Patellar tendon Vs. Hamstring Autograft
The 2 most common autografts used are
1. Bone–patellar tendon–bone (BPTB)
2. Quadrupled hamstring (HS)
Numerous studies compare these graft types, but most focus on short-term outcomes with follow-ups of 2 years or less.
Substantive evidence favoring one technique over another is lacking.
Poehling-Monaghan et al. (2017), systematically reviewed current literature comparing BPTB autograft versus HS autografts with a minimum of 5-year follow-up and compared long-term outcomes with regard to:
1. Knee stability or graft failure
3. Functional outcome
4. Radiographic evidenced osteoarthritis
(12) Studies (953) Participants
(9 yrs) Avg. Follow-up time .
1. No differences in graft failure or manual or instrumented laxity were seen in any studies.
2. Lower clinical outcomes scores and greater motion loss were seen in BPTB patients in 1 and 2 studies, respectively.
3. 2/4 reported on anterior knee pain, and 3/7 recorded on kneeling pain; found more frequently among BPTB patients.
4. 1 study reported a significant increase in contralateral ACL tears in BPTB patients.
5. 3/5 studies reporting on radiographic evidence of osteoarthritis noted significantly increased rates in BPTB patients.
No significant differences in manual/instrumented laxity and graft failures between graft types.
An increase in long-term anterior knee pain, kneeling pain, and higher rates of osteoarthritis were noted with BPTB graft use.
Variety of concomitant pathology was encountered at the time of index surgery
Not enough consistency in the description of surgical technique
Did not uniformly address patient activity level or sport; or return to sport or preinjury activity level with any consistency
Poehling-Monaghan et al. (2017). Long-Term Outcomes in ACL Reconstruction: A Systematic Review of Patellar Tendon Versus Hamstring Autografts. Orthop J Sprts Med. 5(6).