Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction Using Bone–Patellar Tendon–Bone and Gracilis Tendon Graft: A Comparative Study With 2-Year Follow-up Results of Semitendinosus Tendon Grafts Alone or Semitendinosus–Gracilis Tendon Grafts

• Published in: Arthroscopy Vol. 27; no. 9; pp. 1242 - 1251
• Main Authors: Niki, Yasuo, M.D., Ph.D, Matsumoto, Hideo, M.D., Ph.D, Hakozaki, Akihiro, M.D, Kanagawa, Hiroya, M.D, Toyama, Yoshiaki, M.D., Ph.D, Suda, Yasunori, M.D., Ph.D
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.09.2011; Elsevier
• Subjects: Adolescent; Adult; Anterior Cruciate Ligament - surgery; Anterior Cruciate Ligament Injuries; Anterior Cruciate Ligament Reconstruction - methods; Anterior Cruciate Ligament Reconstruction - rehabilitation; Anterior Cruciate Ligament Reconstruction - statistics & numerical data; Arthroscopy; Arthroscopy - methods; Biological and medical sciences; Bone-Patellar Tendon-Bone Grafting - rehabilitation; Endoscopy; Female; Follow-Up Studies; Humans; Incidence; Investigative techniques, diagnostic techniques (general aspects); Knee Injuries - rehabilitation; Male; Medical sciences; Middle Aged; Orthopedic surgery; Orthopedics; Pain, Postoperative - epidemiology; Pain, Postoperative - etiology; Pain, Postoperative - physiopathology; Recovery of Function; Retrospective Studies; Rupture - surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Tendons - surgery; Tendons - transplantation; Treatment Outcome; Weight-Bearing; Young Adult; Arthroscopy; Orthopedic surgery; Treatment; Patellar tendon; Bone graft; Endoscopy; Bone; Comparative study; Anterior cruciate ligament
• ISSN: 0749-8063; 1526-3231
• DOI: 10.1016/j.arthro.2011.03.086

Purpose The purpose of this study was to assess the clinical results of anatomic double-bundle anterior cruciate ligament (ACL) reconstruction by use of bone–patellar tendon–bone and gracilis tendon (BPTB-G) grafts and to compare them with the results of double-bundle ACL reconstruction by use of semitendinosus tendon (ST) or semitendinosus-gracilis tendon (ST-G) grafts, with particular emphasis on the postoperative incidence of anterior knee pain. Methods The study comprised 144 patients who underwent unilateral anatomic double-bundle ACL reconstruction with 3 graft types, including 55 BPTB-G, 56 ST, and 33 ST-G grafts. A traumatic graft rupture occurred within 2 years postoperatively in 5 patients (1 BPTB-G, 3 ST, and 1 ST-G). Clinical results and incidence and severity of anterior knee pain were assessed and compared among the 3 different graft groups at 2 years postoperatively. Potential variables influencing postoperative anterior knee pain development were subjected to univariate analysis, followed by logistic regression analysis to identify risk factors for anterior knee pain. Results Both subjective and objective clinical results in anatomic double-bundle ACL reconstruction with BPTB-G graft were similar to those using ST or ST-G graft at 2 years postoperatively. The incidences of anterior knee pain at 2 years' follow-up were 18.5%, 9.4%, and 9.3% in the BPTB-G, ST, and ST-G groups, respectively, indicating no statistically significant difference among the 3 groups. Multivariate logistic regression analyses showed that BPTB graft harvest and patellofemoral cartilage defect failed to be significant factors for anterior knee pain whereas quadriceps peak torque at 60°/s was the only significant factor for anterior knee pain at 2 years. Conclusions Clinical results including the incidence of anterior knee pain 2 years after anatomic double-bundle ACL reconstruction with BPTB-G grafts were comparable to those after ACL reconstruction with ST or ST-G grafts. Level of Evidence Level III, therapeutic, retrospective comparative study.