There is no difference between quadriceps- and hamstring tendon autografts in primary anterior cruciate ligament reconstruction: a 2-year patient-reported outcome study Is Quadriceps Tendon Autograft a Better Choice Than Hamstring Autograft for Anterior Cruciate Ligament Reconstruction? A Comparative Study With a Mean Follow-up of 3.6 Years Lower Risk of Revision With Patellar Tendon Autografts Compared With Hamstring Autografts Patellar Tendon or Semitendinosus Tendon Autografts for Anterior Cruciate Ligament Reconstruction Management of Injuries to the Anterior Cruciate Ligament: Results of a Survey of Orthopaedic Surgeons in Canada Early post-operative morbidity following anterior cruciate ligament reconstruction: patellar tendon versus hamstring graft Comparing 2-Year Outcomes of Anterior Cruciate Ligament Reconstruction Using Either Patella-Tendon or Semitendinosus-Tendon Autografts: A Non-Randomised Prospective Study Anterior cruciate ligament reconstruction with bone-patellar tendon-bone autograft versus allograft. Single-bundle patellar tendon versus non-anatomical double-bundle hamstrings ACL reconstruction: a prospective randomized study at 8-year minimum follow-up Strength recovery after anterior cruciate ligament reconstruction with quadriceps tendon versus hamstring tendon autografts in soccer players: A randomized controlled trial. Patellar tendon or semitendinosus tendon autografts for anterior cruciate ligament reconstruction: a prospective, randomized study with a 7-Year follow-up. Hamstring and Quadriceps Strength Balance in Normal and Hamstring Anterior Cruciate Ligament-Reconstructed Subjects Quality of Life and Clinical Outcome Comparison of Semitendinosus and Gracilis Tendon Versus Patellar Tendon Autografts for Anterior Cruciate Ligament Reconstruction A 10-year comparison of anterior cruciate ligament reconstructions with hamstring tendon and patellar tendon autograft: a controlled, prospective trial. Arthroscopic single-bundle anterior cruciate ligament reconstruction with six-strand hamstring tendon allograft versus bone-patellar tendon-bone allograft A Prospective Randomized Study of Patellar versus Hamstring Tendon Autografts for Anterior Cruciate Ligament Reconstruction Prospective Comparison of Auto and Allograft Hamstring Tendon Constructs for ACL Reconstruction
Purpose Graft choice for anterior cruciate ligament ( ACL ) reconstruction is crucial , however the optimal graft source remains a topic of controversy . The purpose of this study is to compare subjective and functional patient-reported outcomes ( PRO ) after single-bundle ACL reconstruction using quadriceps tendon ( QT ) or hamstring tendon ( HT ) autografts for single-bundle ACL reconstruction . We hypothesize that there is no difference in patient-reported functional outcomes after ACL reconstruction using either HT- or QT autograft . Methods All data were extracted from a prospect ively collected ACL registry . A total of 80 patients with at least 2-year follow-up were included in this study . A total of 40 patients with primary ACL reconstruction using a QT autograft harvested via a minimally invasive technique were matched by sex , age and pre-injury Tegner and Lysholm score to 40 patients who received HT autografts .  Subjective and functional PRO scores including Lysholm score , Tegner activity level and visual analogue scale for pain were obtained at 6 , 12 and 24 months after index surgery . Results No significant difference between the QT and the HT group was seen at any follow-up in regard to any of the PRO scores for function or pain . 24 months post-surgery the mean Tegner activity score of the HT group was significantly ( p = 0.04 ) lower compared to the pre-injury status . At final follow-up , 27 patients ( 67.5 % ) in the QT group and 32 patients ( 80.0 % ) in the HT returned to their pre-injury activity level ( n.s . ) . A total of 37 patients ( 92.5 % ) of the QT cohort and 35 patients ( 87.5 % ) of the HT cohort reported “ good ” or “ excellent ” results according to the Lysholm score ( n.s . ) . “ No pain ” or “ slight pain ” during severe exertion was reported by 33 patients ( 82.5 % ) with QT autograft and 28 patients ( 82.4 % ) with HT autograft ( n.s . ) . Conclusion There is no significant difference between PRO 2 years post-operative using either QT or HT autografts . Both QT and HT grafts show acceptable and comparable PRO scores making the QT a reliable graft alternative to HT for primary ACL reconstruction . Level of evidence III Background : The quadriceps tendon ( QT ) autograft is known as an effective graft for anterior cruciate ligament ( ACL ) reconstruction and shows a similar functional outcome to the bone-patellar tendon-bone ( BPTB ) in r and omized controlled trials , with a lesser incidence of complications . Up until now , only 2 studies have compared QT to hamstring tendon ( HT ) autograft . Hypothesis : The functional outcomes of the QT technique are at least as good as those of the HT technique , with the same morbidity . Study Design : Cohort study ; Level of evidence , 3 . Methods : Ninety-five patients underwent isolated ACL reconstruction between January 1 and December 31 , 2012 . Fifty underwent ACL reconstruction with the QT and 45 with the HT .  