Purpose: The purpose of this study was to compare the bone-patellar-tendon-bone (BPTB) and the four-strand hamstring grafts for anterior cruciate ligament (ACL) reconstruction in patients aged less than 40 years and to evaluate the influence of meniscectomies performed before, during, or after the ACL reconstruction.

Material and methods: Between March 1997 and March 2000, 114 patients who underwent ACL reconstruction (58 BPTB then 56 hamstring) were included. Exclusion criteria were: peripheral ligament repair or associated bone procedures, surgical revision. The continuous series was analysed retrospectively by two surgeons different from the operator. The BTPB group included 58 patients (mean age 28 years) evaluated at a mean 44 months; meniscectomy was associated in eleven cases. The hamstring group included 56 patients (mean age 27.5 years) evaluated at a mean 28 months; there were 19 associated meniscectomies. The IKDC score and laxity (KT2000, Telos) as well as the radiological aspect (AP, lateral and 30° flexion views) were used to assess outcome.

Results: At last follow-up (89 patients, 78%) there were three failures in each group; 77% of patients were in IKDC classes A or B. Subjectively, 90% of the patients considered their knee was normal or nearly normal. For both types of grafts, the outcome was significantly better if the meniscus was preserved. For knees with preserved menisci, there was no difference between BTPB and hamstring reconstruction. Anterior pain was greater after BTPB and posterior thigh pain was greater after hamstring reconstruction. Mean deficit was 14% in extension force in the BTPB group and 25% in flexion force in the hamstring group.

Discussion: Meniscectomy before, during or after ACL reconstruction has a negative effect on the graft outcome for both techniques. If the meniscus is preserved, there is no difference between BTPB and hamstring reconstruction; the morbidities are different, but equivalent (anterior pain for BTPB and posterior for hamstring) and muscle deficit is different (extension for BTPB and flexion for hamstring).

Conclusion: More important than the type of transplant used to reconstruct the ACL, meniscal preservation is a major element affecting outcome.