study published in the June 5 issue of The Journal of Bone & Joint Surgery.

Nicholas G. Mohtadi, M.D., of the University of Calgary Sport Medicine Centre, and Denise S. Chan, of the McCaig Institute for Bone and Joint Health, both in Calgary, Alberta, Canada, analyzed five-year, disease-specific quality-of-life (QOL) outcomes in three groups of 110 patients ages 14 to 50 years who were randomly assigned to receive ACL reconstruction with a patellar tendon graft, a quadruple-stranded hamstring tendon construct, or a double-bundle hamstring tendon construct.

Ninety-five percent of the original patients completed the five-year follow-up survey. Scores on the ACL-QOL measure increased significantly from baseline for all groups (P < 0.0001), but there was no significant difference at five years among the groups (P = 0.548). A significantly lower percentage of patients had traumatic reinjuries in the patellar group (four patients compared with 16 for hamstring tendon and 17 for double-bundle grafts; P = 0.010); however, there was a higher percentage of kneeling pain in the patellar group (10 percent of patients compared with 4 percent for hamstring tendon and 2 percent for double-bundle grafts; P = 0.029).

"[Traumatic re-injury] is even more of an issue for younger patients who are at higher risk," Mohtadi said in a statement. "We recommend patellar tendon reconstruction for higher-risk, younger patients."

Mohtadi reported receiving grants from Workers' Compensation Board Alberta and from Calgary Orthopaedic Research and Education Fund.

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