The same surgical technique , fixation method , and postoperative protocol were used in both groups . The following parameters were evaluated : surgical revisions , functional outcome ( Lysholm , Knee injury and Osteoarthritis Outcome Score [ KOOS ] , Tegner , subjective International Knee Documentation Committee ) , joint stability ( KT-1000 , Lachman , pivot shift ) , anterior knee pain ( Shelbourne-Trumper score ) , and isokinetic strength . Descriptive statistics are presented for these variables using the Student t test . Results : Eighty-six patients ( 45 QT , 41 HT ) were review ed with a mean follow-up of 3.6 ± 0.4 years ; minimum follow-up was 3 years . There were 4 reoperations in the QT group ( including 1 ACL revision ) and 3 in the HT group ( including 2 ACL revisions ) ( P > .05 ) . 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 . 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 ) . The negative Lachman component was higher in the QT group than in the HT group ( 90 % vs 46 % , P < .005 ) . There was a trend for the negative pivot-shift component to be higher in the QT group than in the HT group ( 90 % vs 64 % , P = .052 ) . The Shelbourne-Trumper score was the same in both groups . There was no difference between groups in terms of isokinetic strength . Conclusion : The use of a QT graft in ACL reconstruction leads to equal or better functional outcomes than does the use of an HT graft , without affecting morbidity Background : A number of studies have found comparable results after  anterior cruciate ligament ( ACL ) reconstruction with patellar tendon autografts and hamstring autografts ; however , few studies have been large enough to reveal differences in risk of revision with regard to clinical and demographic factors . Purpose : To present the distribution of grafts for ACL reconstruction based on data in the Sc and inavian ACL registries and to compare the risk of revision between patellar tendon autografts and hamstring autografts . Potential associations with other clinical and demographic factors were also explored . Study design : Cohort study ; Level of evidence , 2 . Methods : A total of 45,998 primary ACL reconstructions , including 6736 patellar tendon autografts and 38,666 hamstring autografts , were identified in the Sc and inavian ACL registries . The overall median follow-up time was 3 years ( range , 0 - 8 years ) . To compare the risk of revision between groups of patients , univariate Kaplan-Meier analysis ( with log-rank test ) and the Cox proportional hazard regression model were applied . The hazard rate ratio with 95 % CI was reported as a measure of effect . Results : Patellar tendon and hamstring autografts were used in 14.6 % and 84.1 % of the patients , respectively . The remaining patients received  allografts , direct sutures , or other graft types  ( 1.3 % ) . The primary ACL injury occurred during soccer , team h and ball , or alpine activities in 67.5 % of the patients in the patellar tendon group and 66.2 % in the hamstring group . A total of 156 patients in the patellar tendon group and 1042 patients in the hamstring group underwent revision . The overall risk of revision was significantly lower in the patellar tendon group versus the hamstring group ( hazard rate ratio = 0.63 ; 95 % CI , 0.53 - 0.74 ) , and it decreased with increasing age at surgery , although not strictly linearly . The lower risk of revision in the patellar tendon group was consistently observed across subgroups of patient sex , age , and concomitant cartilage injury ( P > .05 , test for interaction ) but seemed to be slightly more pronounced for patients injured during certain pivoting activities ( soccer , team h and ball , and alpine activities ) compared with other activities ( hazard rate ratio = 0.57 vs 0.81 ; P = .058 , test for interaction ) . Conclusion : The majority of primary  ACL reconstructions in Sc and inavia are performed with hamstring autografts . Results from the present large prospect i ve study show that patients receiving patellar tendon autografts  have a