title: Anterior cruciate ligament reconstruction with contralateral autogenous patellar tendon graft: evaluation of donor site strength and subjective results.
abstract: BACKGROUND
  Few surgeons use a contralateral patellar tendon autograft for primary anterior cruciate ligament (ACL) reconstruction because of concern for donor site morbidity.
  
  
  OBJECTIVE
  There will be no difference in quadriceps muscle strength or International Knee Documentation Committee (IKDC) subjective scores in patients with contralateral grafts compared with patients with ipsilateral grafts.
  
  
  METHODS
  Cohort study; Level of evidence, 3.
  
  
  METHODS
  Between 2007 and 2009, a total of 279 patients who underwent primary ACL reconstruction with autogenous patellar tendon graft from the contralateral knee met the inclusion criteria of unilateral knee involvement, no arthritic changes preoperatively, and minimum 2-year follow-up objective and subjective evaluations. A control group was obtained of 58 patients who had the same inclusion criteria and were of the same age but who underwent surgery with ipsilateral graft. Patients underwent a goal-directed and sequential postoperative rehabilitation program that first emphasized controlling a hemarthrosis and obtaining full knee range of motion immediately after surgery, followed by increasing leg strength and performing functional activities. The rehabilitation for the contralateral donor site emphasized high-repetition/low-resistance exercises beginning the day after surgery. The IKDC subjective data were compared between surgery groups. Quadriceps muscle strength was evaluated in both knees compared with the preoperative values obtained in the noninvolved knee and between knees at 2 years postoperatively.
  
  
  RESULTS
  Quadriceps muscle strength compared with the preoperative normal value (mean ± SD) was 105% ± 29% in the ipsilateral ACL-reconstructed knee versus 114% ± 28.4% in the contralateral donor knee (P < .01) and 116% ± 25% in the contralateral ACL-reconstructed knee (P = .0339). Mean side-to-side strength (ACL-reconstructed knee/opposite knee) was 98.4% ± 13.6% in the contralateral group versus 92.9% ± 13.0% in the ipsilateral group (P < .01). The mean total IKDC score was 92.4 ± 9.6 for the contralateral donor knee. The mean IKDC total score for the ACL-reconstructed knee was 88.8 ± 12.3 in the contralateral group and 88.9 ± 11.2 in the ipsilateral group (P = .626).
  
  
  CONCLUSIONS
  After ACL reconstruction with contralateral patellar tendon graft, patients can achieve strength symmetry between legs after surgery without experiencing adverse subjective symptoms after graft harvest. Furthermore, strength return can be superior with a contralateral graft than with an ipsilateral graft.
authors.affiliation: Shelbourne Knee Center, Indianapolis, Indiana, USA tgray@fixknee.com.
authors.forename: K Donald
authors.initials: KD
authors.lastname: Shelbourne
authors.affiliation: Orthopaedic Surgery Residency, Indiana University School of Medicine, Indianapolis, Indiana, USA.
authors.forename: Matthew B
authors.initials: MB
authors.lastname: Beck
authors.affiliation: Shelbourne Knee Center, Indianapolis, Indiana, USA.
authors.forename: Tinker
authors.initials: T
authors.lastname: Gray
mesh_terms: D000293:Adolescent; D000328:Adult; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods* / Q000534:rehabilitation; D064592:Autografts; D005081:Exercise Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007719:Knee Joint / Q000502:physiology; D008297:Male; D053580:Muscle Strength; D017847:Patellar Ligament / Q000637:transplantation*; D052097:Quadriceps Muscle / Q000502:physiology*; D016059:Range of Motion, Articular; D055070:Resistance Training; D012189:Retrospective Studies; D060053:Transplant Donor Site / Q000502:physiology*; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D055815:Young Adult
keywords: International Knee Document Committee; anterior cruciate ligament; contralateral; patellar tendon donor site; quadriceps strength; reconstruction; rehabilitation; subjective results