Hamstring Grafts More Effective in Knee Reconstruction

Patients receiving anterior cruciate ligament (ACL) knee reconstruction with a hamstring tendon (HT) graft rather than a knee tendon graft are less likely to suffer from long-term pain and reduced mobility after surgery.

Researchers at the North Sydney Orthopedic and Sports Medicine Center (Wollstonecraft, Australia) followed 180 knee reconstruction patients, with 90 (48 men and 42 women, between the ages of 15-42 years) receiving a patellar tendon (PT) graft and the other 90 (47 men and 43 women, between the ages of 13-52 years) receiving a HT graft. After 15 years, 80% of the PT group and 73% of the HT group were assessed based on their symptoms of pain, swelling, and knee mobility.

The results showed that the HT group demonstrated significantly higher activity levels, with 77% performing at least strenuous activities, compared to 62% being able to perform strenuous activity in the PT group. In evaluating pain when kneeling, 42% of the PT group patients reported moderate or greater pain, while only 26% of the HT group reported pain; the PT group also showed worse outcomes in tests for motion loss and osteoarthritis. On the other hand, patients in the in the HT graft showed increased osteoarthritis (OA), the reasons which remained uncertain and warrant further investigation. The study was presented at the American Orthopedic Society for Sports Medicine's Specialty Day, held during February 2011 in San Diego (CA, USA).

"We know that these surgeries work, but this information helps us determine which approaches can be most effective. Getting athletes back on the field is certainly important, but long term success rates are crucial as well,” said lead author and study presenter Leo Pinczewski, MD. "Patients with a hamstring graft reported less knee pain and discomfort and demonstrated a higher activity level.”

The HT graft used for a reconstruction is usually harvested from one of the medial hamstrings, the semitendonosis or semimembranosis. The tendon is collected from an anterior-medial incision, and is folded over itself twice (producing a graft that is four layers thick), which is then fixed into the bone tunnels using various hardware, often involving screws and washers. The HT graft does not compromise the extensor mechanism, allowing for faster return of range of motion and quadriceps function. It does however harbor the possibility for stretching out, and has a higher incidence of hardware removal over time.

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