Arthroscopic ACL reconstruction with aperture interference fixation: Graft comparison, BPTB versus hamstring tendon- Cohort study with two year follow-up

Abstract

Purpose: To compare the results of a single surgeon, arthroscopically assisted Anterior cruciate ligament (ACL) reconstruction with the Bone-patellar tendon-bone (BPTB) and the hamstring tendons grafts using aperture screw fixation. Study design: Prospective cohort study. Materials and methods: Two groups of patients, 30 each in BPTB group and hamstring group, were followed for at least 2 years. Patients with width of patellar tendon > 28mm had BPTB graft and all others received hamstring tendon graft. Results: Cohorts were comparable with regard to demographic data. At two year follow-up there was no significant difference in knee scores (Modified Cincinnati, BPTB 96.07 ± 4.58 vs Hamstring 93.96 ± 5.54, p=0.123; Tegner Lysholm, BPTB 93.30 ± 5.70 vs Hamstring 91.40 ± 5.71, p=0.203). On clinical examination, laxity was found in more number of hamstring patients. None of the patients had recurrent symptoms and none required revision for any other reasons. Anterior knee pain was present in 5 patients in each group. Kneeling pain was significantly higher in BPTB group (7 vs 3). 28 patients in BPTB group and 27 in hamstring group were able to achieve pre-injury activity level. Conclusion: Both graft options give excellent short term results. Proper selection of the patients based on their activity level and requirement of kneeling can improve functional results. BPTB may be preferred in high demand individuals. Use of two incision technique of graft harvest lead to fewer donor site complications in BPTB.

Keywords

• ACL reconstruction
• bone patellar tendon graft
• hamstring tendon graft
• aperture interference screw fixation