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J Knee Surg 2017; 30(03): 258-263
DOI: 10.1055/s-0036-1584561
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Autograft Choice in Young Female Patients: Patella Tendon versus Hamstring

Rachel Shakked
1   Department of Orthopaedic Surgery, NYULMC Hospital for Joint Diseases Ringgold Standard Institution, New York, New York
,
Maxwell Weinberg
1   Department of Orthopaedic Surgery, NYULMC Hospital for Joint Diseases Ringgold Standard Institution, New York, New York
,
Jason Capo
1   Department of Orthopaedic Surgery, NYULMC Hospital for Joint Diseases Ringgold Standard Institution, New York, New York
,
Laith Jazrawi
1   Department of Orthopaedic Surgery, NYULMC Hospital for Joint Diseases Ringgold Standard Institution, New York, New York
,
Eric Strauss
1   Department of Orthopaedic Surgery, NYULMC Hospital for Joint Diseases Ringgold Standard Institution, New York, New York
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Publikationsverlauf

21. Januar 2016

09. Mai 2016

Publikationsdatum:
30. Juni 2016 (online)

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Abstract

With the increasing incidence of anterior cruciate ligament (ACL) reconstruction in women and younger patients, the optimal graft choice in the young female patient has become the subject of much debate. This study aimed to evaluate patient-reported outcomes, objective knee stability, complication rates, and the incidence of failure after ACL reconstruction using bone–patellar tendon–bone (BPTB) autograft compared with hamstring (HS) autograft in young female patients. Female patients who underwent primary ACL reconstruction with BPTB or HS autograft between ages 15 and 25 years were identified. Medical records were reviewed for postoperative complications and subsequent procedures on the operative knee. Patients were evaluated with functional surveys, physical examination including Lachman and pivot-shift tests, and arthrometric testing with a KT-1000 arthrometer. There were 37 patients in the BPTB group and 28 patients in the HS group. For patients who did not undergo revision, significant differences were not found in visual analog score (p = 0.94), Lysholm score (p = 0.81), Kujala score (p = 0.85), or Tegner level (p = 0.81). No difference was detected in the rate of return to a level of activity at or above the same level prior to injury (p = 0.31). Significantly more patients in the BPTB group were graded 1a Lachman and negative pivot shift compared with the HS group (p < 0.001). There was a significant difference in mean side-to-side manual maximum arthrometric testing (p < 0.001). There were significantly fewer subsequent procedures and a lower rate of graft failures in the BPTB group. We detected no difference in subjective functional outcomes following ACL reconstruction. However, a higher failure rate in the HS reconstructions and greater laxity by arthrometric testing may indicate increased objective stability with the use of BPTB autograft in the young female patient population. The level of evidence for this article is (level III, retrospective cohort).

