title: A 6-year follow-up of the effect of graft site on strength, stability, range of motion, function, and joint degeneration after anterior cruciate ligament reconstruction: patellar tendon versus semitendinosus and Gracilis tendon graft.
abstract: BACKGROUND
  The choice of graft material for anterior cruciate ligament reconstruction remains controversial. Despite the need for well-controlled, long-term outcome studies comparing patellar tendon with hamstring grafting, few studies have followed results for more than 5 years.
  
  
  OBJECTIVE
  Graft source will not affect outcome 6 years after reconstruction.
  
  
  METHODS
  Cohort study; Level of evidence, 2.
  
  
  METHODS
  Sixty-two patients with anterior cruciate ligament reconstruction and 18 uninjured control subjects were studied over 6 years. Thirty-one patients received patellar tendon grafts, and 31 received hamstring tendon grafts. Assessment included knee joint stability, range of motion, muscle strength, subjective function, objective function (running, sidestepping, carioca, and hop tests), and joint degeneration.
  
  
  RESULTS
  Clinical stability was restored to all patients other than to the 2 hamstring graft recipients who suffered reinjuries. The KT-1000 arthrometer side-to-side differences were similar in the patellar tendon (1.9 mm) and hamstring tendon (2.0 mm) groups but were significantly greater than that of uninjured control subjects (P < .001). There were no significant strength differences between surgical and control groups, although a 6% quadriceps deficit existed after patellar tendon grafting. In the more demanding functional tests (hop and triple-hop indices and carioca), the hamstring graft recipients performed similarly to the control group, whereas a significant difference (P < .05) existed between the patellar tendon graft and the control group. The incidence of early tibiofemoral osteoarthritis was significantly greater after reconstruction using patellar tendon (62%) than after hamstring tendon grafting (33%; P = .002).
  
  
  CONCLUSIONS
  Six-year outcomes were very satisfactory irrespective of graft source. However, reconstruction using the hamstring tendons resulted in improved functional performance and a lower incidence of osteoarthritis.
authors.affiliation: Division of Physiotherapy, University of Queensland, Queensland, Australia. slkeays@optusnet.com.au
authors.forename: Susan L
authors.initials: SL
authors.lastname: Keays
authors.forename: Joanne E
authors.initials: JE
authors.lastname: Bullock-Saxton
authors.forename: Anthony C
authors.initials: AC
authors.lastname: Keays
authors.forename: Peter A
authors.initials: PA
authors.lastname: Newcombe
authors.forename: Margaret I
authors.initials: MI
authors.lastname: Bullock
mesh_terms: D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery; D000070598:Anterior Cruciate Ligament Injuries; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000503:physiopathology* / Q000601:surgery; D007719:Knee Joint / Q000502:physiology*; D008297:Male; D009119:Muscle Contraction / Q000502:physiology*; D053580:Muscle Strength / Q000502:physiology*; D018482:Muscle, Skeletal / Q000502:physiology*; D017847:Patellar Ligament / Q000601:surgery; D011446:Prospective Studies; D016059:Range of Motion, Articular; D019651:Plastic Surgery Procedures; D013997:Time Factors; D019737:Transplants; D016896:Treatment Outcome