title: Reconstruction of the anterior cruciate ligament: a comparison between bone-patellar tendon-bone grafts and fourstrand hamstring grafts.
abstract: BACKGROUND
  Disruption of anterior cruciate ligament (ACL) is a common ligamentous injury of the knee. The choice of graft for (ACL) reconstruction remains controversial. This prospective, randomized clinical trial aimed to compare clinical results of bone-patellar tendon-bone (BPTB) grafts and four-strand semitendinosus-gracilis (ST) grafts for ACL reconstruction over a 3-year follow-up interval.
  
  
  METHODS
  Seventy-one patients with an average age of 29± 4.5yearswere treated for torn ACL between 2008 and 2009. Forty-sixpatients underwent reconstruction with BPTB autograft, and 41 were treated with ST autograft. At the time of final follow-up, 37 patients in patella group and 34 patients in hamstring group were evaluated in terms of return to pre-injury activity level, pain, knee stability, range of motion, IKDC (International Knee Documentation Committee) score and complications.
  
  
  RESULTS
  At 36thmonth of follow-up, 34 (92%) and 28 (82%) patients in BPTB and ST group, respectively had good-to-excellent IKDC score (p > 0.05). The activity levels were higher in BPTB group (p> 0.05). At 3rd yearof follow up, the Lachman test was graded normal, for 23 (62%) and 11 (32%) patients in BPTB and ST group, respectively (p=0.019). Regarding the pivot-shift test, 29 (79%) and 15 (44%) patients in patella and hamstring group, respectively had normal test at the latest follow-up (p=0.021).There were no significant differences in terms of thigh circumference difference, effusion, knee range of motion, pain and complications.
  
  
  CONCLUSIONS
  The results indicate a trend toward increased graft laxity and pivot-shift grades in patients undergoing reconstruction with hamstring autograft compared with patella tendon. However, the two groups had comparable results in terms of activity level and knee function.
authors.affiliation: 1. Assistant Professor of Orthopedics, Department of Orthopedics and Sport Medicine, Rassole Akram Hospital, Iran University of Medical Sciences,Tehran, Iran. m_razi@yahoo.com.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Razi
authors.affiliation: 2. Assistant Professor of Orthopedics, Department of Orthopedic Surgery, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. mmsarzaeem@yahoo.com.
authors.forename: Mohammad Mahdi
authors.initials: MM
authors.lastname: Sarzaeem
authors.affiliation: 3. Associate Professor of Orthopedics, Department of Orthopedic Surgery, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. gh_kazemian@yahoo.com.
authors.forename: Gholam Hossein
authors.initials: GH
authors.lastname: Kazemian
authors.affiliation: 4. Resident of Orthopedics, Department of Orthopedic Surgery, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. faridehnajafi1@gmail.com.
authors.forename: Farideh
authors.initials: F
authors.lastname: Najafi
authors.affiliation: 5. Medical Student, Faculty of Medicine, Isfahan University of Medical Sciences, Esfahan, Iran. najafi.ma@yahoo.com.
authors.forename: Mohammad Amin
authors.initials: MA
authors.lastname: Najafi
keywords: Anterior Cruciate Ligament (ACL); Bone-Patellar Tendon-Bone (BPTB) graft; Outcome; Reconstruction; Semitendinosus-gracilis graft