title: A Randomized Clinical Trial Comparing Patellar Tendon, Hamstring Tendon, and Double-Bundle ACL Reconstructions: Patient-Reported and Clinical Outcomes at a Minimal 2-Year Follow-up.
abstract: OBJECTIVE
  To compare 3 anatomically positioned autografts for anterior cruciate ligament (ACL) reconstruction, by measuring patient-reported disease-specific quality of life at 2 years postoperatively.
  
  
  METHODS
  Double-blinded, randomized clinical trial with intraoperative computer-generated treatment allocation. Patients and an independent trained evaluator were blinded.
  
  
  METHODS
  University-based orthopedic referral practice.
  
  
  METHODS
  Three hundred thirty patients (14-50 years; 183 male patients) with isolated ACL deficiency were equally randomized to: (1) patellar tendon, PT: 28.7 years (SD = 9.7); (2) quadruple-stranded hamstring tendon, HT: 28.5 years (SD = 9.9); and (3) double bundle using HT, DB: 28.3 years (SD = 9.8); 322 patients completed 2-year follow-up.
  
  
  METHODS
  Anterior cruciate ligament reconstruction using PT, HT, or DB autografts.
  
  
  METHODS
  Measured at baseline, 1 and 2 years postoperatively-primary: anterior cruciate ligament quality-of-life scores; secondary: International Knee Documentation Committee (IKDC) scores, KT-1000 arthrometer, pivot shift, range of motion, Tegner activity, Cincinnati Occupational Scale, and single-leg hop. Proportions of correct graft type guesses by the patients and evaluator assessed blinding effectiveness.
  
  
  RESULTS
  Baseline characteristics were not different. Anterior cruciate ligament quality-of-life scores increased over time for all groups (P = 0.001) but were not different at 2 years (P = 0.591): PT = 84.6 (SD = 16.6, 95% confidence interval [CI] = 81.4-87.8), HT = 82.5 (SD = 17.7, 95% CI = 79.2-85.9), and DB = 82.4 (SD = 17.5, 95% CI = 79.1-85.7). Two-year KT-1000 side-to-side differences (PT = 1.86 mm; HT = 2.97 mm; DB = 2.65 mm) were statistically significant between PT-HT (P = 0.002) and PT-DB (P = 0.044). The remaining secondary outcomes were not statistically different. Correct graft type guesses occurred 51% of the time for patients and 46% for the evaluator.
  
  
  CONCLUSIONS
  Two-year disease-specific quality-of-life outcome was not different between the ACL reconstruction techniques. The PT reconstructions had significantly lower side-to-side differences on static stability measures. Patient and evaluator blinding was achieved.
  
  
  METHODS
  Level 1 (Therapeutic Studies).
  
  
  CONCLUSIONS
  This high-quality, large, double-blind randomized clinical trial (RCT) addresses the insufficient evidence in the literature comparing PT, single-bundle hamstring, and DB hamstring reconstructions for ACL rupture in adults. In addition to the clinical and functional results, this RCT uniquely reports on the disease-specific, patient-reported quality-of-life outcome at 2 years postoperatively.
authors.affiliation: *Sport Medicine Centre, University of Calgary, Calgary, Alberta; †Department of Surgery, Faculty of Medicine and the Sport Medicine Centre, University of Calgary, Calgary, Alberta; and ‡Departments of Surgery & Community Health Sciences, Faculty of Medicine, Health Sciences Centre. Foothills Campus, University of Calgary, Calgary, Alberta.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Mohtadi
authors.forename: Denise
authors.initials: D
authors.lastname: Chan
authors.forename: Rhamona
authors.initials: R
authors.lastname: Barber
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Oddone Paolucci
mesh_terms: D000293:Adolescent; D000328:Adult; D000070598:Anterior Cruciate Ligament Injuries; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000601:surgery*; D008023:Ligaments, Articular / Q000637:transplantation; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal; D017847:Patellar Ligament / Q000637:transplantation*; D011788:Quality of Life; D016059:Range of Motion, Articular; D013848:Thigh; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D055815:Young Adult