The goal of this prospective, randomized study is the long-term evaluation of clinical, functional and MRI results after implant free press-fit ACL reconstruction performed using the bone-patella-tendon (PT) vs. hamstrings (HT) graft.

62 ACL insufficient patients without any concomitant sports injuries took part in a prospective, randomized study (31 PT, 31 HT). All procedures were conducted by the senior author between 10/98 and 09/99. Both surgical procedures were performed without any implants in press-fit technique with intra-operative x-ray control. At a mean FU time of 8.8 years 53 patients (28 PT, 25 HT) were examined by different scores, KT-1000, one leg hop test, kneeling- and knee-walking-test and isokinetic examination. We also performed bilateral MRI to determine the cartilage defects of both injured and uninjured knee. The results were compared with the intra-operative cartilage status. All MRIs were examined by an independent radiologist. For statistical analysis, the Student’s t-test and the chi²–test was used (p< 0.05).

On FU, neither the Tegner nor the Lysholm Score showed any significant results (Tegner 4.86 PT/5.29 HT, Lysholm 87.2/92.47). In the IKDC Score 84% of the PT and 94.4% of the HT group had a normal or nearly normal result (A or B) (p< 0.05), none had a severely abnormal result (D). The KT-1000 stability test and the pivot shift test showed no significance (KT-1000 side-to-side difference of < 3 mm 95.1%/91.7%; pivot glide in 28.0%/17.6%, no cross pivot shift). Isokinetic testing showed nearly normal quadriceps function in both groups (96.0%/96.4%), the hamstring strength was lower in the HT group without reaching statistical significance (100.3%/95.1%). The significant difference of the kneeling- and knee-walking-tests at 1 year FU persisted at year 9 (kneeling: 1.5/1.1; knee-walking: 1.72/1.14 (p< 0.05). Also, the single leg hop test was better in the HT group; however, the results were not significant (95.8%/99.1%).

The MRI results showed no difference in cartilage status grade 0–2 using the ICRS-protocol (69.6%/65.0%), the cartilage status of the uninjured knees showed in both groups a similar distribution. Tunnel measurements did not show any widening of the femoral tunnel (−11.3%PT, −0.4%HT). However, the tibial tunnels were clearly widened in both groups (+16.0%/+15.7%). Also, the Caton Index for patellar height (−0.073/−0.085) as well as the sagittal ACL angle (+1.96°/+2.37°), both compared to the uninjured knee, revealed no significant difference.

The implant free press-fit technique of ACL reconstruction using PT and HT grafts with anatomic graft placement is an excellent technique to preserve the cartilage and meniscal status without any significant differences between the operated and non-operated knees on FU. A significantly lower morbidity was noted in the HT group.

Introduction: Looking at the controversial discussion about indication, transplant choice and fixation techniques in active ACL-injured patients with open physes we recommend even in childhood an ACL reconstruction using a quadruple hamstring graft.

Material and Methods: ACL-replacement was performed with a four strand hamstring graft using an Endobutton and a suture washer or staple for extracortical fixation. The drilled tunnels were positioned transepiphyseal in the anatomic position. A standardized examination was performed. IKDC, Tegner, Lysholm and Cincinatti Knee Score were raised. With the KT-1000 the functional stability was tested. Variation in leg length and leg deformity were analyzed.

Results: 54 patients (22 female/32 male) operated at an age between 8 to 16 years (mean 13.3) were examined at mean f/u of 32 months (range 12–90) postoperatively. Measured with the Cincinatti and Lysholm Score 94% were classified as normal or nearly normal. Mean Tegner Score difference before trauma and postoperatively was 0.29 (range 0–3). Four patients developed instability due to an adequate trauma. Clinical and radiological examinations did not show growth disturbances in any patient. The results did not correlate to gender.

Conclusion: Presuming a bad progression in conservatively treated ACL-injured young patients and performing a careful operative treatment (small tunnel diameters, ligamentous graft, extracortical fixation, etc.) the above mentioned technique shows satisfying results and should be considered as a standard treatment in this special group.