statistically significantly lower risk of revision compared with patients receiving hamstring autografts Background The aim of the study was to compare the results after arthroscopic anterior cruciate ligament ( ACL ) reconstruction  using central -third bone — patellar tendon — bone ( BTB ) autografts and triple/quadruple semitendinosus ( ST ) autografts . Hypothesis In the long-term , ACL reconstruction using BTB autografts will render more donor-site problems than ST autografts . Study Design R and omized controlled trial ; Level of evidence , 1 . Methods A r and omized series of 71 patients ( 22 women and 49 men ) with a unilateral ACL rupture who underwent reconstructive surgery were included in the study . The BTB graft was used in 34 patients ( BTB group ) and the ST-tendon graft was used in 37 patients ( ST group ) . The patients were examined a median of 86 months ( range , 68 to 114 months ) after the reconstruction . Results Sixty-eight of 71 patients ( 96 % ) were examined at follow-up . The clinical assessment s at follow-up revealed no significant differences between the BTB group and the ST group in terms of the Lysholm score , Tegner activity level , International Knee Documentation Committee evaluation system , 1-legged hop test , KT-1000 arthrometer laxity measurements , manual Lachman test , and range of motion . A significant improvement was seen in both groups compared with the preoperative values in terms of most clinical assessment s. Donor-site morbidity in the form of knee-walking ability , kneeling ability , and area of disturbed anterior knee sensitivity revealed no significant differences between the groups . Conclusion Seven years after ACL reconstruction , the subjective and objective outcomes were similar after using the central -third BTB autograft and triple/quadruple ST autograft . Furthermore , no difference in terms of donor-site morbidity was found between the 2 groups Objective To identify the approaches to management of anterior cruciate ligament ( ACL ) injury by Canadian orthopedic surgeons . Methods A question naire was mailed to 234 physicians r and omly chosen from the Canadian Orthopaedic Association directory to obtain the following information : 1 ) how orthopaedic surgeons diagnose acute hemarthroses ; 2 ) how patients in any of three common ACL injury scenarios would be managed ; 3 ) what variations exist in surgical technique ; and 4 ) how patient variables such as age , gender , and alignment influence the decision-making process . Results The return rate was 72 % , and 56 % of respondents were from academic centers . Patients such as those described in the protocol are routinely managed by 80 % of the respondents . The diagnosis of acute hemarthrosis is predominantly made by means of clinical examination and radiographs . Magnetic resonance imaging ( MRI ) is used occasionally by 43 % and routinely by 6 % of those who responded ; arthroscopy is used routinely by 24 % . For the competitive athlete with a complete ACL tear , 64 % would recommend reconstruction and 33 % would recommend bracing and rehabilitation . For reconstruction , 59 % would use bone – patellar tendon – bone ( B-PT-B ) autograft and 32 % would use hamstring tendon autograft ; 40 % would incorporate the ACL stump during reconstruction . Of the respondents , 77 % would advocate ACL reconstruction for competitive athletes with chronic ACL injury . Of these , 63 % would use B-PT-B autograft and 27 % would use  hamstring tendons .  If bracing and rehabilitation failed , 98 % would recommend  ACL reconstruction . In ACL reconstruction , synthetic augmentation would be used by 12 % in chronic cases and by 16 % in acute cases . In making the decision to perform ACL reconstruction , 53 % consider limb alignment to be important and 67 % consider moderate patellofemoral pain to be important . Seventy-one percent are influenced by patellofemoral pain when choosing a surgical technique , with a trend toward semitendinosis autograft rather than B-PT-B autograft reconstruction . For the 8-year-old child with an acute ACL injury , 63 % of the respondents would recommend rehabilitation and bracing . For the 14-year-old , 45 % would recommend rehabilitation and bracing and 37 % would recommend ACL reconstruction after physeal closure . Conclusion The results of the survey indicate that , with respect to some of the issues , there is a wide variation in management of acute and chronic ACL injuries among Canadian orthopedic surgeons . Future research and r and omized , controlled clinical trials should be directed toward these areas Abstract . This study documented postoperative morbidity during the first 4 months following  anterior cruciate ligament ( ACL ) reconstruction  using either patellar tendon or hamstring tendon autograft .  