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.

Aim: Goal of this prospective, randomized study is the functional evaluation of two different techniques of ACL reconstruction by using bone-patellatendon (BPT) vs. hamstrings (ST/G). Methods: 62 ACL-insufficient patients (33 women/29 men) took part in this study. 31 (mean:29,8 y.) underwent ACL-reconstruction using BPT (GI). 31 (mean: 34,2 y.) patients underwent ACL-reconstruction using ST/G (GII). Both techniques were press-fit and implant-free. We used accelerated rehabilitation for both groups. Patients were evaluated by IKDC, Lysholm and Tegner score, KT 1000, one-leg-hop, isokinetics, internal torque, kneeling- and knee-walking-test, 1 day preop., and 3, 6 and 12 months postop. Results: One year results of GII were according to IKDC-score (GII: 30 patients= A and B vs. GI: 24 patients= A and B), Lysholm-score (GII: 95,61 vs. GI: 90,87 (p=0.017) and Tegner-score (GII: 7,07 vs. GI: 6,61 (p=0.00)) better than those of GI. The Evaluation of the strength of hamstrings using isokinetics showed significant differences: GII: 90,34 Nm vs. 99,19 Nm in GI, (p=0.008). However results concerning the internal torque evaluation were not significant. The one-leg-hop comparing injured and non-injured leg resulted in significant differences: GII: 96% vs. GI: 91%, (p=0.012). Results in GI were significantly worse than in GII at kneelling and kneewalking-testings ((p=0.00)(p=0.00)). Conclusion: All scoring, clinical and functional evaluations, except isokinetic hamstring evaluation, showed a hamstring’s supperiority in ACL reconstruction.

Aim: To evaluate activity level and remaining symptoms concerning the donor site morbidity in patients having anterior cruciate ligament reconstruction (ACLreconstruction) with either ipsilateral or contralateral bone-patellar-tendon graft (BPT-graft). Methods: 100 patients aged from 18 to 49 years (mean 34) having an ACL-reconstruction with BPT-graft (with one bone block) from 1997 to 1999 were included in this study. In 52 of them a BPT-graft from the ipsilateral side was used (Group I). In 48 the contralateral BPT was used (Group II). A questionaire, including Cincinnati-, Tegner-activity score and special questions concerning persisting symptoms at the donor site, such as tenderness, numbness, kneeling pain and knee-walking pain, was sent to all patients. Results: The average Cincinnati Scoring was 85,2 in Group I and 86,3 in Group II. There was no statistical significance in Tegner scoring between the two groups. In Group I, 37,5% of the patients refered local tenderness, 59,6% kneeling pain and 82,65% knee-walking pain. According to contralateral leg in Group II, 37,5% of the patients refered local tenderness, 52% kneeling pain and 62,5% knee-walking pain vs. 8,3%, 25% and 25% respectively in the ACL reconstructed knee. Conclusions: This study showed that there are no benefits if the contralateral BPT graft is used, because all symptoms concerning donor site morbidity are shifted from the injured into the healthy knee if the graft is taken from the contralateral side.

Introduction: The goal of this prospective, randomized study is the functional evaluation of two different techniques of ACL reconstruction by using the bone-patella tendon (BPT) vs. hamstrings (ST/G).62 ACL-insufficient patients without any concommitent sport injuries took part in a prospective randomized study.

Material and Methods: Eighteen men and 13 women underwent ACL-reconstruction with BPT graft (Group I) with average age 29,87 (16–46) years. 31 patients (16 women and 15 men) with average age 34,23 (16–55) years underwent ACL-reconstruction using a quadrupled hamstrings graft (Group II). Both techniques were performed by using a press-fit and implant-free technique. We used the same accelerated rehabilitation protocol for both groups. The patients were evaluated by IKDC, Lysholm and Tegner scoring systems, KT 1000, one leg hop, isokinetics, internal torque, kneeling and knee walking test, 1 day preoperatively (VU), and 3 (NU I), 6 (NU II) and 12 months (NU III) postoperatively.

Results: One year postop.the results of Group II (30 patients classified as A and B) were according to IKDC scoring system better than those in Group I (Group I: 24 patients classified as A and B). We had similar results according to Lysholm-scoring evaluation (Group 11:95,61 points vs. 90,87 in Group I (p=0.017)) and Tegner-scoring (Group II: 7,07 vs. 6,61 in Group I (p=0.00)). According to the KT 1000 stability evaluation, there was no statistical significant difference between injured and uninjured knees in both groups. The evaluation of the strength of the hamstrings by isokinetics in both groups showed statistical significant differences (Group II: 90,34 Nm vs. 99,19 Nm in Group I, (p=0.008)). However, our results concerning internal torque evaluation were not statistical significant. The evaluation of one leg hop by comparing injured and non-injured leg showed a significant difference between group II and group I (Group II: 96% vs. 91% in Group I, (p=0.012)). We had worse results in Group I vs. Group II at kneelling and knee-walking-testings ((p=0.00)(p=0.00)), concerning the anterior knee pain.

Conclusion: From our results concerning IKDC, Lysholm, Tegner, kneeling and knee walking tests it seems that hamstrings can be recommended for ACL reconstruction. The isokinetic evaluation of hamstrings showed a statistical significant deficiency compaired to the BPT-group. But this result could not be confirmed with the internal torque evaluation and “one leg hop”-testing.