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Bone-patellar tendon-bone autograft versus hamstring autograft anterior cruciate ligament reconstruction in the young athlete: a retrospective matched analysis with 2-10 year follow-up.

Summary of "Bone-patellar tendon-bone autograft versus hamstring autograft anterior cruciate ligament reconstruction in the young athlete: a retrospective matched analysis with 2-10 year follow-up."


PURPOSE:
The aim of this study was to examine clinical and patient-reported outcomes as well as return to sport in athletes younger than 25 following ACL reconstruction with either bone-patellar tendon-bone (BTB) or hamstring (HS) autografts using a matched-pairs case-control experimental design.
METHODS:
Twenty-three matched pairs were obtained based on gender (57% women), age (18 ± 3 years BTB vs. 18 ± 3 HS), and length of follow-up (5 ± 2 years BTB vs. 4 ± 2 HS). Patients reported participating in very strenuous (soccer, basketball, etc.) or strenuous (skiing, tennis, etc.) sporting activity 4-7 times/week prior to their knee injury. Patient-reported outcomes included return to play data, the IKDC, SAS, ADLS, and SF-36 forms. Clinical outcomes included knee range of motion, laxity, and hop/jump testing.
RESULTS:
The majority of patients in both groups were able to participate in very strenuous or strenuous sporting activity 4-7 times per week following surgery [17 (74%) BTB vs. 16 (70%) HS]. However, only 13 (57%) of the BTB subjects and 10 (44%) of the HS patients were able to return to pre-injury activity levels (P = n.s.). HS patients showed higher ADLS (P < 0.01) and SAS (P < 0.01) scores, better restoration of extension (P < 0.05), and less radiographic evidence of osteoarthritis (P < 0.05).
CONCLUSIONS:
Hamstring and bone-patellar tendon-bone autografts allow approximately 70% of young athletes to return to some degree of strenuous or very strenuous sporting activity, while only approximately half of patients were able to return to their pre-injury sporting activity level. Hamstring grafts lead to better preservation of extension, higher patient-reported outcome scores, and less radiographic evidence of osteoarthritis. LEVEL OF
EVIDENCE:
Therapeutic (case-control study) Level III.

Affiliation

Section of Orthopaedic Surgery, University of Manitoba, AD4-820 Sherbrook Street, Winnipeg, MB, R3A 1R9, Canada, mascarer@hotmail.com.

Journal Details

This article was published in the following journal.

Name: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA
ISSN: 1433-7347
Pages:

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Medical and Biotech [MESH] Definitions

Fixation of the ANTERIOR CRUCIATE LIGAMENT, during surgical reconstruction, by the use of a bone- patellar tendon autograft.

A bone-patellar tendon graft used for fixation of the ANTERIOR CRUCIATE LIGAMENT during surgical reconstruction of the knee.

Fixation of the ANTERIOR CRUCIATE LIGAMENT, during surgical reconstruction, by the use of a bone-patellar tendon graft.

A band of fibrous tissue that attaches the apex of the PATELLA to the lower part of the tubercle of the TIBIA. The ligament is actually the caudal continuation of the common tendon of the QUADRICEPS FEMORIS. The patella is embedded in that tendon. As such, the patellar ligament can be thought of as connecting the quadriceps femoris tendon to the tibia, and therefore it is sometimes called the patellar tendon.

Tearing away of the CORTICAL BONE fragment at the location of a strong ligament or tendon attachment. The bone fragment detachment site often occurs near a soft site (e.g., GROWTH PLATE) at the base where LIGAMENTS; TENDONS; or JOINT CAPSULES attach. In younger patients it is most often caused by a sudden forceful pull on a tendon in the opposite direction of the bone movement. In the elderly it is associated with osteoporotic INSUFFICIENCY FRACTURES.

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