Sixty-five patients undergoing primary arthroscopically assisted single-incision ACL reconstruction  were r and omized to have a central third bone patellar tendon bone autograft ( PT ) or a doubled semitendinosus/doubled gracilis autograft ( HS ) . Postoperatively patients undertook a st and ard ' accelerated ' rehabilitation protocol . Patients were review ed after 2 weeks , 8 weeks , and 4 months . At each review the location and severity of general knee pain and the presence and severity of anterior knee pain ( AKP ) were recorded as were the presence and size of an effusion as well as the active and passive flexion and passive extension deficits compared to the contralateral limb . Pain on kneeling , KT-1000 measured side to side difference in anterior tibial displacement , isokinetic assessment of quadriceps and hamstring peak torque deficits , IKDC score and Cincinnati sports activity level were also recorded after 4 months . After 2 weeks more patients in the PT group complained of AKP and reported that the pain was more severe . After 8 weeks there was no significant difference between the groups for any variable . After 4 months the severity of general pain experienced and the incidence of pain on kneeling were greater in the PT group . The PT group also demonstrated a significantly greater quadriceps peak torque deficit at 240 ° /s . IKDC scores were higher in the HS group , but Cincinnati sports activity scores were higher in the PT group . Although we observed a lower morbidity in the HS group , primarily related to pain , the severity of pain in both groups was relatively low and , in light of the higher mean sports activity level observed in the PT group at 4 months the clinical impact of the difference may not be significant Purpose . To compare the results of  anterior cruciate ligament ( ACL ) reconstructions  using either a patella-tendon autograft or a semitendinosus-tendon autograft . Methods . Based on surgeon experience and preference , 68 patients underwent ACL reconstruction using either a quadruple-str and semitendinosus autograft  ( n=34 )  or a central one-third bone-patella tendon-bone autograft  ( n=34 ) . Each patient was assessed preoperatively and postoperatively at 3 , 6 , and 24 months using the International Knee Documentation Committee ( IKDC ) knee score , Biodex muscle strength and endurance testing , and the KT1000 instrumented arthrometer test of knee laxity to anterior translation . All assessment s at the 2-year follow-up were performed by the same physician and physiotherapist . Results . While ACL reconstruction improved knee stability and IKDC knee scores significantly , there was no statistically significant difference between semitendinosus- and patella-tendon autograft reconstructions in terms of long-term knee score or laxity to anterior translation .  Semitendinosus graft reconstruction was associated with less donor-site morbidity and hamstring weakness . Meniscectomy was associated with poorer long-term knee scores . Conclusion . ACL reconstruction is associated with a significantly better IKDC knee score and laxity measurement at 2-year follow-up . However , we were unable to demonstrate a significantly better long-term outcome in knee score or laxity to anterior translation with either a patella-tendon autograft or a semitendinosus-tendon autograft PURPOSE The purpose of this study was to analyze the clinical outcome of  arthroscopic anterior cruciate ligament ( ACL ) reconstruction  with bone-patellar tendon-bone autograft versus allograft . METHODS Between May 2000 and June 2004 , 172 patients undergoing arthroscopic bone-patellar tendon-bone ACL reconstruction  were prospect ively r and omized  into autograft ( n = 86 ) or allograft ( n = 86 ) groups . The senior surgeon performed all operations using the same surgical technique . Each fixation was performed by means of an interference screw . Patients were evaluated preoperatively and postoperatively at follow-up . Of the patients , 156 ( 76 in the autograft group and 80 in the allograft group ) were available for full evaluation . Evaluations included a detailed history , physical examination , functional knee ligament testing , KT-2000 arthrometer testing ( MEDmetric , San Diego , CA ) , Harner 's vertical jump and Daniel 's 1-leg hop tests , Lysholm score , Tegner score , International Knee Documentation Committee st and ard evaluation form , Cincinnati knee score , and radiograph . RESULTS Demographic data were comparable between groups . The mean follow-up