Anterior cruciate ligament reconstruction, hamstring versus bone-patella tendon-bone grafts: a systematic literature review of outcome from surgery

Abstract

The Anterior Cruciate Ligament (ACL) is regarded as critical to the normal functioning of the knee, its disruption causing functional impairment. In recent years central third of the patellar tendon (PT) and combined Semitendinosis and gracilis tendons (HT) have become the most frequently used graft types for anterior cruciate knee ligament reconstruction. For the past two decades, the gold standard in ACL reconstructions has been the PT, but increasingly the HT graft has been used. This shift in popularity has occurred for several reasons, including concerns about damaging the knee extensor apparatus using the PT procedure, but potential complications also exist with HT techniques. Despite the vast amount of literature on ACL reconstruction and its outcome, there are very few controlled randomised studies directly comparing the two most commonly used tissue grafts. This review aimed to examine the data available from randomised trials, in order to combine and evaluate the best available evidence for choice between these two popular tissue grafts for use in ACL reconstruction. A literature search revealed 13 studies, which met the inclusion criteria of the review. The results of the 13 studies included in this review suggest that there is no significant evidence to indicate that one graft is superior. Both the PT and HT grafts appear to improve patients' performance, and therefore both would be good choices for ACL reconstruction.