Comparison of Semitendinosus and Gracilis Tendon Versus Patellar Tendon Autografts
Quality of Life and Clinical Outcome Comparison of Semitendinosus and Gracilis Tendon Versus Patellar Tendon Autografts for Anterior Cruciate Ligament Reconstruction: An 11-Year Follow-up of a Randomized Controlled TrialAm J Sports Med; 2011; 39(10): 2161-2169
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Dr. Sajovic comparing ACL hamstring and patellar tendon autografts
64 patients scheduled to undergo reconstruction for anterior cruciate ligament (ACL) ruptures were randomized to receive either hamstring tendon autograft or patellar tendon autograft. The results from 11 year follow-up indicated that there were no significant differences between the two groups in regards to functional or pain outcomes.It was also found that there were no significant differences in rate of graft failures between the two groups. However, the patellar tendon autograft group had a higher prevalence of osteoarthritis at 11 years.
Was the allocation sequence adequately generated?
Was allocation adequately concealed?
Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?
Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?
Blinding Patients: Was knowledge of the allocated interventions adequately prevented?
Was loss to follow-up (missing outcome data) infrequent?
Are reports of the study free of suggestion of selective outcome reporting?
Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?
Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?
Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?
Yes = 1
Uncertain = 0.5
Not Relevant = 0
No = 0
The Reporting Criteria Assessment evaluates the transparency with which authors report the methodological and trial characteristics of the trial within the publication. The assessment is divided into five categories which are presented below.
Inclusion / Exclusion
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
The Fragility Index is a tool that aids in the interpretation of significant findings, providing a measure of strength for a result. The Fragility Index represents the number of consecutive events that need to be added to a dichotomous outcome to make the finding no longer significant. A small number represents a weaker finding and a large number represents a stronger finding.
Why was this study needed now?
ACL injuries are common sports injuries, often in the younger population. The return to sports, long life, and prevention of secondary osteoarthritis are of primary importance. The choice of graft is an important decision for both the patient and the surgeon. Controversies still exist about graft selection for primary anterior cruciate ligament reconstruction. This study evaluates the long 14-year outcomes with two most common autografts (hamstring tendon autograft or patellar tendon autograft) used in ACL repair.
What was the principal research question?
Does patellar tendon autograft lead to similar functional and pain outcomes in comparison to hamstring tendon autograft in patients with ACL ruptures at 11 year follow-up?
What were the important findings?
- preoperative versus postoperative Lysholm knee scores showed a significant improvement in both groups (p<0.001)
- a greater number of patients reported anterior knee pain during strenuous activities or in kneeling-squatting position in the patellar tendon autograft group in comparison to the hamstring tendon autograft group (p=0.255)
- positive pivot-shift test (1 ) was significantly more frequent in the PT group (p=0.036)
- no significant differences in Short Form-36 or KT-1000 arthrometer laxity testing scores were observed between the two groups (p>0.05)
What should I remember most?
Both interventions provided similar improvements in outcomes; however, it was found that the rate of osteoarthritis was significantly higher in the patellar tendon autograft group.
How will this affect the care of my patients?
Similar long-term results could be obtained by using either hamstring tendon or patellar tendon autografts in patients undergoing ACL reconstruction.
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