Original article| Volume 21, ISSUE 8, P965-969, August 2005

Posterior Cruciate Ligament Reconstruction: Double-Loop Hamstring Tendon Autograft Versus Achilles Tendon Allograft—Clinical Results of a Minimum 2-Year Follow-up

      Purpose: The purpose of this study was to compare clinical results of arthroscopic posterior cruciate ligament (PCL) reconstructions using double-loop hamstring tendon autograft and Achilles tendon allograft while preserving the original PCL remnant. Type of Study: Case-control study of results of treatment. Methods: From September 1997 to December 2000, 36 patients who received only PCL reconstruction were reviewed retrospectively. Of these, 18 patients received autogenous double-loop hamstring tendon reconstruction (group I) and 18 received Achilles tendon allograft reconstruction (group II). The same PCL reconstruction procedure was performed in both groups. At final follow-up at a minimum of 2 years, patients were evaluated by 4 measures: the International Knee Documentation Committee (IKDC) evaluation, Lysholm knee scores, the posterior draw test, and Telos stress radiography. Results: Between the 2 groups, preoperative demographic factors (age, gender, activity level, and mean duration to surgery) showed no statistically significant difference (P > .05). According to IKDC evaluation of group I, 16 of the 18 knees rated normal or nearly normal, whereas 2 fell into the abnormal category. By the same criteria, 14 of the 18 knees in group II were normal to nearly normal, 3 were abnormal, and 1 was severely abnormal. IKDC scores showed no statistical difference between the 2 groups (P = .98). Postoperative mean Lysholm knee scores were 90 points (range, 78–100) for group I and 85 (range, 70–95) for group II; improvements of 22 and 17 points, respectively. According to the Lysholm knee scores, group I showed slightly better results than did group II, with a statistical significance of P < .01. Telos stress radiography showed the mean difference in posterior translation between the injured and uninjured knees to be 2.2 mm (range, 0 to 7.0 mm) for group I and 2.9 mm (range, 1.0 to 7.0 mm) for group II. The Telos stress test showed no statistical difference between the 2 groups (P = .14). Conclusions: The clinical outcome was the same for both groups. Despite its comparatively short length and small diameter, the double-loop hamstring tendon autograft was as good as Achilles tendon allograft in PCL reconstruction. Level of Evidence: Level III, case-control study.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Arthroscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Inderster A.
        • Benedetto K.P.
        • Klestil T.
        • Kunzel K.H.
        • Gaber O.
        Fiber orientation of posterior cruciate ligament: An experimental morphological and functional study. Part 2.
        Clin Anat. 1995; 8: 315-322
        • Morgan C.D.
        • Kalman V.R.
        • Grawl D.M.
        The anatomic origin of the posterior cruciate ligament: Where is it? Reference landmarks for PCL reconstruction.
        Arthroscopy. 1997; 13: 325-331
        • Oakes D.A.
        • Markolf K.L.
        • McWilliams J.
        • Young C.R.
        • McAllister D.R.
        Biomechanical comparison of tibial inlay and tibial tunnel techniques for reconstruction of the posterior cruciate ligament. Analysis of graft forces.
        J Bone Joint Surg Am. 2002; 84: 938-944
        • Wang C.J.
        • Chen H.H.
        • Chen H.S.
        • Huang T.W.
        Effects of knee position, graft tension, and mode of fixation in posterior cruciate ligament reconstruction.
        Arthroscopy. 2002; 18: 496-501
        • Ahn J.H.
        • Chung Y.S.
        • Oh I.
        Arthroscopic posterior cruciate ligament reconstruction using the posterior trans-septal portal.
        Arthroscopy. 2003; 19: 101-107
        • Hoher J.
        • Scheffler S.
        • Weiler A.
        Graft choice and graft fixation in PCL reconstruction.
        Knee Surg Sports Traumatol Arthrosc. 2003; 11: 297-306
        • Fanelli G.C.
        • Giannotti B.F.
        • Edson C.J.
        Arthroscopically assisted combined posterior cruciate ligament/posterior lateral complex reconstruction.
        Arthroscopy. 1996; 12: 521-530
        • Bullis D.W.
        • Paulos L.E.
        Reconstruction of the posterior cruciate ligament with allograft.
        Clin Sports Med. 1994; 13: 581-597
        • Indelicato P.A.
        • Bittar E.S.
        • Prevot T.J.
        • Woods G.A.
        • Branch T.P.
        • Huegel M.
        Clinical comparison of freeze-dried and fresh frozen patellar tendon allografts for anterior cruciate ligament reconstruction of the knee.
        Am J Sports Med. 1990; 18: 335-342
        • Nemzek J.A.
        • Arnoczky S.P.
        • Swenson C.L.
        Retroviral transmission in bone allotransplantation. The effects of tissue processing.
        Clin Orthop. 1996; 324: 275-282
        • Jackson D.W.
        • Grood E.S.
        • Arnoczky S.P.
        • Butler D.L.
        • Simon T.M.
        Freeze dried anterior cruciate ligament allografts. Preliminary studies in a goat model.
        Am J Sports Med. 1987; 15: 295-303
        • Defrere J.
        • Franckart A.
        Freeze-dried fascia lata allografts in the reconstruction of anterior cruciate ligament defects. A two- to seven-year follow-up study.
        Clin Orthop. 1994; 303: 56-66
        • Marder R.A.
        • Raskind J.R.
        • Carroll M.
        Prospective evaluation of arthroscopically assisted anterior cruciate ligament reconstruction. Patellar tendon versus semitendinosus and gracilis tendons.
        Am J Sports Med. 1991; 19: 478-484
        • Prietto M.P.B.J.
        • Stonebrook S.N.
        • Settlage R.A.
        Tensile strength of the human posterior cruciate ligament (PCL).
        Trans Orthop Res Soc. 1988; 13: 195
        • Pinczewski L.A.
        • Thuresson P.
        • Otto D.
        • Nyquist F.
        Arthroscopic posterior cruciate ligament reconstruction using four-strand hamstring tendon graft and interference screws.
        Arthroscopy. 1997; 13: 661-665
        • Shino K.
        • Nakagawa S.
        • Nakamura N.
        • Matsumoto N.
        • Toritsuka Y.
        • Natsu-ume T.
        Arthroscopic posterior cruciate ligament reconstruction using hamstring tendons.
        Arthroscopy. 1996; 12: 638-642
        • Chen C.H.
        • Chen W.J.
        • Shih C.H.
        Arthroscopic reconstruction of the posterior cruciate ligament with quadruple hamstring tendon graft.
        J Trauma. 2002; 52: 938-945