ACL Reconstruction: Patellar Tendon vs. Hamstring Graft. The present study was designed to investigate the fixation strength of a quadruple semitendinosus-gracilis graft compared with a middle-third bone-patellar tendon-bone graft using a new interference screw developed to fix hamstrings grafts for ACL reconstructions (RCI, Smith & Nephew Donjoy). The main difference between the groups was that people who got the patellar tendon graft had more pain when they kneeled, although the pain was mild. The debate to know which graft should be better has been going on for decades. There is no consensus with respect to the choice between these two grafts in ACL surgery. I think that young athletes are going to benefit from a patellar tendon graft as opposed to the hamstring graft because by having a ACL that is going to remain a lot more tighter and more stable for a longer period of time, will in turn decrease the likelihood of the ACL tearing again and other knee injuries occurring as well. Change ), You are commenting using your Twitter account. During the past decades, hamstring tendon (HT) and bone- patellar tendon (middle 1/3)-bone (BPTB) autografts are the most used grafts for ACL reconstruction. Patellar tendon versus hamstring tendon autograft for anterior cruciate ligament rupture in adults. The strength of patellar tendon and hamstring grafts is essentially equal. It is evident that the individual was not properly rehabbed during her acute stages all the way to her return to activity stage. After patellar tendon reconstruction, more people had some loss in their ability to straighten out their leg at the knee. We discuss this briefly in a previous blog entitled: hamstring versus patellar tendon grafts what is the difference? Art. Conversely, people had more anterior knee pain and discomfort with kneeling after patellar tendon reconstruction. Risk ratios with 95% confidence intervals were calculated for dichotomous outcomes, and mean differences and 95% confidence intervals for continuous outcomes. Because it has two bony fixation points, the Patella tendon graft is relatively more stable during the initial 6-8 weeks post surgery compared to the hamstring graft, which only has a single bony point of fixation. All tests for knee stability favoured patellar tendon grafts. We are collecting information on visitors to our website to ensure Cochrane resources meet the needs of our users. Purpose: Recent registry data have demonstrated a higher revision rate of quadriceps tendon (QT) graft compared with hamstring tendon (HT) and patellar tendon … Surgical interventions for treating acute Achilles tendon ruptures, Interventions for preventing and treating stress fractures and stress reactions of bone of the lower limbs in young adults, Surgical interventions for the treatment of anterior shoulder instability, Surgery versus conservative treatment for acute ankle sprains in adults. You Already Have A History Of Patellar Tendonitis Or Patellar Tendon Issues. I have seen these athletes 2 years down the road post surgery. a carpenter), a patellar tendon would be discouraged given the higher incidence of kneeling pain with this graft choice. To me, the gold standard of ACL reconstruction is the patella tendon autograft and should be considered for most people in their teens, 20’s and for many in their 30’s or 40’s. ( Log Out / This result has been reported by other researchers. A recent large Scandinavian registry study reported a higher risk of graft failure with hamstring graft than with BPTB graft, [6] and a Norwegian study indicated that patients with hamstring grafts had twice the risk of revision compared with patients with patellar tendon grafts at 5 years of follow-up. A graft is where the tissue is taken from to replace your ACL. The other is the hamstring tendon graft. In young athletic females of smaller stature, a hamstring graft would be suboptimal as the hamstring tendons may be too small in diameter to afford a good, strong graft. This means a difference in cost of 90 €. Change ), You are commenting using your Facebook account. Now that you have an idea of what the hamstring tendon graft is, let’s take a look at the pros and cons of this particular graft. Your data will be anonymised for processing, will be stored securely, and will not be shared with any third parties. By that new ACL not being able keep its elasticity, allowed that femur to go into places is wasn’t suppose to be going with activity, which led to unneeded stress on the meniscus and the eventual tear on her lateral aspect. Randomized and quasi-randomized controlled trials comparing outcomes (minimum two year follow-up) following ACL reconstruction using either PT or HT autografts in skeletally mature adults, irrespective of the number of bundles, fixation method or incision technique. (Knee Surg Sports Traumatol Arthrosc, 2018). Create a free website or blog at WordPress.com. Similarly, there were no differences found between