Purpose: To compare the results of reconstruction of the anterior cruciate ligament (ACL) using autologous patellar bone-tendon-bone (BTB) graft with four semitendinous-medial rectus bundles (STMR). Our technique involved a double incision and attachment with an interference screw.

Materials and methods: Non-randomised prospective study of 296 athletes operated on between 1988 and 2001: 202 BTB and 94 STMR. The mean ages were 22.8 and 21.6, males 52.9% and 58.5%, right knee involved in 54.46% and 54.3% of cases and mean follow-up of 13.7 and 12.4 months in the BTB and STMR groups, respectively.

The evaluation of the results was based on the IKDC protocol and pre- and post-surgical anterior tibial displacement was evaluated with the radiological Lachman test and Telos® arthrometer.

Results: The final IKDC evaluation was excellent or good in 86% and 89%, post-surgery Lachman tests showed less than 3 mm in 58.6 and 50.6%, from 4 to 8 mm in 33.3% and 31.6%, the athlete dropping sports activity in 9.3 and 3.4%, infection in 3 and 2 cases, stiffness in 2 and 2 cases and discomfort on kneeling in 8.7 and 2.2% of athletes in the BTB and STMR groups, respectively.

Conclusions: We found no clinical differences between the two procedures. Anteroposterior stability was better in the BTB group. There was less discomfort on kneeling and fewer athletes dropped sports in the STMR group.