Clinical comparison between six-strand hamstring tendon and patellar tendon autograft in arthroscopic anterior cruciate ligament reconstruction: a prospective, randomized clinical trial.
OBJECTIVE
Many randomized clinical trials demonstrated that 4-strand hamstring tendon grafts have comparable results both subjectively and objectively with the patellar tendon grafts. The authors hypothesized that the increment of hamstring tendons strength with 6-strand graft could improve the knee stability compared to the result from using the gold standard patellar tendon.


METHODS
Thirty-four patients were prospectively randomized into two groups for arthroscopic anterior cruciate ligament reconstruction. Seventeen patients underwent reconstruction with 6-strand hamstring tendons and the remaining seventeen were treated with bone-patellar tendon-bone graft. Patients were followed-up under the similar rehabilitation protocol for at least 12 months. At the time of final follow-up, all the patients in both groups were evaluated in terms of patient's satisfaction, activity level, and knee stability.


RESULTS
Fifteen patients in bone-patellar tendon-bone graft (two lost to follow-up) and thirteen patients used 6-strand hamstring tendons (four were converted to 4-strand hamstring tendons) were evaluated at a mean of 19 months (range 12-31 months). The mean of KT-2000 side-to-side laxity measurement in 6-strand hamstring group (0.96 mm) is less than BPTB group (1.22 mm) significantly (p < 0.05). Eleven of 13 patients (84.62%) that received the 6-strand hamstring tendons could return to sport activities compared to 10 of 15 patients (66.67%) that received BPTB graft. Hamstring group have a lower prevalence of donor-site morbidity resulting in less difficult in kneeling.


CONCLUSIONS
The authors concluded that using 6-strand hamstring tendons could improve knee stability in the early clinical outcomes. With no difference in subjective assessment, anterior cruciate ligament reconstruction used hamstring tendons have less donor-site morbidity, which is more compatible to Asian life-style.
Department of Orthopaedics, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand. artitlao@yahoo.com
Artit
A
Laoruengthana
Somsak
S
Pattayakorn
Thanainit
T
Chotanaputhi
Arkaphat
A
Kosiyatrakul
D000293:Adolescent; D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D001182:Arthroscopy; D050376:Bone-Patellar Tendon-Bone Grafting; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007593:Joint Instability / Q000601:surgery*; D007718:Knee Injuries / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011446:Prospective Studies; D019651:Plastic Surgery Procedures; D020127:Recovery of Function / Q000502:physiology*; D013710:Tendons / Q000503:physiopathology* / Q000637:transplantation*; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D055815:Young Adult