the two types of graft for re-rupture or in the results of an internationally used knee score. Pivot shift analysis showed a positive pivot shift in 19% (291 of 1508) of the bone-tendon-bone group compared with 17% (844 of 5062) in the hamstring group (odds ratio = 0.89; p = 0.51). In this case, use of a patellar tendon graft can aggravate the pre-existing pattelar tendonitis, and may not be the best graft choice. Existing clinical trials, registry studies, and meta-analyses offer conflicting opinions regarding the most favorable graft choice. The anterior cruciate ligament (ACL) is important for maintaining the stability in the knee, particularly in activities involving cutting, pivoting or kicking. What are the best ways for recovering movement in the hand after surgery to repair flexor tendons (tendons in the hand that enable fingers to bend). The patellar tendon graft also provides fixation options “with the ability to put interfering screws in and not rely on suspensory fixation, which is sometimes used in hamstring grafts… Women have a thinner patellar tendon to begin with and are already at a higher risk of knee injury. 2. Either way, I think it comes down to one thing. Hamstring tendon graft vs. Patellar tendon graft. The only 2 significant differences between the 2 groups at that point were weakness in isokinetic knee flexion strength among the hamstring tendon … Many trials used flawed methods that might have affected their results. Weakness surrounding her knee was evident. In contrast, more people had some loss in their ability to bend their leg at the knee after hamstring tendon reconstruction. Reconstruction of the anterior cruciate ligament (ACL) commonly involves patellar tendon (PT) or hamstring tendon(s) (HT) autografts. ... grafts was 96% compared with 93% for HT grafts (p<0.001). For these reasons, I use fewer hamstring tendon grafts. Bone-patellar tendon-bone autograft could be recommended as a superior graft to hamstring autograft for ACL reconstruction in patients with generalized joint laxity: 2- and 5-year follow-up study. Hamstrings and patellar tendon (PT) are the most common autografts used to perform anterior cruciate ligament (ACL) reconstructions. People with ruptured ACLs have unstable knees that generally become more damaged over time. The options normally are a “hamstring graft” or “Patella Tendon graft”. There were also no differences found between the two interventions for re-rupture or International Knee Documentation Committee scores. The graft choice for anterior cruciate ligament reconstruction (ACLR) is controversial. Hamstring tendon (HT) autografts and patellar tendon (PT) autografts are the most common grafts used and have shown similar subjective and objective outcomes. The review concluded that the current evidence was insufficient to recommend which of the two types of graft was better for ACL reconstruction. Unfortunately, it’s also a ligament that is often injured, especially in athletes. [14–16] Reconstructed ACL graft rupture more commonly occurred in the hamstring autograft than in the patellar tendon autograft. For this reason the graft is referred to as Bone - Patella … However, hamstring autografts did seem to have a higher risk of infection than patellar tendon grafts. Abstract. This review aimed to find out if one graft was better than the other. Synopsis: Sixty-one of 72 patients randomized into hamstring vs. patellar tendon graft ACL reconstruction returned for 2-year follow-up. Patellar Tendon Graft For ACL Tears – The Pros and Cons The anterior cruciate ligament, commonly referred to as the ACL, is a significant component in maintaining stabilization in the knee. From a strict economic point of view we therefore recommend or at least consider the use of the patellar tendon as a graft in ACL reconstructions. This review included 19 studies reporting the outcomes of ACL reconstruction with patellar tendon versus hamstring tendon grafts in a total of 1597 young to middle-aged adults. This study also looked at different age groups and found this increased rate to be consistent across all age group.s However, the younger group (age 15-19) had a 9.5 revision rate at 5 years using the hamstring graft in comparison to 3.5% using a patellar tendon graft. DOI: 10.1002/14651858.CD005960.pub2, Copyright © 2021 The Cochrane Collaboration. We use cookies to improve your experience on our site. Many trials were at high risk of bias reflecting inadequate methods of randomization, lack of blinding and incomplete assessment of outcome. Nineteen trials providing outcome data for 1597 young to middle-aged adults were included. Pooled data for primary outcomes, reported in a minority of trials, showed no statistically significant differences between the two graft choices for functional assessment (single leg hop test), return to activity, Tegner and Lysholm scores, and subjective measures of outcome. The clinical importance of the above range of motion losses