was 5.6 years for both groups . There were no statistically significant differences according to evaluations of outcome between the 2 groups except that patients in the allograft group had a shorter operation time and longer fever time postoperatively compared with the autograft group . The postoperative infection rates were 0 % and 1.25 % for the autograft group and allograft group , respectively . There was a significant difference ( P < .05 ) in the development of osteoarthritis between the operated knee in comparison to the contralateral knee according to radiographs . However , no significant difference was found between the 2 groups at the final follow-up examination ( P > .05 ) . CONCLUSIONS Both groups of patients achieved almost the same satisfactory outcomes after a mean of 5.6 years of follow-up . Allograft is a reasonable alternative to autograft for ACL reconstruction . LEVEL OF EVIDENCE Level II , prospect i ve comparative study Purpose The purpose of this study was to compare subjective , objective and radiographic outcome of the lateralized single-bundle bone-patellar tendon-bone autograft with a non-anatomical double-bundle hamstring tendons autograft anterior cruciate ligament ( ACL ) reconstruction technique at long-term follow-up . Methods Seventy-nine non-consecutive r and omized patients ( 42 men ; 37 women ) with unilateral ACL insufficiency were prospect ively evaluated , before and after ACL reconstruction by means of the above-mentioned techniques , with a minimum follow-up of 8 years ( range 8–10 years ; mean 8.6 years ) . In the double-bundle hamstrings technique , we used one tibial and one femoral tunnel combined with one “ over-the-top ” passage , cortical staple ’s fixation and we left intact hamstrings ’ tibial insertion . Patients were evaluated subjectively and objective ly , using IKDC score , Tegner level , manual maximum displacement test with KT-2000 ™ arthrometer . Radiographic evaluation was performed according to IKDC grading system , and re-intervention rate for meniscal lesions was also recorded . Results The subjective and objective IKDC were similar in both groups while double-bundle hamstrings group showed significantly higher Tegner level ( P = 0.0007 ) , higher passive range of motion recovery ( P = 0.0014 ) , faster sport resumption ( P = 0.0052 ) , lower glide pivot-shift phenomenon ( P = 0.0302 ) and lower re-intervention rate ( P = 0.0116 ) compared with patellar tendon group . Radiographic evaluation showed significant lower objective degenerative changes in double-bundle hamstrings group at final follow-up ( P = 0.0056 ) . Conclusion Although both techniques provide satisfactory results , double-bundle ACL reconstruction shows better functional results , with a faster return to sport activity , a lower re-operation rate and lower degenerative knee changes BACKGROUND The comparison between HT and QT grafts in strength recovery and function  after an ACLR is scarce in the literature . METHODS A total of 56 participants were enrolled in this r and omized controlled trial and placed into two groups : HT or QT .  The hamstring/quadriceps ( H/Q ) ratio was the primary end-point measured with a Genu-3 dynamometer . Peak torque , functional assessment ( Lysholm knee scoring scale and Cincinnati Knee Rating System ) , and anteroposterior laxity ( KT-2000 ™ arthrometer ) were also assessed . An intention-to-treat analysis was performed . RESULTS The results of the H/Q ratio analysis of the participants over time revealed significant differences at 60 , 180 , and 300 ° /s at three , six , and 12months of follow-up ( 60 ° /s : F=5.3 , p=0.005 ; 180 ° /s : F=5.5 , p=0.004 ; 300 ° /s : F=5.1 , p=0.005 ) . Furthermore , they revealed significant differences at 60 ° /s , 180 ° /s , and 300 ° /s in the participants over time for peak torque in the extensor muscle strength at three and six months of follow-up , with higher values in the hamstring tendon group but not at 12months of follow-up . There were no significant differences in functional endpoints or arthrometer assessment s at 24months of follow-up . CONCLUSION An ACLR with a QT graft showed similar functional results with a better isokinetic H/Q ratio compared to an ACLR with the HT at 12months of follow-up in soccer players . This higher H/Q ratio observed with the QT could be an advantage of this graft over the HT for an ACLR BACKGROUND The aim of the study was to compare the results after arthroscopic anterior cruciate ligament ( ACL ) reconstruction  using central -third bone-patellar tendon-bone ( BTB ) autografts and triple/quadruple semitendinosus ( ST ) autografts . HYPOTHESIS In the long-term , ACL