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      Increased risk of revision with hamstring tendon grafts compared with patellar tendon grafts after anterior cruciate ligament reconstruction: a study of 12,643 patients from the Norwegian Cruciate Ligament Registry, 2004-2012.

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          Abstract

          The graft choice for anterior cruciate ligament reconstruction (ACLR) is controversial. Hamstring tendon (HT) autografts and patellar tendon (PT) autografts are the most common grafts used and have shown similar subjective and objective outcomes.

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          A meta-analysis of the incidence of anterior cruciate ligament tears as a function of gender, sport, and a knee injury-reduction regimen.

          Chadwick C. Prodromos, Yung Han, Julie Rogowski … (2007)
          The literature has shown that anterior cruciate ligament (ACL) tear rates vary by gender, by sport, and in response to injury-reduction training programs. However, there is no consensus as to the magnitudes of these tear rates or their variations as a function of these variables. For example, the female-male ACL tear ratio has been reported to be as high as 9:1. Our purpose was to apply meta-analysis to the entire applicable literature to generate accurate estimates of the true incidences of ACL tear as a function of gender, sport, and injury-reduction training. A PubMed literature search was done to identify all studies dealing with ACL tear incidence. Bibliographic cross-referencing was done to identify additional articles. Meta-analytic principles were applied to generate ACL incidences as a function of gender, sport, and prior injury-reduction training. Female-male ACL tear incidences ratios were as follows: basketball, 3.5; soccer, 2.67; lacrosse, 1.18; and Alpine skiing, 1.0. The collegiate soccer tear rate was 0.32 for female subjects and 0.12 for male subjects. For basketball, the rates were 0.29 and 0.08, respectively. The rate for recreational Alpine skiers was 0.63, and that for experts was 0.03, with no gender variance. The two volleyball studies had no ACL tears. Training reduced the ACL tear incidence in soccer by 0.24 but did not reduce it at all in basketball. Female subjects had a roughly 3 times greater incidence of ACL tears in soccer and basketball versus male subjects. Injury-reduction programs were effective for soccer but not basketball. Recreational Alpine skiers had the highest incidences of ACL tear, whereas expert Alpine skiers had the lowest incidences. Volleyball may in fact be a low-risk sport rather than a high-risk sport. Alpine skiers and lacrosse players had no gender difference for ACL tear rate. Year-round female athletes who play soccer and basketball have an ACL tear rate of approximately 5%. Level IV, therapeutic case series.
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            Incidence of anterior cruciate ligament injury and other knee ligament injuries: a national population-based study.

            M Gianotti, Maxwell A. Hume, Lorna Bunt … (2009)
            There has been an intensive research effort directed at determining the cause of non-contact anterior cruciate ligament (ACL) injury over the past decade, but few studies have reported data on the incidence of ACL and other knee ligament injury in the general population. New Zealand's no-fault injury compensation data provides a national injury resource of data on claims for knee ligament injury. The goal of this paper was to provide a descriptive epidemiology of knee ligament injury in this country. Data were obtained for knee ligament injuries between 1 July 2000 and 30 June 2005. Injuries were categorised as non-surgical (NS), ACL surgeries (ACLS) and other knee ligament surgeries (OKLS). Incidence rates per 100,000 person-years were computed using population estimates. Costs and number of treatment/rehabilitation visits were obtained as an indication of severity. The incidence rate per 100,000 person-years was 1147.1 for NS, 36.9 for ACLS and 9.1 for OKLS. Males had a higher incidence rate than females for NS, ACLS, and OKLS. The mean (and median) number of treatment visits were NS: 6.6 (4), ACLS: 27.1 (24), and OKLS: 31.3 (24). The mean (median) treatment costs of these injuries were NS $885 ($129), ACLS $11,157 ($8574), and OKLS $15,663 ($8054). Analysis of injury descriptions for ACLS injuries indicated that 58% involved a non-contact mechanism of injury. These data underscore the high level of short-term disability associated with knee ligament injuries, especially ACL injuries that require surgery.
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              A 10-year comparison of anterior cruciate ligament reconstructions with hamstring tendon and patellar tendon autograft: a controlled, prospective trial.

              J. Roe, L Pinczewski, Sharon L. Salmon … (2007)
              There are no controlled, prospective studies comparing the 10-year outcomes of anterior cruciate ligament (ACL) reconstruction using patellar tendon (PT) and 4-strand hamstring tendon (HT) autografts. Comparable results are possible with HT and PT autografts. Cohort study; Level of evidence, 2. 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 prospective fashion with subjective, objective, and radiographic evaluation at 2, 5, 7, and 10-year intervals. 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. 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.
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                Author and article information

                Journal
                Journal ID (iso-abbrev): Am J Sports Med
                Title: The American journal of sports medicine
                ISSN (Electronic): 1552-3365
                ISSN (Print): 0363-5465
                Publication date (Electronic): Feb 2014
                Volume: 42
                Issue: 2
                Affiliations
                [1 ] Andreas Persson, Department of Orthopaedic Surgery, Haukeland University Hospital, Jonas Lies vei 65, Bergen, 5021 Norway. andreas.persson@helse-bergen.no.
                Article
                Publisher Item ID: 0363546513511419
                DOI: 10.1177/0363546513511419
                PubMed ID: 24322979
                SO-VID: bfa4c94b-6472-465f-8bf7-c697c7645366
                History

                Keywords: ACL,graft,hamstring tendon,patellar tendon,reconstruction,revision
                Data availability:
                Keywords: ACL, graft, hamstring tendon, patellar tendon, reconstruction, revision

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