is unclear. We hypothesized that a more anatomic fixation would be favorable compared with a fixation PT reconstructions resulted in a statistically significant loss of extension range of motion and a trend towards loss of knee extension strength. Again, I am no doctor and I do understand as to why they prefer to do the hamstring graft over the patellar graft at times, especially in women. Improved hamstring-tendon graft preparation and fixation techniques now provide results in terms of laxity and retear comparable to patellar tendon graft, which has long been the gold-standard for patients with strong functional demand, despite its higher risk of extension stiffness and anterior pain. In terms of stability, the mean side-to-side difference was 1.1 ± 0.9 mm for the QT group and 3.1 ± 1.3 mm for the HT group based on KT-1000 measurements ( P < .005). A total of 84.1% of the patients in the study had hamstring grafts, compared with 14.6% with patella tendon autografts. No language restrictions were applied. Importance Controversy exists with respect to the best graft choice for anterior cruciate ligament reconstruction (ACLR) with accelerated, brace-free rehabilitation. Change ), You are commenting using your Google account. Patella Tendon Autograft. In patients who kneel a lot in their sport or work (ie. ( Log Out / The patellar tendon group also had more trouble fully extending their legs. The Advantages and Disadvantages of the Hamstring Tendon Graft As with any option for surgery, there are certain advantages to keep in mind when considering this particular one. Abstract & Commentary. On the other hand, hamstring tendon grafts were looser, although this didn’t seem to affect knee function. You might be wondering what a hamstring or patella tendon graft actually is. I personally believe that a patellar tendon graft holds its elasticity a lot longer then a hamstring tendon graft does. What this generally means is that a surgeon will harvest (take) a piece of either the hamstring or patella tendon to reconstruct a new ACL with one of these tendons. ( Log Out / That weakness in turn puts more stress on your ligaments, as you are relying on them to do more work when really it shoulder be your muscles job. There is insufficient evidence to draw conclusions on differences between the two grafts for long-term functional outcome. It is not clear how important these losses in range of motion of the knee were to the patients themselves. There were inadequate long-term results, such as to assess the development of osteoarthritis. The Lysholm (89 ± 6.9 vs 83.1 ± 5.3), KOOS Symptoms (90 ± 11.2 vs 81 ± 10.3), and KOOS Sport (82 ± 11.3 vs 67 ± 12.4) scores were significantly better in the QT group than in the HT group. This review aimed to find out if one graft was better than the other. Just recently I had a college athlete come in reporting knee pain and a “clicking” sound upon doing certain activities. Come to find out, the individual had tore her ACL in high school and got a hamstring tendon graft. For a long time, the patellar tendon. Trial authors were contacted for additional data and information. But something that I have noticed is that individuals that had gotten a hamstring graft opposed to a patellar tendon graft have been more susceptible to knee injuries, especially athletes. I personally believe that a patellar tendon graft holds its elasticity a lot longer then a hamstring tendon graft does. Lachman testing showed a positive Lachman in 25% (71 of 280) of patients receiving bone-tendon-bone grafts compared with 25% (73 of 288) in the hamstring group (odds ratio = 0.96; … The strength of allograft tissue is less than the other grafts, but the strength of both the patellar tendon and hamstring tendon grafts exceed the strength of a normal ACL. was the preferred choice because it is easy to get to, holds well in its new location, and heals fast. Regardless of the graft, there is no reason a 2 year old ACL reconstruction should show losing of its elasticity. All tests (instrumental, Lachman, pivot shift) for static stability consistently showed that PT reconstruction resulted in a more statically stable knee compared with HT reconstruction. No knee pain with hamstring graft, where as, the patellar commonly results in a lifetime of pain when kneeling; Hamstring graft is stronger than the patellar, because of 4 dense strands bound together, instead of just 1 with the patellar (W hen the Patella tendon graft is 'harvested' by the surgeon he takes the central third of the tendon, including its bony attachment to the knee cap and shin. Her ACL was not torn, we knew that but we noticed that she lost a great deal of elasticity in her new ACL (hamstring tendon). HT reconstructions demonstrated a trend towards loss of flexion range of motion and a statistically significant loss of knee flexion strength. The revision rates for hamstring tendon grafts were 5.1% at 5 years after surgery, and 2.1% for patellar tendon