Clinical evaluation of arthroscopically assisted anterior cruciate ligament reconstruction: patellar tendon versus gracilis and semitendinosus autograft.
OBJECTIVE
To evaluate the clinical results of anterior cruciate ligament (ACL) reconstruction in patients with ACL-deficient knee in 2 similar groups of patients.


METHODS
A prospective randomized comparison of patellar tendon (PT) versus semitendinosus and gracilis tendon (STG) autografts for ACL reconstruction.


METHODS
Between 1994 and 1996, 85 consecutive male patients with chronic ACL-deficient knees underwent arthroscopically assisted reconstruction with either autologous PT or double-loop STG (4-strand) graft. PT grafts were used in patients with even-numbered birth dates and STG grafts for those with odd-numbered birth dates. Preoperatively, no significant differences between the 2 groups were noted with respect to age, level of activity, and degree of laxity (chi-square analysis). A standardized rehabilitation program was used for both groups postoperatively that included immediate active extension and early weight bearing and gradual flexion. Return to sports was permitted 8 months postoperatively. Assessment of the patients was carried out using a questionnaire, clinical assessment, Lysholm knee scores, the International Knee Documentation Committee scale, and radiological examination.


RESULTS
At a mean follow-up of 81 months, there was no significant difference between the 2 groups with respect to subjective complaints (recurrent giving way, functional level) or objective laxity evaluation, including KT-1000 measurement or return to sports. Loss of extension of < or =5 degrees was greater in the PT group (12 patients, 30 %) than in the STG group (8 patients, 17 %). There was loss of flexion of < or =15 degrees in 5 patients (12 %) in the PT group and 1 patient (2.2 %) in the STG group. Anterior knee pain was recorded in 10 patients (24 %) in the PT group and 3 patients (5 %) in the STG group. The Lysholm knee score was 91.6 and 92.7 for the PT and STG groups, respectively, and the Tegner activity score decreased from 8.9 preoperatively for both groups to 7.9 for the PT group and 7.8 for the STG group.


CONCLUSIONS
In this study, the 2 groups had comparable results in terms of patient satisfaction, activity level, and knee function. Our study showed that patellofemoral problems and loss of knee motion are more frequent in patients with PT grafts than in those with STG grafts.


METHODS
Level I, Randomized Controlled Trial.
Ibrahim
Samir Abdul-Razik
SA
Orthopaedic Unit, Al Razi Orthopaedic Hospital, Sports Medicine Center, Kuwait University, Safat, Kuwait. samirabdulrazik@yahoo.com
Al-Kussary
Ibrahim Mohamed
IM
Al-Misfer
Abdul Rahman Khalid
AR
Al-Mutairi
Hussein Quwaian
HQ
Ghafar
Sami Abdul
SA
El Noor
Tarkek Abo
TA
D000293:Adolescent; D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D009043:Motor Activity; D010329:Patella / Q000601:surgery*; D011184:Postoperative Period; D019651:Plastic Surgery Procedures / Q000379:methods*; D013177:Sports; D013710:Tendons / Q000601:surgery*; D013997:Time Factors; D014182:Transplantation, Autologous