Young men undergoing anterior cruciate ligament reconstruction with patellar tendon autograft and anteromedial drilling outperform at 5- to 10-year follow-up in terms of graft stability and activity levels compared to those undergoing reconstruction with hamstring autograft and transtibial drilling

Iftach Hetsroni; Gideon Mann; Eyal Arami; Mischa van Stee; Niv Marom; Nissim Ohana

doi:10.1016/j.jisako.2024.04.001

Young men undergoing anterior cruciate ligament reconstruction with patellar tendon autograft and anteromedial drilling outperform at 5- to 10-year follow-up in terms of graft stability and activity levels compared to those undergoing reconstruction with hamstring autograft and transtibial drilling

J ISAKOS. 2024 Apr 3:S2059-7754(24)00071-3. doi: 10.1016/j.jisako.2024.04.001. Online ahead of print.

Authors

Iftach Hetsroni¹, Gideon Mann², Eyal Arami³, Mischa van Stee⁴, Niv Marom⁵, Nissim Ohana⁶

Affiliations

¹ Department of Orthopedic Surgery, Meir Medical Center, Kfar Saba 44281, Israel; Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv 69978, Israel. Electronic address: iftachhetsroni@gmail.com.
² Department of Orthopedic Surgery, Meir Medical Center, Kfar Saba 44281, Israel; Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv 69978, Israel. Electronic address: Gideon.mann.md@gmail.com.
³ Department of Orthopedic Surgery, Barzilai Medical Center, Ashkelon 7845637, Israel; The Joyce & Irving Goldman Faculty of Medicine, Ben-Gurion University of the Negev, Beer Sheva 8443944, Israel. Electronic address: Eyal.Arami@mail.huji.ac.il.
⁴ Physiotherapy Service, Meir Medical Center, Kfar Saba 44281, Israel. Electronic address: mischavanstee74@gmail.com.
⁵ Department of Orthopedic Surgery, Meir Medical Center, Kfar Saba 44281, Israel; Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv 69978, Israel. Electronic address: niv.marom@gmail.com.
⁶ Department of Orthopedic Surgery, Meir Medical Center, Kfar Saba 44281, Israel; Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv 69978, Israel. Electronic address: niso62@yahoo.com.

PMID: 38580054
DOI: 10.1016/j.jisako.2024.04.001

Abstract

Objective: To compare 5- to 10-year outcomes of anterior cruciate ligament (ACL) reconstruction in young men performed with bone-patellar tendon bone (BPTB) autograft and anteromedial portal to reconstruction with hamstring autograft and transtibial technique. It was hypothesised that in young adult men, at 5- to 10-year follow-up, superior restoration of knee laxity and activity levels would be demonstrated using BPTB autograft and anteromedial portal technique.

Methods: Ninety-four men who had ACL reconstruction with BPTB autograft and anteromedial portal were eligible for comparison to 106 men who had reconstruction with hamstring autograft and transtibial technique. Inclusion criteria were: (1) age 18-35 years, (2) ACL tear caused by sports trauma only, (3) no concomitant ligament reconstruction and (4) 5- to 10-year follow-up. Outcome measures compared between the two groups included Lachman and pivot shift tests, KT side-to-side difference, Tegner and Marx scores, International Knee Documentation Committee (IKDC)-subjective score, Knee Osteoarthritis Outcome Scale (KOOS), Short Form (SF)-36, and single hop test for distance. P value < 0.05 indicated statistical significance.

Results: Forty-five patients with BPTB and 55 patients with hamstring ACL reconstruction were available for in-person assessment at 5-10 years after surgery. Outcomes in the BPTB group compared to the hamstring group showed KT difference 1.4 ± 1.9 mm vs. 2.8 ± 2.3 mm (p < 0.01), pivot shift grade 2-3 in 4% vs. 34% (p < 0.01), return to preinjury Tegner level in 51% vs. 36% (p = 0.1) and to preinjury Marx score in 29% vs. 11% (p = 0.02), and IKDC-subjective 88 ± 10 vs. 82 ± 13 vs (p < 0.01), respectively. Statistically significant inter-relationships were found between KT side-to-side difference and the Tegner, Marx and IKDC-subjective scores at follow-up (r = -0.314, p < 0.01; r = -0.263, p < 0.01; r = -0.218, p = 0.03, respectively).

Conclusion: Young men undergoing ACL reconstruction with patellar tendon autograft and anteromedial drilling outperform at 5- to 10-year follow-up in terms of graft stability and activity levels compared to young men undergoing reconstruction with hamstring autograft and transtibial drilling.

Level of evidence: III (Retrospective cross-sectional comparative study).

Keywords: ACL; Anteromedial; BPTB; Hamstring; KT; Marx score; Transtibial.