Bone-patellar tendon-bone vs hamstring tendon autograft for anatomical anterior cruciate ligament reconstruction: outcomes at a mean follow-up of 8 years

Background. Anterior cruciate ligament (ACL) tear is a common ligament injury of the knee joint. Anterior cruciate ligament reconstruction (ACLR) using autografts or allografts is the standard of treatment for complete ACL tear. Anatomical tunnel positioning provides a better rotational as well as anteroposterior stability following ACLR. Nevertheless, a well-performed anatomical ACLR does fail due to various reasons. Graft selection may be one of the contributing factors. The aim of the study is to compare the outcome of anatomical anterior cruciate ligament reconstruction using bone-patellar tendon-bone autograft and hamstring tendon autograft at a mean follow-up of 8 years. Methods. The study enrolled 150 patients who underwent primary anatomical anterior cruciate ligament reconstruction using either bone-patellar tendon-bone (BPTB) or hamstring tendon (HT) autograft. Plain radiography was used to differentiate anatomical and nonanatomical reconstruction. Eighty patients (BPTB — 36, HT — 44) with anatomical reconstruction were then compared for their clinico-radiological outcome at a mean follow-up of 8 years. Results. The BPTB group showed better outcome over the HT group in terms of increased rotational and anteroposterior stability at long-term follow-up (pivot-shift test, p = 0.001; anterior drawer test, p = 0.001; the Lachman’s test, p = 0.001; radiological Lachman’s test, p = 0.001). There was no difference between the groups in terms of objective and subjective IKDC forms (p = 0.363 and p = 0.154, relatively), the Lysholm score (p = 0.894), anterior knee pain (p = 0.678), single-leg hop testing (p = 0.248) and osteoarthritic change (p = 0.550) at a mean follow-up of 8 years. Conclusions. Bone-patellar tendon-bone autograft resulted in superior clinical outcome over hamstring tendon autograft in terms of increased knee stability. No difference was observed between the grafts in other clinical outcomes and osteoarthritic change at a mean follow-up of 8 years.