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Ten-Year Results of ACL Repairs

After many years there still isn't agreement about which of the two commonly used methods of repair for a ruptured ACL is the best. Long-term studies may be able to help answer the question of which one is the better choice.

In this study, a single surgeon compared 90 patients with a hamstring tendon graft (HTG) to 90 patients with a patellar tendon graft (PTG). All patients had anterior cruciate ligament (ACL) deficient knees. Everyone was followed closely for 10 years.

X-rays, clinical tests, and reports of pain, activity level, and function were used as the primary measures of results. Failure was defined as graft rupture. After 10 years, the results of the two groups were very similar. There were no differences in the number of graft failures between the two groups.

Function was normal or near-normal in almost all the patients in both groups. As has been reported in many other studies, the PTG had more pain and problems at the harvest site. Kneeling is often a problem for this group. And the PTG had more osteoarthritis of the knee after 10 years compared with the HTG.

Although the authors favor the HTG, they point out that there are other factors in the success or failure of ACL repair. Graft choice is only one consideration. Other factors include the surgeon's experience, correct graft position, and graft fixation. The presence of other damage to the knee and postoperative rehab can also make a difference.

References: Leo A. Pinczewski, MD, et al. A 10-Year Comparison of Anterior Cruciate Ligament Reconstructions with Hamstring Tendon and Patellar Tendon Autograft. In The American Journal of Sports Medicine. April 2007. Vol. 35. No. 4. Pp. 564-574.

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