A COMPARATIVE STUDY OF FUNCTIONAL AND CLINICAL OUTCOMES IN ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION: BONE–PATELLAR TENDON–BONE (BPTB) AUTOGRAFT VERSUS HAMSTRING TENDON AUTOGRAFT

Background: Reconstruction is the treatment of choice for symptomatic anterior cruciate ligament (ACL) deficiency inactive patients. Bone–patellar tendon–bone (BPTB) and quadrupled hamstring (semitendinosus–gracilis) tendon autograftsremain the two most widely used graft options, yet debate persists regarding their relative benefits in terms of knee stability,functional recovery and donor-site morbidity. This study compared the short-term clinical and functional outcomes of thetwo grafts in a single tertiary-care centre. Materials and Methods: A prospective comparative study was conducted in theDepartment of Orthopaedics, Murshidabad Medical College and Hospital, from January 2025 to December 2025. Fifty-twopatients with isolated primary ACL tears were allocated to arthroscopic reconstruction with either a BPTB autograft (GroupA, n = 26) or a quadrupled hamstring tendon autograft (Group B, n = 26). Patients were assessed pre-operatively and atfollow-up using the Lysholm knee score, the subjective International Knee Documentation Committee (IKDC) score, theTegner activity scale, clinical laxity tests (Lachman, pivot-shift), instrumented laxity (KT-1000), and the incidence of donorsitemorbidity and complications. Results: Both groups were comparable in baseline demographics. At final follow-up(mean 9.2 months), mean Lysholm (90.4 ± 6.2 vs 89.3 ± 6.9; p = 0.55) and IKDC scores (88.7 ± 7.1 vs 87.6 ± 7.4; p = 0.58)were similar between the BPTB and hamstring groups. Anterior knee pain (30.8% vs 11.5%) and kneeling discomfort(26.9% vs 7.7%) were more frequent after BPTB reconstruction, whereas a trend toward greater residual instrumented laxity(mean KT-1000 side-to-side difference 1.8 ± 1.1 mm vs 2.4 ± 1.3 mm) and saphenous-nerve–related numbness was observedin the hamstring group. Graft failure occurred in 1 (3.8%) BPTB and 2 (7.7%) hamstring patients. Rates of return to preinjuryactivity were comparable (80.8% vs 76.9%). Conclusion: Both BPTB and hamstring tendon autografts providereliable restoration of knee stability and good short-term functional outcomes after ACL reconstruction, with no clinicallysignificant difference in patient-reported scores. Graft choice should therefore be individualised, balancing the marginallysuperior stability and higher anterior knee pain of BPTB against the lower donor-site pain but greater residual laxity andpotential flexion weakness of the hamstring graft.