Keywords

ACL reconstruction - female - patella tendon - hamstring tendon - autograft
 

  • References

  • 1 Prodromos CC, Han Y, Rogowski J, Joyce B, Shi K. A meta-analysis of the incidence of anterior cruciate ligament tears as a function of gender, sport, and a knee injury-reduction regimen. Arthroscopy 2007; 23 (12) 1320-1325.e6
    CrossrefPubMedSuche in Google Scholar
  • 2 Agel J, Arendt EA, Bershadsky B. Anterior cruciate ligament injury in national collegiate athletic association basketball and soccer: a 13-year review. Am J Sports Med 2005; 33 (4) 524-530
    CrossrefPubMedSuche in Google Scholar
  • 3 Arendt E, Dick R. Knee injury patterns among men and women in collegiate basketball and soccer. NCAA data and review of literature. Am J Sports Med 1995; 23 (6) 694-701
    CrossrefPubMedSuche in Google Scholar
  • 4 Brophy RH, Stepan JG, Silvers HJ, Mandelbaum BR. Defending puts the anterior cruciate ligament at risk during soccer: a gender-based analysis. Sports Health 2015; 7 (3) 244-249
    CrossrefPubMedSuche in Google Scholar
  • 5 Sutton KM, Bullock JM. Anterior cruciate ligament rupture: differences between males and females. J Am Acad Orthop Surg 2013; 21 (1) 41-50
    CrossrefPubMedSuche in Google Scholar
  • 6 Renstrom P, Ljungqvist A, Arendt E , et al. Non-contact ACL injuries in female athletes: an International Olympic Committee current concepts statement. Br J Sports Med 2008; 42 (6) 394-412
    CrossrefPubMedSuche in Google Scholar
  • 7 Cheung EC, Boguszewski DV, Joshi NB, Wang D, McAllister DR. Anatomic factors that may predispose female athletes to anterior cruciate ligament injury. Curr Sports Med Rep 2015; 14 (5) 368-372
    CrossrefPubMedSuche in Google Scholar
  • 8 Chandrashekar N, Slauterbeck J, Hashemi J. Sex-based differences in the anthropometric characteristics of the anterior cruciate ligament and its relation to intercondylar notch geometry: a cadaveric study. Am J Sports Med 2005; 33 (10) 1492-1498
    CrossrefPubMedSuche in Google Scholar
  • 9 Chandrashekar N, Mansouri H, Slauterbeck J, Hashemi J. Sex-based differences in the tensile properties of the human anterior cruciate ligament. J Biomech 2006; 39 (16) 2943-2950
    CrossrefPubMedSuche in Google Scholar
  • 10 Mall NA, Chalmers PN, Moric M , et al. Incidence and trends of anterior cruciate ligament reconstruction in the United States. Am J Sports Med 2014; 42 (10) 2363-2370
    CrossrefPubMedSuche in Google Scholar
  • 11 Leathers MP, Merz A, Wong J, Scott T, Wang JC, Hame SL. Trends and demographics in anterior cruciate ligament reconstruction in the United States. J Knee Surg 2015; 28 (5) 390-394
    Thieme ConnectPubMedSuche in Google Scholar
  • 12 Shelton WR, Fagan BC. Autografts commonly used in anterior cruciate ligament reconstruction. J Am Acad Orthop Surg 2011; 19 (5) 259-264
    CrossrefPubMedSuche in Google Scholar
  • 13 Pinczewski LA, Lyman J, Salmon LJ, Russell VJ, Roe J, Linklater J. A 10-year comparison of anterior cruciate ligament reconstructions with hamstring tendon and patellar tendon autograft: a controlled, prospective trial. Am J Sports Med 2007; 35 (4) 564-574
    CrossrefPubMedSuche in Google Scholar
  • 14 Forster MC, Forster IW. Patellar tendon or four-strand hamstring? A systematic review of autografts for anterior cruciate ligament reconstruction. Knee 2005; 12 (3) 225-230
    CrossrefPubMedSuche in Google Scholar
  • 15 Feller JA, Webster KE, Gavin B. Early post-operative morbidity following anterior cruciate ligament reconstruction: patellar tendon versus hamstring graft. Knee Surg Sports Traumatol Arthrosc 2001; 9 (5) 260-266
    CrossrefPubMedSuche in Google Scholar
  • 16 Feller JA, Webster KE. A randomized comparison of patellar tendon and hamstring tendon anterior cruciate ligament reconstruction. Am J Sports Med 2003; 31 (4) 564-573
    CrossrefPubMedSuche in Google Scholar
  • 17 Aglietti P, Giron F, Buzzi R, Biddau F, Sasso F. Anterior cruciate ligament reconstruction: bone-patellar tendon-bone compared with double semitendinosus and gracilis tendon grafts. A prospective, randomized clinical trial. J Bone Joint Surg Am 2004; 86-A (10) 2143-2155
    PubMedSuche in Google Scholar
  • 18 Svensson M, Sernert N, Ejerhed L, Karlsson J, Kartus JT. A prospective comparison of bone-patellar tendon-bone and hamstring grafts for anterior cruciate ligament reconstruction in female patients. Knee Surg Sports Traumatol Arthrosc 2006; 14 (3) 278-286
    CrossrefPubMedSuche in Google Scholar
  • 19 Barrett GR, Noojin FK, Hartzog CW, Nash CR. Reconstruction of the anterior cruciate ligament in females: a comparison of hamstring versus patellar tendon autograft. Arthroscopy 2002; 18 (1) 46-54
    PubMedSuche in Google Scholar
  • 20 Kamien PM, Hydrick JM, Replogle WH, Go LT, Barrett GR. Age, graft size, and Tegner activity level as predictors of failure in anterior cruciate ligament reconstruction with hamstring autograft. Am J Sports Med 2013; 41 (8) 1808-1812
    CrossrefPubMedSuche in Google Scholar
  • 21 Ott SM, Ireland ML, Ballantyne BT, Willson JD, McClay Davis IS. Comparison of outcomes between males and females after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2003; 11 (2) 75-80