Introduction: Some authors have suggested that the results of ACL reconstruction in females using hamstring tendon (HS) autograft are inferior to those using patellar tendon (PT) autograft. The purpose of this study was to compare our results of ACL reconstruction in females using both graft types.

Material and methods: 80 females who had undergone primary ACL reconstruction using either HS (n=48) or PT (n=32) were evaluated at mean 3.7 year follow-up (2.4 – 5.7). The same surgeon carried out all the reconstructions, using Endobutton femoral fixation and interference screw tibial fixation, and the same rapid rehabilitation protocol was followed by all patients. Independent assessment included IKDC 2000, SF-36, and Cincinnati Sports Activity Score (CSAS) and measurements of anterior knee pain (AKP), kneeling pain and anterior knee laxity (KT-1000).

Results: One patient in the PT group sustained a traumatic graft rupture. For the remaining patients there were no significant differences between the two graft types in terms of objective IKDC 2000 or KT-1000. In terms of subjective IKDC the HS group scored significantly higher (PT: 85 pts., HS: 90pts, p< 0.05), as well as for the CSAS (PT:72.8 vs. HS: 82.1, p< 0.01) and for the SF-36 on the Physical Functioning (PT:90 vs. HS:95, p< 0.01) and General Health subscales (PT:79 vs. HS 86, p< 0.05). Although there was no significant difference in AKP between the two groups, there was a significantly greater mean kneeling pain in the PT group (PT:4.1 vs. HS: 2.5, p=0.001).

Conclusions: Both PT and HS primary ACL reconstructions appear to provide comparable good objective results in females, but ACL reconstruction with HS showed significantly better subjective results. This finding seems to be related to less donor site problems compared with PT. Our results indicate that a quadruple hamstring autograft is an adequate alternative to a patellar tendon autograft for ACL reconstruction in female patients.

Introduction and Aims: Some authors have suggested that, in females, the results of ACL reconstruction using hamstring tendon (HS) grafts are inferior to those using patellar tendon (PT) grafts, while others have suggested that HS grafts may be preferable. This study compared the mid-term results of ACL reconstruction in females using both graft types.

Method: Sixty-six females who had undergone primary ACL reconstruction using either HS (n=43) or PT autograft (n=22) were evaluated at a mean 3.7 years follow-up (range 2.6–5.5). All procedures were performed by the same experienced knee surgeon using an arthroscopically assisted, single-incision technique, with Endobutton femoral fixation and interference screw tibial fixation. The same rapid rehabilitation protocol (immediate full extension and weight-bearing; no brace) was used for all patients. Assessment was performed by an independent orthopaedic surgeon and included IKDC 2000, SF-36 and Cincinatti Sports Activity scores and measurements of anterior knee pain (AKP), kneeling pain and anterior knee laxity (KT-1000).

Results: The overall results in both groups were good. One PT patient sustained a traumatic graft rupture. The HS patients had higher Cincinnati Sports Activity Scores (HS: 83 vs. PT: 72, p< 0.05), but there was no difference in IKDC subjective scores (HS: 89.6 vs. PT: 85.7). For the SF-36, the HS group scored significantly higher on Physical Functioning (HS: 95.4 vs. PT: 89.8, p< 0.01) and General Health subscales (HS: 87.5 vs. PT: 78.4, p< 0.05), but there were no differences for the other subscales. Although there was no significant difference in AKP between the two groups (HS: 1.3/10 vs. PT: 1.7), there was a significantly greater mean kneeling pain in the PT group (PT: 4.0/10 vs. HS: 1.3, p< 0.001). There was no difference between the groups in side to side difference in anterior knee laxity at 134N (HS: 1.7mm vs. PT: 1.8mm). Seventy percent HS and 71% PT patients had a difference of < 3mm, with all remaining patients having 3–5mm difference. There was no difference in terms of overall IKDC knee examination grade, but the HS group had a lesser (hyper)extension deficit (HS: 1.0° vs. PT: 1.8°, p< 0.05).

Conclusion: Both PT and HS ACL reconstructions appear to provide satisfactory results in females, but HS grafts are associated with fewer symptoms, a greater return to pre-injury level of activity and higher quality of life scores.