I n a two-centre study, 164 patients with unilateral instability of the anterior cruciate ligament were prospectively randomised to arthroscopic reconstruction with either a patellar tendon graft using interference screw fixation or a quadruple semitendinosus graft using an endobutton fixation technique. The same postoperative rehabilitation protocol was used for all patients and follow-up at a median of 31 months (24 to 59) was carried out by independent observers. Four patients (2%) were lost to follow-up.No significant differences were found between the groups regarding the Stryker laxity test, one-leg hop test, Tegner activity level, Lysholm score, patellofemoral pain score, International Knee Documentation Committee (IKDC) score or visual analogue scale, reflecting patient satisfaction and knee function. Slightly decreased extension, compared with the non-operated side, was found in the patellar tendon group (p < 0.05). Patients with associated meniscal injuries had lower IKDC, visual analogue (p < 0.01) and Lysholm scores (p < 0.05) than those without such injuries. Patients in whom reconstruction had been carried out less than five months after the injury had better final IKDC scores than the more chronic cases (p < 0.05).We conclude that patellar tendon and quadruple semitendinous tendon grafts have similar outcomes in the medium term. Associated meniscal pathology significantly affects the final outcome and early reconstruction seems to be beneficial. The bone-patellar tendon-bone graft has been regarded as the procedure of choice in reconstruction of the anterior cruciate ligament (ACL) for more than two decades. [1][2][3][4] Alternatives include semitendinosus or combined semitendinosus/gracilis tendon grafts. Few of the numerous studies reflecting the functional outcome after these different procedures are prospective investigations and even fewer are both prospective and randomised.5-7 Combined semitendinosus and gracilis grafts have been used in previous randomised studies. To the best of our knowledge, no prospective, randomised study comparing bone-patellar tendon-bone grafts with quadruple semitendinosus tendon grafts has been published. The particular clinical issues relate to possible elongation of hamstring tendon grafts over time, their possible lower donor site morbidity, especially reflecting patellofemoral problems, and optimal fixation technique.Our aim was to compare arthroscopically-assisted reconstruction of the ACL using bone-patellar tendon-bone graft and interference screw fixation with quadruple semitendinosus tendon graft using endobutton fixation proximally and screws distally. Patients and MethodsBetween 1995 and 1997, in a two-centre study, 180 patients were prospectively randomised to reconstruction of the ACL with either an ipsilateral bone-patellar tendon-bone graft or a quadruple semitendinosus graft. Inclusion criteria were single-leg insufficiency of the ACL with the trauma occurring at least two months before reconstruction, age between 15 and 45 years, no previous reco...

The main objective of this study was to study solely early postoperative morbidity following anterior cruciate ligament (ACL) reconstruction by comparing the gold standard procedure, the bone-patellar tendon-bone graft (BTB), and one of the most common alternatives, the semitendinosus tendon graft (ST). The prospective study included 107 randomized patients (50 BTB and 57 ST). The follow-up period was set to 20-35 weeks postoperatively (mean 26.8∫3.5 weeks). One patient suffered early graft rupture and 89 (84%) of the remaining 106 patients were able to attend the follow-up within the given time limit. There were no differences in sick leave between the groups. The Lysholm score, Tegner activity level score and Visual Analog Scales (VAS) with the questions ''How does your