title: Anatomic double-bundle anterior cruciate ligament reconstruction using bone-patellar tendon-bone and gracilis tendon graft: a comparative study with 2-year follow-up results of semitendinosus tendon grafts alone or semitendinosus-gracilis tendon grafts.
abstract: OBJECTIVE
  The purpose of this study was to assess the clinical results of anatomic double-bundle anterior cruciate ligament (ACL) reconstruction by use of bone-patellar tendon-bone and gracilis tendon (BPTB-G) grafts and to compare them with the results of double-bundle ACL reconstruction by use of semitendinosus tendon (ST) or semitendinosus-gracilis tendon (ST-G) grafts, with particular emphasis on the postoperative incidence of anterior knee pain.
  
  
  METHODS
  The study comprised 144 patients who underwent unilateral anatomic double-bundle ACL reconstruction with 3 graft types, including 55 BPTB-G, 56 ST, and 33 ST-G grafts. A traumatic graft rupture occurred within 2 years postoperatively in 5 patients (1 BPTB-G, 3 ST, and 1 ST-G). Clinical results and incidence and severity of anterior knee pain were assessed and compared among the 3 different graft groups at 2 years postoperatively. Potential variables influencing postoperative anterior knee pain development were subjected to univariate analysis, followed by logistic regression analysis to identify risk factors for anterior knee pain.
  
  
  RESULTS
  Both subjective and objective clinical results in anatomic double-bundle ACL reconstruction with BPTB-G graft were similar to those using ST or ST-G graft at 2 years postoperatively. The incidences of anterior knee pain at 2 years' follow-up were 18.5%, 9.4%, and 9.3% in the BPTB-G, ST, and ST-G groups, respectively, indicating no statistically significant difference among the 3 groups. Multivariate logistic regression analyses showed that BPTB graft harvest and patellofemoral cartilage defect failed to be significant factors for anterior knee pain whereas quadriceps peak torque at 60°/s was the only significant factor for anterior knee pain at 2 years.
  
  
  CONCLUSIONS
  Clinical results including the incidence of anterior knee pain 2 years after anatomic double-bundle ACL reconstruction with BPTB-G grafts were comparable to those after ACL reconstruction with ST or ST-G grafts.
  
  
  METHODS
  Level III, therapeutic, retrospective comparative study.
authors.affiliation: Department of Orthopaedic Surgery, Keio University, Tokyo, Japan. y.niki@lib.bekkoame.ne.jp
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Niki
authors.forename: Hideo
authors.initials: H
authors.lastname: Matsumoto
authors.forename: Akihiro
authors.initials: A
authors.lastname: Hakozaki
authors.forename: Hiroya
authors.initials: H
authors.lastname: Kanagawa
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Toyama
authors.forename: Yasunori
authors.initials: Y
authors.lastname: Suda
mesh_terms: D000293:Adolescent; D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery; D000070598:Anterior Cruciate Ligament Injuries; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods* / Q000534:rehabilitation / Q000706:statistics & numerical data; D001182:Arthroscopy / Q000379:methods*; D050376:Bone-Patellar Tendon-Bone Grafting / Q000534:rehabilitation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007718:Knee Injuries / Q000534:rehabilitation; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D020127:Recovery of Function; D012189:Retrospective Studies; D012421:Rupture / Q000601:surgery; D013710:Tendons / Q000601:surgery / Q000637:transplantation*; D016896:Treatment Outcome; D016474:Weight-Bearing; D055815:Young Adult