reconstruction using BTB autografts will render more donor-site problems than ST autografts . STUDY DESIGN R and omized controlled trial ; Level of evidence , 1 . METHODS A r and omized series of 71 patients ( 22 women and 49 men ) with a unilateral ACL rupture who underwent reconstructive surgery were included in the study . The BTB graft was used in 34 patients ( BTB group ) and the ST-tendon graft was used in 37 patients ( ST group ) . The patients were examined a median of 86 months ( range , 68 to 114 months ) after the reconstruction . RESULTS Sixty-eight of 71 patients ( 96 % ) were examined at follow-up . The clinical assessment s at follow-up revealed no significant differences between the BTB group and the ST group in terms of the Lysholm score , Tegner activity level , International Knee Documentation Committee evaluation system , 1-legged hop test , KT-1000 arthrometer laxity measurements , manual Lachman test , and range of motion . A significant improvement was seen in both groups compared with the preoperative values in terms of most clinical assessment s. Donor-site morbidity in the form of knee-walking ability , kneeling ability , and area of disturbed anterior knee sensitivity revealed no significant differences between the groups . CONCLUSION Seven years after ACL reconstruction , the subjective and objective outcomes were similar after using the central -third BTB autograft and triple/quadruple ST autograft . Furthermore , no difference in terms of donor-site morbidity was found between the 2 groups Objective : The purpose of this study was to evaluate and characterize the agonist-antagonist strength balance ( hamstring/quadriceps [ H/Q ] ratio and dynamic control ratio [ DCR ] ) about the knee specific to velocity , range of motion , and contraction type . We hypothesized that there would be systematic variation in the H/Q ratio and DCR based on knee joint angle , angular velocity , and contraction type . We also hypothesized that these ratios would be altered in the anterior cruciate ligament (ACL)-reconstructed group in favor of protecting the ACL graft ( relative knee flexor strength when strain on the ACL is the greatest ) . Design : Cross-sectional design . Setting : A tertiary care sport medicine clinic . Patients or Participants : Sixteen subjects more than 1 year after hamstring tendon ACL reconstruction were compared with 30 active uninjured control subjects . Interventions : Isokinetic strength testing was performed over 5 ° to 95 ° knee joint range of motion , 5 angular velocities ( 50 , 100 , 150 , 200 , 250 ° /s ) , for concentric and eccentric contractions . Main Outcome Measurements : Angle and velocity-matched H/Q ratio maps and DCR maps were produced for each group . Difference maps allowed quantification of the differences between the groups . Results : Angle and velocity-matched H/Q ratio maps demonstrated systematic variation based on joint angle , velocity , and contraction type for both the control ( H/Q , ~0–1.42 ; DCR , ~0–1.57 ) and the ACL-reconstructed group ( H/Q , ~0–1.33 ; DCR , ~0–1.35 ) . Difference maps demonstrate regional ( angle and velocity-specific ) alteration in the ratio between the ACL-reconstructed and control groups . Conclusions : Specific imbalances were demonstrated in the ACL-reconstructed group compared with control . In high knee flexion angles , the low H/Q ratio may represent a compromised ability of the hamstrings to stabilize the knee joint throughout the full range of motion . Near full knee extension shifts in favor of the knee flexors may represent an attempt to stabilize the knee at the angle of greatest ACL strain . These finding have implication s for graft donor site selection and postoperative rehabilitation as well as provide insight into the neuromuscular control of the knee Background : There are still controversies about graft selection for  primary anterior cruciate ligament reconstruction .  Prospect i ve , r and omized long-term studies are needed to determine the differences between the graft material s. Hypothesis : Eleven years after anterior cruciate ligament reconstruction  there is no difference in functional outcome and quality of life between patients with patellar tendon or hamstring tendon autografts ; however , the patients with patellar tendon autograft would have a higher prevalence of osteoarthritis . Study Design : R and omized controlled trial ; Level of evidence , 2 . Methods : From June 1999 to March 2000 , 64 patients were included in this prospect i ve study . A single surgeon performed primary arthroscopically assisted anterior cruciate ligament reconstruction  in an alternating sequence . In 