Comparison of patellar tendon versus hamstrings autografts for anterior cruciate ligament reconstruction in Indian population: A randomised control trial study

Abstract

Disruption of anterior cruciate ligament (ACL) is a common ligamentous injury of the knee. The best choice of graft for reconstruction remains undecided. This prospective, randomized clinical trial aimed to compare clinical results of bone-patellar tendon-bone (BPTB) grafts and four-strand semitendinosusgracilis (QHT) grafts for ACL reconstruction over a 1-year follow-up interval in Indian population. Methods: 42 consecutive patients with ACL injury were recruited, by pick and draw method and allotted into two groups with 21 patients in each group. Group A patients underwent arthroscopic ACL reconstruction using BPTB graft while QHT autograft was used for patients in Group B. All the patients underwent standard ipsilateral arthroscopic ACL reconstruction procedure using a single incision, antero-medial (AM) portal technique for BPTB or the QHT autograft by a same surgeon. Patients were followed up regularly for a minimum period of 1 year. Results: After one year, the Cincinnati score was 91 AE 4.117 in BPTB group and 89.29 AE 5.371 in QHT group (P = 0.282). There was no significant difference between the two groups in the mean scores with respect to pain, overall activity level and running in the Cincinnati score. None of the patients complained of the knee giving way. Similarly, at 1 year, the Lysholm score was 92.84 AE 2.630 and 90.55 AE 2.395 in the two groups respectively (P = 0.842). There were no episodes of locking or instability and there was no significant difference in the mean Lysholm scores regarding pain and squatting. Conclusion: There was no significant functional difference between the two grafts in terms of Lysholm and the Cincinnati score, anterior knee laxity and altered sensation over proximal leg. The patients with QHT groups performed better than BPTB functionally at 6 month so early return to sport is possible even with QHT autograft.

The reverse fragility index: RCTs reporting non-significant differences in failure rates between hamstring and bone–patellar tendon–bone autografts have fragile results

“…Of the 838 potentially relevant studies identified, 16 RCTs met the inclusion criteria [2, 3, 5, 10, 12, 16–18, 20, 22, 34–36, 41, 43, 46]. A PRISMA flow diagram is shown in Fig.…”

“…Therefore, the result only became significant if twice the number of events would have occurred. The included studies varied in this regard, with some requiring 3 times as many events to be reversed as events that occurred [12, 18]. This result is also independent of sample size since the ratio of the RFQ to the rate of rupture in each study population equals the ratio of the RFI to the number of events.…”

“…In a recent survey study of members of the American Orthopaedic Society for Sports Medicine (AOSSM) and Arthroscopy Association of North America (AANA), the second most important factor for graft selection was graft failure rates reported in the literature [6]. However, the current evidence on re‐rupture/revision rates between two of the most frequently used grafts, hamstring (HT) autografts and bone–patellar tendon–bone (BTB) autografts, is conflicting [2, 3, 5, 9, 10, 12, 14, 16–18, 20, 22, 34–36, 39, 41, 43, 46]. For example, Samuelsen et al performed a meta‐analysis which demonstrated a significantly lower re‐rupture rate among BTB autografts ( P = 0.01), whereas a meta‐analysis from Mouarbes et al showed no significant difference in re‐rupture rates between these two graft types (n.s.)…”

Return to sport soccer after anterior cruciate ligament reconstruction: ISAKOS consensus

“…11.-"In patients with a high level of intensity of pivoting sports practice, BPTB should be the favorite graft as an earlier graft ligamentization allows the implementation of a more aggressive rehabilitation program after surgery, and therefore a faster RTS in soccer" No consensus 69.2% BPTB autografts have been considered to have lower revision rates and higher postoperative stability than HT autografts and may be preferable in competitive high-level athletes in contact sports (77). Xie (78) suggested that BPTB autografts should be used in young and high-demand athletes to enable a greater proportion of patients to return to J o u r n a l P r e -p r o o f their preinjury sport postoperatively with higher levels of activity, but despite it provides better initial fixation and allows an early return, has been associated with different morbidities, such as anterior knee pain and loss of range of motion, and longer time to reach the Rh progression milestone than HS (29).…”

Canine ACL reconstruction with an injectable hydroxyapatite/collagen paste for accelerated healing of tendon-bone interface

“…BPTB graft was once the gold standard due to the achieved bone-bone healing in the bone tunnels. Lately hamstring tendon is becoming the most common graft applied in the orthopaedic community [ [6] , [7] , [8] ] because significant complications such as donor pain, quadriceps atrophy and flexion contracture were reported in BPTB therapy [ 9 , 10 ].…”