@article{3032591,
    title = "Comparison of Bone-Patella Tendon-Bone Four-Strand Hamstring Tendon
Grafts for Anterior Cruciate Ligament Reconstruction: A Prospective
Study",
    author = "Arida, Christina and Tsikrikas, Chrisovalantis G. and Mastrokalos, and Dimitrios S. and Panagopoulos, Andreas and Vlamis, John and and Triantafyllopoulos, Ioannis K.",
    journal = "CUREUS",
    year = "2021",
    volume = "13",
    number = "11",
    publisher = "CUREUS INC",
    doi = "10.7759/cureus.19197",
    keywords = "re-rupture; knee injuries; bone-patella tendon-bone graft; four strand
hamstring tendon graft; anterior cruciate ligament (acl) reconstruction",
    abstract = "Introduction
To date, the proper choice of graft for anterior cruciate ligament (ACL)
reconstruction remains a matter of conflict. We aimed to compare the
clinical and functional outcomes of the two most commonly utilized
autografts, bone-patella tendon-bone (BPTB) and four-strand hamstring
tendon (HT) graft, at 6 and 12 months after surgery.
Methods
In a prospective randomized study, we included a total of 60 patients
undergoing ACL reconstruction, thirty in BPTB and thirty in HT group.
All patients were amateur athletes and were evaluated at 6 and 12 months
after surgery for: (a) postoperative functionality of the operated knee
by the Thgner, the Lysholm and the International Knee Documentation
Committee (IKDC) scoring scales, (b) anterior cruciate ligament (ACL)
instability of the operated knee compared to the healthy contralateral
knee by the KT-1000 arthrometer and (c) the extension and flexion muscle
strength of the operated knee by a CYBEX isokinetic dynamometer.
Results
Patients in the two groups did not differ regarding demographics, and
pre-injury functionality status. Significantly more patients in the HT
group (n=6) compared to the BPTB group (n=1) experienced ACL re-rupture
and underwent revision surgery before follow-up end (p=0.044). All
patients, regardless of graft, showed significant improvement within
each group of functional assessments by Lysholm, Thgner and IKDC scores,
as well as of Cybex measurements -with an increase of peak torque at 60
degrees extension and 180 degrees extension and 60 degrees flexion and
180 degrees flexion- at 12 months compared to 6 months follow-up
(p<0.05). However, there was no difference between the two groups
regarding knee function improvement or extension measurements neither at
6 nor 12 months. Contrarily, the BPTB graft group had higher values of
peak torque (Nm) at 60 degrees and 180 degrees flexion compared to the
HT group, both at 6 (p=0.014 and 0.029, respectively) and 12 months
(p=0.033 and 0.030, respectively). Postoperative stability was similar
between the two groups at 12 months (p=0.519).
Conclusion
Both BPTB and HT grafts present with benefits and drawbacks and remain
viable autograft options for primary ACL reconstruction as each has,
although HT grafts seem to be more susceptible to re-rupture. The graft
selection should be based on the needs and activities of each patient."
}