32 patients ,  anterior cruciate ligament reconstruction was performed with hamstring tendon autograft ( semitendinosus and gracilis [ STG ] group ) while in the other 32 patients the reconstruction was performed with patellar tendon autograft ( PT group ) . Results : At the 11-year follow-up , no statistically significant differences were seen with respect to the Lysholm score and Short Form-36 , KT-1000 arthrometer laxity testing , anterior knee pain , single-legged hop test , or International Knee Documentation Committee ( IKDC ) classification results . Positive pivot-shift test ( 1 + ) was significantly more frequent in the PT group ( P = .036 ) . Twenty-two patients ( 81 % ) in the STG group and 18 patients ( 72 % ) in the PT group were still at their preinjury level of activity . Graft rupture occurred in 2 patients from the STG group ( 6 % ) and in 4 patients from the PT ( 12 % ) . Grade B and C abnormal radiographic findings were seen in 84 % ( 21 of 25 ) of patients in the PT group and in 63 % ( 17 of 27 ) of patients in the STG group ( P = .008 ) . Conclusion : Both hamstring and patellar tendon autografts provided good subjective outcomes and objective stability at 11 years . Positive pivot-shift test ( 1 + ) was significantly more frequent in the PT group . No significant differences in the rate of graft failure were identified . Patients with patellar tendon graft had a greater prevalence of osteoarthritis at 11 years after surgery BACKGROUND There are no controlled , prospect i ve studies comparing the 10-year outcomes of anterior cruciate ligament ( ACL ) reconstruction using patellar tendon ( PT ) and 4-str and hamstring tendon ( HT ) autografts . HYPOTHESIS Comparable results are possible with HT and PT autografts . STUDY DESIGN Cohort study ; Level of evidence , 2 . METHODS One hundred eighty ACL-deficient knees that met inclusion criteria underwent ACL reconstruction ( 90 HT autograft , 90 PT autograft ) by one surgeon and were treated with an accelerated rehabilitation program . All knees were observed in a prospect i ve fashion with subjective , objective , and radiographic evaluation at 2 , 5 , 7 , and 10-year intervals . RESULTS At 10 years , there were no differences in graft rupture rates ( 7/90 PT vs. 12/90 HT , P = .24 ) . There were 20 contralateral ACL ruptures in the PT group , compared with 9 in the HT group ( P = .02 ) . In all patients , graft rupture was associated with instrumented laxity > 2 mm at 2 years ( P = .001 ) . Normal or near-normal function of the knee was reported in 97 % of patients in both groups . In the PT group , harvest-site symptoms ( P = .001 ) and kneeling pain ( P = .01 ) were more common than in the HT group . More patients reported pain with strenuous activities in PT knees than in HT knees ( P = .05 ) . Radiographic osteoarthritis was more common in PT knees than the HT-reconstructed knees ( P = .04 ) . The difference , however , was composed of patients with mild osteoarthritis . Other predictors of radiographic osteoarthritis were < 90 % single-legged hop test at 1 year and the need for further knee surgery . An " ideal " outcome , defined as an overall International Knee Documentation Committee grade of A or B and a radiographic grade of A at 10 years after ACL reconstruction , was associated with <3 mm of instrumented laxity at 2 years , the absence of additional surgery in the knee , and HT grafts . CONCLUSIONS It is possible to obtain excellent results with both HT and PT autografts . We recommend HT reconstructions to our patients because of decreased harvest-site symptoms and radiographic osteoarthritis Purpose The aim of this study was to compare the clinical outcomes of arthroscopic single-bundle anterior cruciate ligament ( ACL ) reconstruction with six-str and hamstring tendon ( HT ) allograft versus bone-patellar tendon-bone ( BPTB ) allograft . Methods The prospect i ve r and omized controlled trial was included 129 patients . Sixty-nine patients received reconstruction with six-str and HT allografts ( HT group ) , whereas 60 patients with BPTB allografts  (  BPTB  group ) . Outcome assessment included re-rupture findings , International Knee Documentation Committee ( IKDC ) scores , Lysholm scores , KT-1000 arthrometer , Lachman test , pivot-shift test , range of motion ( ROM ) and single-leg hop test . Results At a mean follow-up of 52 months , 113 patients ( HT group , 61 patients ; BPTB group , 52 patients ) completed a minimum 4-year follow-up . Four patients in HT group and six in BPTB group experienced ACL re-rupture ( 6.2 vs. 10.3 % ) and received revision surgery . Significant between-group differences were observed