    CrossrefPubMedSuche in Google Scholar
  • 22 Persson A, Fjeldsgaard K, Gjertsen JE , et al. Increased risk of revision with hamstring tendon grafts compared with patellar tendon grafts after anterior cruciate ligament reconstruction: a study of 12,643 patients from the Norwegian Cruciate Ligament Registry, 2004-2012. Am J Sports Med 2014; 42 (2) 285-291
    CrossrefPubMedSuche in Google Scholar
  • 23 Ryan J, Magnussen RA, Cox CL, Hurbanek JG, Flanigan DC, Kaeding CC. ACL reconstruction: do outcomes differ by sex? A systematic review. J Bone Joint Surg Am 2014; 96 (6) 507-512
    CrossrefPubMedSuche in Google Scholar
  • 24 Ahldén M, Sernert N, Karlsson J, Kartus J. Outcome of anterior cruciate ligament reconstruction with emphasis on sex-related differences. Scand J Med Sci Sports 2012; 22 (5) 618-626
    CrossrefPubMedSuche in Google Scholar
  • 25 Kautzner J, Kos P, Hanus M, Trc T, Havlas V. A comparison of ACL reconstruction using patellar tendon versus hamstring autograft in female patients: a prospective randomised study. Int Orthop 2015; 39 (1) 125-130
    CrossrefPubMedSuche in Google Scholar
  • 26 Siebold R, Webster KE, Feller JA, Sutherland AG, Elliott J. Anterior cruciate ligament reconstruction in females: a comparison of hamstring tendon and patellar tendon autografts. Knee Surg Sports Traumatol Arthrosc 2006; 14 (11) 1070-1076
    Suche in Google Scholar
  • 27 Gobbi A, Domzalski M, Pascual J. Comparison of anterior cruciate ligament reconstruction in male and female athletes using the patellar tendon and hamstring autografts. Knee Surg Sports Traumatol Arthrosc 2004; 12 (6) 534-539
    CrossrefPubMedSuche in Google Scholar
  • 28 Soltani N, Rahimi A, Naimi SS, Khademi K, Saeedi H. Studying the balance of the coper and non-coper ACL-deficient knee subjects. Asian J Sports Med 2014; 5 (2) 91-98
    PubMedSuche in Google Scholar
  • 29 Hurd WJ, Axe MJ, Snyder-Mackler L. Influence of age, gender, and injury mechanism on the development of dynamic knee stability after acute ACL rupture. J Orthop Sports Phys Ther 2008; 38 (2) 36-41
    CrossrefPubMedSuche in Google Scholar
  • 30 Kato Y, Maeyama A, Lertwanich P , et al. Biomechanical comparison of different graft positions for single-bundle anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2013; 21 (4) 816-823
    CrossrefPubMedSuche in Google Scholar
  • 31 Duffee A, Magnussen RA, Pedroza AD, Flanigan DC, Kaeding CC ; MOON Group. Transtibial ACL femoral tunnel preparation increases odds of repeat ipsilateral knee surgery. J Bone Joint Surg Am 2013; 95 (22) 2035-2042
    CrossrefPubMedSuche in Google Scholar
  • 32 Lee JK, Lee S, Seong SC, Lee MC. Anatomic single-bundle ACL reconstruction is possible with use of the modified transtibial technique: a comparison with the anteromedial transportal technique. J Bone Joint Surg Am 2014; 96 (8) 664-672
    CrossrefPubMedSuche in Google Scholar
  • 33 Rahr-Wagner L, Thillemann TM, Pedersen AB, Lind MC. Increased risk of revision after anteromedial compared with transtibial drilling of the femoral tunnel during primary anterior cruciate ligament reconstruction: results from the Danish Knee Ligament Reconstruction Register. Arthroscopy 2013; 29 (1) 98-105
    CrossrefPubMedSuche in Google Scholar
  • 34 Tegner Y, Lysholm J. Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 1985; (198) 43-49
    PubMedSuche in Google Scholar
  • 35 Kujala UM, Jaakkola LH, Koskinen SK, Taimela S, Hurme M, Nelimarkka O. Scoring of patellofemoral disorders. Arthroscopy 1993; 9 (2) 159-163
    CrossrefPubMedSuche in Google Scholar
  • 36 Kaeding CC, Aros B, Pedroza A , et al. Allograft versus autograft anterior cruciate ligament reconstruction: predictors of failure from a MOON prospective longitudinal cohort. Sports Health 2011; 3 (1) 73-81
    CrossrefPubMedSuche in Google Scholar
  • 37 Barrett GR, Luber K, Replogle WH, Manley JL. Allograft anterior cruciate ligament reconstruction in the young, active patient: Tegner activity level and failure rate. Arthroscopy 2010; 26 (12) 1593-1601
    CrossrefPubMedSuche in Google Scholar
  • 38 Beynnon BD, Johnson RJ, Fleming BC , et al. Anterior cruciate ligament replacement: comparison of bone-patellar tendon-bone grafts with two-strand hamstring grafts. A prospective, randomized study. J Bone Joint Surg Am 2002; 84-A (9) 1503-1513
    PubMedSuche in Google Scholar
  • 39 Noojin FK, Barrett GR, Hartzog CW, Nash CR. Clinical comparison of intraarticular anterior cruciate ligament reconstruction using autogenous semitendinosus and gracilis tendons in men versus women. Am J Sports Med 2000; 28 (6) 783-789
    CrossrefPubMedSuche in Google Scholar
  • 40 Chaves SF, Marques NP, Silva RL , et al. Neuromuscular efficiency of the vastus medialis obliquus and postural balance in professional soccer athletes after anterior cruciate ligament reconstruction. Muscles Ligaments Tendons J 2012; 2 (2) 121-126
    PubMedSuche in Google Scholar
  • 41 Dhillon MS, Bali K, Prabhakar S. Differences among mechanoreceptors in healthy and injured anterior cruciate ligaments and their clinical importance. Muscles Ligaments Tendons J 2012; 2 (1) 38-43
    PubMedSuche in Google Scholar