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Comparison of Bone-Patella Tendon-Bone and Four-Strand Hamstring Tendon Grafts for Anterior Cruciate Ligament Reconstruction: A Prospective Study

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 (...

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Autores principales: Arida, Christina, Tsikrikas, Chrisovalantis G, Mastrokalos, Dimitrios S, Panagopoulos, Andreas, Vlamis, John, Triantafyllopoulos, Ioannis K
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8642134/
https://www.ncbi.nlm.nih.gov/pubmed/34877191
http://dx.doi.org/10.7759/cureus.19197
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author Arida, Christina
Tsikrikas, Chrisovalantis G
Mastrokalos, Dimitrios S
Panagopoulos, Andreas
Vlamis, John
Triantafyllopoulos, Ioannis K
author_facet Arida, Christina
Tsikrikas, Chrisovalantis G
Mastrokalos, Dimitrios S
Panagopoulos, Andreas
Vlamis, John
Triantafyllopoulos, Ioannis K
author_sort Arida, Christina
collection PubMed
description 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 and12 months after surgery for: (a)postoperativefunctionality of the operated knee by the Tegner, 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) theextension and flexion muscle strength of the operated knee by a CYBEXisokinetic 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, Tegner and IKDC scores, as well as of Cybex measurements -with an increase of peak torque at 60° extension and 180°extension and 60° flexion and 180° 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° and 180° 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. 
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spelling pubmed-86421342021-12-06 Comparison of Bone-Patella Tendon-Bone and Four-Strand Hamstring Tendon Grafts for Anterior Cruciate Ligament Reconstruction: A Prospective Study Arida, Christina Tsikrikas, Chrisovalantis G Mastrokalos, Dimitrios S Panagopoulos, Andreas Vlamis, John Triantafyllopoulos, Ioannis K Cureus Physical Medicine & Rehabilitation 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 and12 months after surgery for: (a)postoperativefunctionality of the operated knee by the Tegner, 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) theextension and flexion muscle strength of the operated knee by a CYBEXisokinetic 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, Tegner and IKDC scores, as well as of Cybex measurements -with an increase of peak torque at 60° extension and 180°extension and 60° flexion and 180° 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° and 180° 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.  Cureus 2021-11-02 /pmc/articles/PMC8642134/ /pubmed/34877191 http://dx.doi.org/10.7759/cureus.19197 Text en Copyright © 2021, Arida et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Physical Medicine & Rehabilitation
Arida, Christina
Tsikrikas, Chrisovalantis G
Mastrokalos, Dimitrios S
Panagopoulos, Andreas
Vlamis, John
Triantafyllopoulos, Ioannis K
Comparison of Bone-Patella Tendon-Bone and Four-Strand Hamstring Tendon Grafts for Anterior Cruciate Ligament Reconstruction: A Prospective Study
title Comparison of Bone-Patella Tendon-Bone and Four-Strand Hamstring Tendon Grafts for Anterior Cruciate Ligament Reconstruction: A Prospective Study
title_full Comparison of Bone-Patella Tendon-Bone and Four-Strand Hamstring Tendon Grafts for Anterior Cruciate Ligament Reconstruction: A Prospective Study
title_fullStr Comparison of Bone-Patella Tendon-Bone and Four-Strand Hamstring Tendon Grafts for Anterior Cruciate Ligament Reconstruction: A Prospective Study
title_full_unstemmed Comparison of Bone-Patella Tendon-Bone and Four-Strand Hamstring Tendon Grafts for Anterior Cruciate Ligament Reconstruction: A Prospective Study
title_short Comparison of Bone-Patella Tendon-Bone and Four-Strand Hamstring Tendon Grafts for Anterior Cruciate Ligament Reconstruction: A Prospective Study
title_sort comparison of bone-patella tendon-bone and four-strand hamstring tendon grafts for anterior cruciate ligament reconstruction: a prospective study
topic Physical Medicine & Rehabilitation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8642134/
https://www.ncbi.nlm.nih.gov/pubmed/34877191
http://dx.doi.org/10.7759/cureus.19197
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