in KT-1000 outcomes and pivot-shift test 1 ( 1.2 ± 1.5 vs. 1.8 ± 1.3 , p = 0.025 ; positive rate 6.5 vs. 18.9 % , p = 0.036 ) , 2 ( 1.1 ± 1.4 vs. 1.6 ± 1.2 , p = 0.044 ; 8.1 vs. 20.7 % , p = 0.039 ) , 4 ( 1.1 ± 1.5 vs. 1.7 ± 1.4 , p = 0.031 ; 9.7 vs. 25 % , p = 0.012 ) years postoperatively . The outcomes between the two groups were comparable in terms of IKDC scores , Lysholm scores , Lachman test , ROM and single-leg hop test . Conclusions Six-str and HT allograft achieved superior anteroposterior and rotational stability after single-bundle ACL reconstruction . It is a reasonable graft substitute for ACL reconstruction . Level of evidence II Background Bone-patellar tendon-bone graft has been the most commonly used graft material in anterior cruciate reconstructions , but there has been increasing use of hamstring tendon grafts . However , no existing clinical studies show adequate support for the choice of one graft over the other . Hypothesis Hamstring tendons are equally as good as patellar tendon in anterior cruciate ligament reconstructions . Study Design Prospect i ve r and omized clinical trial . Methods Ninety-nine patients with laxity caused by a torn anterior cruciate ligament underwent arthroscopically assisted reconstruction with graft r and omization according to their birth year . Grafts were either bone-patellar tendon-bone with metal interference screw fixation or double-looped hamstring tendons with metal plate fixation . There were no significant differences between the two groups preoperatively or at operation . St and ard rehabilitation included immediate postoperative mobilization without a knee brace , protected weightbearing for 2 weeks , and return to full activity at 6 to 12 months . Results Forty-three patients in the patellar tendon group and 46 patients in the hamstring tendon group were available for clinical evaluation at a minimum of 21 months after surgery . No statistically significant differences were seen with respect to clinical and instrumented laxity testing , International Knee Documentation Committee Score ratings , isokinetic muscle torque measurements , and Kujala patellofemoral , Lysholm , and Tegner scores . Conclusion Equal results were seen for patellar and hamstring tendon autograft anterior cruciate ligament reconstructions at 2 years after surgery . Both techniques seem to improve patients ' performance Although allograft use for primary anterior cruciate ligament reconstruction has continued to increase during the last 10 years , concerns remain regarding the long-term function of allografts ( primarily that they may stretch with time ) and clinical efficacy compared with autograft tendons . We attempted to address these issues by prospect ively comparing identical quadrupled hamstring autografts with allograft constructs for primary anterior cruciate ligament reconstruction in patients with a minimum followup of 3 years . Eighty-four patients ( 37 with autografts and 47 with allografts ) were enrolled ; the mean followup was 52 ± 11 months for the autograft group and 48 ± 8 months for the allograft group . Outcome measurements included objective and subjective International Knee Documentation Committee scores , Lysholm scores , Tegner activity scales , and KT-1000 arthrometer measurements . The two cohorts were similar in average age , acute or chronic nature of the anterior cruciate ligament rupture , and incidence of concomitant meniscal surgeries . At final followup , we found no difference in terms of Tegner , Lysholm , KT-1000 , or International Knee Documentation Committee scores . Five anterior cruciate ligament reconstructions failed : three in the autograft group and two in the allograft group . Our data suggest laxity is not increased in allograft tendons compared with autografts and clinical outcome scores 3 to 6 years after surgery are similar . Level of Evidence : Level II , therapeutic study . See the Guidelines for Authors for a complete description of levels of evidence
The QT autograft detected comparable rate of Lachman test > 3 mm , Pivot shift test > 3 m and instrumental laxity > 3 mm .
The QT autograft showed a lower rate of autograft failure above all .
The QT autograft detected the reduced rate of AKP than the PT .
Quadriceps tendon autograft may represent a feasible option for primary ACL reconstruction .
The purpose of the current study was to clarify the role of the quadriceps tendon ( QT ) autograft for primary ACL reconstruction .
Thus , a Bayesian network meta- analysis comparing patients undergoing a primary ACL reconstruction with QT versus patellar tendon ( PT ) and hamstring tendon ( HT ) autografts  was conducted .