Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Dec;31(12):5641-5651.
doi: 10.1007/s00167-023-07597-4. Epub 2023 Oct 21.

Contralateral hamstring autografts do not provide benefit compared to ipsilateral hamstring autografts in primary or revision anterior cruciate ligament reconstruction: a systematic review

Prushoth Vivekanantha  1 , Soroush Nedaie  1 , Zackariyah Hassan  1 , Hassaan Abdel Khalik  2 , Sasha Carsen  3 , Kanto Nagai  4 , Yuichi Hoshino  4 , Darren de Sa  5
Affiliations

Contralateral hamstring autografts do not provide benefit compared to ipsilateral hamstring autografts in primary or revision anterior cruciate ligament reconstruction: a systematic review

Prushoth Vivekanantha et al. Knee Surg Sports Traumatol Arthrosc. 2023 Dec.

Abstract

Purpose: To evaluate the clinical outcomes of primary or revision ACL reconstruction (ACLR) after contralateral hamstring autografts versus ipsilateral hamstring autograft harvest.

Methods: Three databases (MEDLINE, PubMed and EMBASE) were searched from inception to April 27th, 2023 for studies investigating contralateral hamstring autografts in primary or revision ACLR. The authors adhered to the PRISMA and R-AMSTAR guidelines as well as the Cochrane Handbook for Systematic Reviews of Interventions. Data on demographics, strength measures, patient-reported outcome measures (PROMs), and rates of positive Lachman test, positive pivot-shift test and graft rupture were extracted. PROMs included Lysholm, International Knee Documentation Committee (IKDC) and Tegner scores.

Results: Nine studies comprising 371 patients were included in this review. In primary ACLR, there were no significant differences between contralateral and ipsilateral groups in isokinetic hamstring torque in the non-ACLR limb or isokinetic quadriceps torque in both limbs when tested at 60, 90, 120 or 180 degrees/second. Isokinetic hamstring torque in the non-ACLR limb was significantly weaker in the contralateral group at six months for primary ACLR; however, these deficits did not persist. There were no significant differences in postoperative median Tegner scores and Lysholm scores between contralateral and ipsilateral groups in primary ACLR. There were no significant differences in postoperative median Tegner, mean Lysholm and IKDC scores between groups in revision ACLR. There were no significant differences in positive Lachman, positive pivot-shift and rupture rates in primary ACLR between groups. Rates of positive Lachman and pivot-shift were slightly higher in the contralateral than ipsilateral group for revision ACLR.

Conclusion: Contralateral hamstring autografts results in comparable muscle strength to ipsilateral hamstring autografts, with the exception of weaker hamstring strengths in the early postoperative period. Patient-reported outcome measures were similar between the two groups across both primary and revision ACLR, with rates of instability and failure being similar between groups for primary ACLR. Contralateral hamstring grafts do not provide additional benefit when compared to ipsilateral options for either primary or revision ACLR, and should be used only in select circumstances including insufficient ipsilateral hamstring grafts or situations where quadriceps or patella autografts are not optimal.

Level of evidence: Level IV.

Keywords: Anterior cruciate ligament; Autograft; Contralateral; Hamstring; Revision.

PubMed Disclaimer

References

    1. Alkhalaf FNA, Hanna S, Alkhaldi MSH, Alenezi F, Khaja A (2021) Autograft diameter in ACL reconstruction: size does matter. SICOT-J 7:16. https://doi.org/10.1051/sicotj/2021018 - DOI - PubMed - PMC
    1. Andernord D, Desai N, Björnsson H, Gillén S, Karlsson J, Samuelsson K (2015) Predictors of contralateral anterior cruciate ligament reconstruction: a cohort study of 9061 patients with 5-year follow-up. Am J Sports Med 43(2):295–302 - DOI - PubMed
    1. Beaudoin A, Ogborn D, McRae S, Larose G, Brown H, McCormack R, MacDonald P (2022) No differences found in long-term outcomes of a randomized controlled trial comparing ipsilateral versus contralateral hamstring graft in ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 30(11):3718–3725 - DOI - PubMed
    1. Bedi A, Srinivasan RC, Salata MJ, Downie B, Jacobson JA, Wojtys EM (2013) Structural and functional analysis of the semitendinosus tendon after harvest for soft tissue reconstructive procedures: a dynamic ultrasonographic study. Knee Surg Sports Traumatol Arthrosc 21(3):606–614 - DOI - PubMed
    1. Brinkman JC, Tummala SV, Hassebrock JD, McQuivey KS, Makovicka JL, Economopoulos KJ (2023) Mid-term outcomes of the all-soft quadriceps tendon autograft are noninferior to hamstring autograft in primary anterior cruciate ligament reconstruction: comparison with minimum 5-year follow-up. Arthroscopy 39(4):1008–1013 - DOI - PubMed

Publication types

MeSH terms