Bone-patellar tendon–bone autograft maturation is superior to double-bundle hamstring tendon autograft maturation following anatomical anterior cruciate ligament reconstruction

Abstract

Purpose The primary purpose of this study was to evaluate the second-look arthroscopic indings 1 year postoperatively and magnetic resonance imaging (MRI) indings 2 years after anterior cruciate ligament reconstruction (ACLR) using bonepatellar tendon-bone autograft (BTB) or hamstring tendon autograft (HT). Secondary purpose included clinical results from physical examination, including range of motion, Lachman test, pivot shift test, and knee anterior laxity evaluation, and the clinical score for subjective evaluations at 2 years after surgery. Methods Between 2015 and 2018, 75 patients with primary ACL injuries were divided into either the BTB group (n = 30) or HT group (n = 45). When using HT, an anatomical double-bundle ACLR was performed. BTB was indicated for athletes with suicient motivation to return to sporting activity. Graft maturation on second-look arthroscopy was scored in terms of synovial coverage and revascularization. All participants underwent postoperative MRI evaluation 2 years postoperatively. The signal intensity (SI) characteristics of the reconstructed graft were evaluated using oblique axial proton density-weighted MR imaging (PDWI) perpendicular to the grafts. The signal/noise quotient (SNQ) was calculated to quantitatively determine the normalized SI. For clinical evaluation, the Lachman test, pivot shift test, KT-2000 evaluation, Lysholm score, and Knee injury and Osteoarthritis Outcome Score (KOOS) were used. Results Arthroscopic indings showed that the graft maturation score in the BTB group (3.6 ± 0.7) was signiicantly greater than that in the anteromedial bundle (AMB; 2.9 ± 0.2, p = 0.02) and posterolateral bundle (PLB; 2.0 ± 0.9, p = 0.001) in the HT group. The mean MRI-SNQs were as follows: BTB, 2.3 ± 0.5; AMB, 2.9 ± 0.9; and PLB, 4.1 ± 1.1. There were signiicant diferences between BTB, AMB, and PLB (BTB and AMB: p = 0.04, BTB and PLB: p = 0.003, AMB and PLB: p = 0.03). Second-look arthroscopic maturation score and MRI-SNQ value signiicantly correlated for BTB, AMB, and PLB. No signiicant diferences were detected in clinical scores. There was a signiicant diference (p = 0.02) in the knee laxity evaluation (BTB: 0.9 ± 1.1 mm; HT: 2.0 ± 1.9 mm). Conclusion BTB maturation is superior to that of double-bundle HT based on morphological and MRI evaluations following anatomical ACLR, although no signiicant diferences were found in clinical scores. Regarding clinical relevance, the advantages of BTB may help clinicians decide on using the autograft option for athletes with higher motivation to return to sporting activity because signiicant diferences were observed in morphological evaluation, MRI assessment, and knee anterior laxity evaluation between BTB and double-bundle HT. Level of evidence Level IV.

Muscle strength after the anterior cruciate ligament reconstruction via contralateral bone-tendon-bone autograft

“…The main concept of the procedure is to secure better quadriceps muscle strength by harvesting a bone-patellar tendon-bone graft from the unaffected limb, which divides the duplicative antagonistic effects of reconstruction and graft harvesting maneuvers on one limb into two separate knees. This earlier return-to-sports strategy is supported by the biological healing advantage of BTB autografts, which mature faster than hamstring grafts [6].…”

Arthroscopic Anterior Cruciate Ligament Repair With Single-Bundle Hamstring Tendon Augmentation Providing Complete Femoral Footprint Restoration for Sherman Type One Tears: A Technique Guide

“…The use of an autograft hamstring tendon is advocated for in this technique due to the improved cellular and biomechanical milieu described previously—albeit its efficacy when compared with bone–patella–bone in ACLR alone remains contested. 13 The use of a hamstring tendon autograft diminishes the morbidity associated with bone–patella–bone tendon harvesting; however, semitendinosus harvesting may be associated with reduced postoperative flexion and tibial internal rotation strength. 14 Future research is needed to determine whether a gracilis-only autograft will suffice for the reconstruction autograft in this technique while avoiding the loss of strength associated with semitendinosus harvesting.…”

In Vitro Collagenase Degradation of Grafts Used Clinically for Anterior Cruciate Ligament Reconstruction: Human Tendon Data

“…Inadequate integration and maturation of the implanted material can affect fixation of the graft and may delay restoration of mechanical properties [52]. Again, comparing the tendons with the fastest (patellar) and slowest (hamstring) collagenase degradation results, it has been reported that BPTB grafts have a slightly faster maturation rate compared with hamstring tendons [53,54] which may indicate a faster restoration of mechanical properties. In this context, the greater susceptibility of the patellar tendon to enzymatic degradation may be more beneficial.…”