Open AccessEvaluation of Graft Tensioning Effects in Anterior Cruciate Ligament Reconstruction between Hamstring and Bone–Patellar Tendon Bone Autografts
Author(s) -
Steven F. DeFroda,
Naga Padmini Karamchedu,
Ross Budacki,
Taylor Wiley,
Paul D. Fadale,
Michael J. Hulstyn,
Robert M. Shalvoy,
Gary J. Badger,
Braden C. Fleming,
Brett D. Owens
Publication year - 2020
Publication title -
the journal of knee surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.984
H-Index - 59
eISSN - 1938-2480
pISSN - 1538-8506
DOI - 10.1055/s-0039-3402046
Subject(s) - medicine , anterior cruciate ligament reconstruction , anterior cruciate ligament , osteoarthritis , patellar tendon , hamstring , radiography , tendon , surgery , alternative medicine , pathology
This article investigates the clinical, functional, and radiographic outcomes in anterior cruciate ligament (ACL) reconstruction patients over 7 years to determine the effects of initial graft tension on outcomes when using patellar tendon (bone-tendon-bone [BTB]) and hamstring tendon (HS) autografts. Ninety patients, reconstructed with BTB or HS, were randomized using two initial graft tension protocols: (1) normal anteroposterior (AP) laxity ("low-tension"; n = 46) and (2) AP laxity overconstrained by 2 mm ("high-tension"; n = 44). Seventy-two patients had data available at 7 years, with 9 excluded for graft failure. Outcomes included the Knee Injury and Osteoarthritis Outcome Score, Short-Form-36 (SF-36), and Tegner activity scale. Clinical outcomes included KT-1000S and International Knee Documentation Committee examination score; and functional outcomes included 1-leg hop distance and peak knee extensor torque. Imaging outcomes included medial joint space width, Osteoarthritis Research Society International radiographic score, and Whole-Organ Magnetic Resonance Score. There were significantly improved outcomes in the high-tension compared with the low-tension HS group for SF-36 subset scores for bodily pain ( p = 0.012), social functioning ( p = 0.004), and mental health ( p = 0.014) 84 months postsurgery. No significant differences in any outcome were found within the BTB groups. Tegner activity scores were also significantly higher for the high-tension HS group compared with the low-tension (6.0 vs. 3.8, p = 0.016). Patients with HS autografts placed in high tension had better outcomes relative to low tension for Tegner activity score and SF-36 subset scores for bodily pain, social functioning, and mental health. For this reason, we recommend that graft fixation be performed with the knee at 30-degree flexion ("high-tension" condition) when reconstructing the ACL with HS autograft.