@article{3125819,
    title = "Anatomic single-bundle anterior cruciate ligament reconstruction improves walking economy: hamstrings tendon versus patellar tendon grafts",
    author = "Iliopoulos, E. and Galanis, N. and Zafeiridis, A. and Iosifidis, M. and Papadopoulos, P. and Potoupnis, M. and Geladas, N. and Vrabas, I.S. and Kirkos, J.",
    journal = "Knee Surgery, Sports Traumatology, Arthroscopy",
    year = "2017",
    volume = "25",
    number = "10",
    pages = "3155-3162",
    publisher = "Springer-Verlag",
    issn = "0942-2056, 1433-7347",
    doi = "10.1007/s00167-016-4229-4",
    keywords = "adult;  anterior cruciate ligament injury;  anterior cruciate ligament reconstruction;  bone patellar tendon bone graft;  comparative study;  controlled study;  energy metabolism;  gait;  hamstring tendon;  human;  male;  patellar ligament;  pathophysiology;  physiology;  procedures;  randomized controlled trial;  transplantation;  treatment outcome;  walking, Adult;  Anterior Cruciate Ligament Injuries;  Anterior Cruciate Ligament Reconstruction;  Bone-Patellar Tendon-Bone Grafting;  Energy Metabolism;  Gait;  Hamstring Tendons;  Humans;  Male;  Patellar Ligament;  Treatment Outcome;  Walking",
    abstract = "Purpose: Anterior cruciate ligament (ACL) injury is associated with a pathologic gait pattern and increased energy cost during locomotion. ACL reconstruction could improve the gait pattern. Hamstrings tendon (HAM) and bone–patellar tendon–bone (BPTB) grafts are usually used for reconstruction. The aim of this study was to compare the efficacy of anatomic ACL reconstruction with HAM and BPTB grafts on improving and normalizing the energy cost and physiologic reserves during flat, uphill, and downhill walking. Methods: Twenty male subjects with unilateral ACL injuries were randomly assigned to ACL reconstruction with a HAM (n = 10) or BPTB (n = 10) graft. Ten matched controls were also enrolled. All participants performed three 8-min walking tasks at 0, +10, and −10 % gradients before and 9 months after surgery. Energy cost (oxygen consumption, VO2), heart rate (HR), and ventilation (VE) were measured. Lysholm/IKDC scores were recorded. Results: Pre-operatively, VO2, HR, and VE were higher in the HAM and BPTB groups than in controls during walking at 0, +10, and −10 % gradients (p < 0.001–0.01). Post-operatively, both HAM and BPTB groups showed reduced VO2, HR, and VE during the three walking tasks (p < 0.001–0.01). Although the post-operative VO2 in both surgical groups reached 90–95 % of the normative (control) value during walking, it remained elevated against the value observed in controls (p < 0.001–0.01). The HAM and BPTB groups showed no differences in post-surgical VO2 or HR during walking at all three gradients. Conclusion: Anatomic ACL reconstruction with either HAM or BPTB graft resulted in similar short-term improvements in energy cost and nearly normalized locomotion economy and cardiorespiratory reserves during flat, uphill, and downhill walking. The improved locomotion economy is an additional benefit of anatomic ACL reconstruction, irrespective of the type of graft used, that the orthopaedic surgeons should consider. Level of evidence: II. © 2016, European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA)."
}