Anterior Cruciate Ligament Reconstruction: Soft Tissue vs. Bone-Tendon-Bone

The ideal graft for use in anterior cruciate ligament reconstruction should have structural and biomechanical properties similar to those of the native ligament, permit secure fixation and rapid biologic incorporation, and limit donor site morbidity. Many options have been clinically successful, but the ideal, graft remains controversial. Graft choice depends on surgeon experience and preference, tissue availability, patient activity level, co morbidities, prior surgery, and patient preference. Patellar tendon auto graft, the most widely used graft source, appears to be associated with an increased incidence of anterior knee pain compared with hamstring auto graft. Use of hamstring auto graft is increasing. Objectives: This study aims to compare two arthroscopic surgical techniques in reconstruction ACL based on fixation and grafting different: the intra-articular auto graft bone-patellar tendon-bone (BTB) ligamentoplasty and quadruple hamstring auto graft (semitendinosus-gracilis) ligamentoplasty. Material and methods: The number of patients who have completed the study is 135. The minimum follow-up period was one year. The inclusion criteria were the presence of ACL insufficiency on one leg, age between 15-45 years, no previous ligament surgery, not insufficient presence of posterior cruciate ligament (PCL) and no evidence of osteoarthritis. 58 patients received a hamstring auto graft and 76 patients received a bone-patellar ligament-bone auto graft. In the last 3 cases of ACL reconstruction with soft tissue, during the recovery period we have injected in the knee joint PRP (Platelet-Rich Plasma)., All patients were enrolled in an exercise program to facilitate motion of the knee immediately after the operation, and all patients returned for postoperative evaluation. All patients, were subjected to a clinical evaluation, with assessment of the anterior drawer, Lachman´s and the pivot-shift, tests. They also completed, the International Knee Documentation Committe- - e, visual analog scale and functional knee score for anterior knee pain. Results: Postoperative, of all 135 patients, almost 80 % had a negative Lachman just one year after surgery. Small laxity (3-5mm) has been seen in, 21% (12 patients) of the STG group, comparing to 11 % in, BTB (8 cases).A moderate to severe pivot shit test, scored in, 64 patients (47,4%), as within 12 months after surgery, a moderate pivot shift testing being positive in, 25 cases (22%, STG comparing to 14 % BTB). All cases where we have registered a residual positive pivot shift were done with a trans tibial technique. In term of knee stability there was no difference between BTB group and hamstrings group and also in return to sport activities., We have tried to measure radiological tunnel enlargement using L´Insalata technique. In post operative period there was an increase in pain score in BTB group, and we have recorded also kneeling discomfort and an increased area of decreased skin sensivity., We have 5, reconstruction with BTB, and all of them had complication from donor site. (patellar tendon shortening 2 cases, anterior knee pain 3 cases). In STG group we had two septic arthritis. Conclusions. There was no statistical significant, difference in clinical results between BTB group and hamstrings group., The most important advantage of the hamstring auto graft is that avoids the disturbance of the extensor mechanism of the knee. In general, patellar tendon auto grafts are preferable for high-performance athletes, and hamstring auto grafts and allografts have some relative advantages for lower-demand individuals.