grafts. The limited data available for functional outcomes including patient-rated assessment did not show whether one graft was better than the other. Many trials used flawed methods that might have affected their results. We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (April 2008), the Cochrane Central Register of Controlled Trials (2008, Issue 2), MEDLINE (1966 to April 10 2008), EMBASE (1980 to April 10 2008), conference proceedings and reference lists. For larger patients with a “stiffer” feel to their non-injured knee, I think the hamstring graft doesn’t provide as much of that stiffness. [17–19] However, whether the risk of CACL tear is related to graft selection remains … ( Log Out / Objective To investigate differences in clinical outcome between patellar tendon (PT) and hamstring tendon (HS) autografts for ACLR with accelerated, brace-free rehabilitation. One big drawback to grafting the patellar tendon is pain at the front of the knee after surgery. Most of these individuals were young athletes. I am not even close to an orthopedic surgeon but have had considerable exposure when treating individuals who have undergone ACL reconstruction surgery by way of the patellar tendon graft of the hamstring tendon graft. Change ). : CD005960. sometimes it would not be worth the risk to take some of their patellar tendon and construct a new ACL with it. Abstract & Commentary. In this blog we are going to focus on the difference between a cadaver and a patellar tendon graft in terms of what you need to do after surgery. Hamstring vs. Patellar Tendon ACL Reconstruction. Mohtadi NGH, Chan DS, Dainty KN, Whelan DB, Mohtadi NGH, Chan DS, Dainty KN, Whelan DB. Consider the Quad Tendon graft for your ACL reconstruction if one of the following applies to you: 1. Graft failure is more frequent after hamstring than patellar tendon autograft. Cochrane Database of Systematic Reviews 2011, Issue 9. The total additional cost (fixation and surgery time) for the hamstring method compared to the patellar tendon method was on an average 329 €. Reconstruction of ruptured ACLs commonly involves using autografts (grafts taken from the person undergoing surgery), obtained by removing part of the patellar tendon or the hamstring tendon. There is some thought that the way in which the hamstring tendon grafts are sterilized might be the reason for an increased risk of infection with these grafts. sometimes it would not be worth the risk to take some of their patellar tendon and construct a new ACL with it. While going through knee tests, I had noticed a great deal of anterior translation while performing the lachmans test. The REHAB!! Bone-patellar tendon-bone (bone-tendon-bone) and four-strand hamstring tendon grafts (hamstring) are the most commonly utilized autografts for primary anterior cruciate ligament (ACL) reconstruction. Women have a thinner patellar tendon to begin with and are already at a higher risk of knee injury. While PT reconstructions are more likely to result in statically stable knees, they are also associated with more anterior knee problems. [42] reconstruction techniques using hamstring tendon grafts that are currently used in clinical practice and compare them with a standard patellar tendon recon-struction technique under incremental cyclic loading conditions. This led to her new injury which was later diagnosed as a lateral meniscus tear. This review compared the outcomes of ACL reconstruction using PT versus HT autografts in ACL deficient patients. Synopsis: Patients who had patellar tendon graft ACL reconstructions had statistically significant better results than patients who had 2-strand hamstring graft ACL reconstructions with or without extra-articular procedures.The extra-articular procedure provided no additional benefit. I have worked with them just days out of surgery and months post surgery as well. Comparison of Hamstring and Patellar Tendon Grafts* Mark E. Steiner,tt§lla MD, Aaron T. Hecker,b Charles H. Brown. No. Some more recent studies have suggested higher re-tear rates than patellar tendon grafts. Evidence review … There is no right answer regarding which is best, at least not one that has been proven in scientific studies. After independent study selection, the four authors independently assessed trial quality and risk of bias, and extracted data using pre-developed forms. One is a strip of the patellar tendon below the kneecap. This review included 19 studies reporting the outcomes of ACL reconstruction with patellar tendon versus hamstring tendon grafts in a total of 1597 young to middle-aged adults. I use patellar tendon autograft as my main graft selection in young, high-demand, active patients. Fill in your details below or click an icon to log in: You are commenting using your WordPress.com account. Conversely, patients experienced more anterior knee problems, especially with kneeling, after PT reconstruction.
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