title: A 10-year comparison of anterior cruciate ligament reconstructions with hamstring tendon and patellar tendon autograft: a controlled, prospective trial.
abstract: BACKGROUND
  There are no controlled, prospective studies comparing the 10-year outcomes of anterior cruciate ligament (ACL) reconstruction using patellar tendon (PT) and 4-strand hamstring tendon (HT) autografts.
  
  
  OBJECTIVE
  Comparable results are possible with HT and PT autografts.
  
  
  METHODS
  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 prospective 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.
authors.affiliation: North Sydney Orthopaedic and Sports Medicine Centre, Crows Nest, Sydney, NSW, Australia. lpinczewski@nsosmc.com.au
authors.forename: Leo A
authors.initials: LA
authors.lastname: Pinczewski
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Lyman
authors.forename: Lucy J
authors.initials: LJ
authors.lastname: Salmon
authors.forename: Vivianne J
authors.initials: VJ
authors.lastname: Russell
authors.forename: Justin
authors.initials: J
authors.lastname: Roe
authors.forename: James
authors.initials: J
authors.lastname: Linklater
mesh_terms: D000293:Adolescent; D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D007717:Knee / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000601:surgery; D017847:Patellar Ligament / Q000637:transplantation*; D011446:Prospective Studies; D019651:Plastic Surgery Procedures; D013997:Time Factors; D014182:Transplantation, Autologous; D016896:Treatment Outcome