NEW YORK (Reuters Health) Jul 23 - Seven to 10 years after anterior cruciate ligament (ACL) reconstruction, hamstring grafts have some advantages over patellar tendon grafts, Swedish researchers have found.
For decades, patellar tendon grafts were standard for ACL reconstruction, but that technique leaves patients with pain at the front of the knee afterward, which can be severe enough to prevent them from kneeling.
Increasingly, surgeons are shifting to semitendinosus tendon grafts, with or without the gracilis tendon.
In 1995 to 1997, Dr. Bjorn Barenius from Karolinska Institutet, Stockholm, Swede, and colleagues enrolled 164 patients with ACL tears in a randomized trial comparing the two approaches to reconstruction.
Now they have long-term follow-up data on 153 of those patients, which they report in a June 21st online article in The American Journal of Sports Medicine. The patellar tendon group currently has a mean age of 33 - two years younger than the mean age in the hamstring tendon group.
The authors first note that two-year results, reported earlier, showed equal stability and knee function with the two approaches, but patients in the semitendinosus group had better kneeling ability.
After surgery, 23 patients in each group had an additional procedure in the reconstructed ACL knee, including 33 (15 semitendinosus, 18 patellar) after the two-year follow-up report.
At a mean of 8.4 years after reconstruction, range of motion, stability, and knee function did not differ in the two groups. Health-related quality of life scores were also similar.
But patients with patellar tendon grafts reported significantly more problems with kneeling, had worse results in the knee-walking test, and reported more pronounced loss of skin sensation, compared with patients who received semitendinosus grafts.
Regardless of graft type, however, "there was a slight deterioration of knee function with time, and the consequences of the ACL injury were still present for many of the subjects after 8 years," the authors say.
Most patients (94%) said they did not regret their ACL surgery.
Patients who had early reconstruction (before 5 months) had better activity levels and better health-related quality of life than patients with late reconstruction.
Health-related quality of life was also better in patients who didn't have meniscal injury at baseline, and patients who didn't need medial meniscal surgery had better knee osteoarthritis outcome scores, especially for sports and recreation subscales.
"The conclusion drawn from this study was that an ACL reconstruction with a semitendinosus graft stood the test of time and is a better choice than is the patellar graft," the investigators say.
SOURCE: http://link.reuters.com/byq39m
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