Patellar tendon vs. hamstrings in ACL reconstruction: Ten-year follow-up prospective randomized study

Single bundle, single tunnel reconstruction of ACL seems to be an “old procedure” after the recent development and knowledge about anatomical reconstructions of ACL (single or double bundle). Despite the new trend, prospective long-term follow-up studies on the single bundle reconstruction are necessary to get more information on a technique that has occupied the last 20 years and has been executed on millions of patients. Methods From January 2002 and February 2003, hundred eight patients were recruited for a prospective randomized trial. The exclusion criteria were previous knee operations, chondral lesions, varus deformity more than 10 degrees, limb imbalance, meniscal lesion extension more than on third of the meniscus and history of knee tendinopathies. Three groups of 36 patients each were selected by the arthroscopically assisted surgical procedure: A B-PT-B reconstruction, B hamstrings (endobutton CL-reabsorbable interference screw), and C hamstrings (endobutton CL-evolgate). A dice method was used for the graft randomization. A standard rehabilitation protocol was used for all the patients, including immediate postoperative mobilisation with a knee brace just for walking (first 3 weeks), protected weight bearing for 2 weeks, and return to full activity at 6–12 months postoperatively. The patients were followed up at 6 months, 1 year and then each year until the tenth year postoperative. Six patients in group A, 8 in group B and 11 in group C were lost at the final follow-up. The methods of evaluation included clinical and instrumented laxity testing (Rolimeter), isokinetic muscle torque measurements (Cybex II), International Knee Documentation Committee II ratings, Lysholm score, Tegner activity level, Kujala patellofemoral knee scores, and radiological tunnel enlargement measure. Results The results revealed no statistically significant differences with respect to IKDC II, Lysholm score, Isokinetic test and Kujala patellofemoral knee scores. There was an enlargement of the tunnels, statistically significant in the hamstring tendon groups, and more evident in the group B. Any widening of the tunnels from 3 to 5 years was recorded into each group. The measurement of laxity using the Rolimeter showed better results for group A without any difference statistically significant. Differently, the Tegner score was statistically favourable for PT group for the first 4 years after surgery. Radiological narrowing of the joint spaces (IKDC) from 1 to 10 years postoperatively was seen in all the groups, At 10 years follow-up, radiological findings were worse for the PT group ( P Conclusions PT and hamstrings ACL reconstruction seem to show similar functional and clinical results at long-term follow-up. Tunnel widening in hamstrings groups, may be a complication in case of revision. The patellar tendon group seems to be more prone to develop osteoarthritis after 5 years postoperatively.