To evaluate and compare the clinical outcomes of anterior cruciate ligament (ACL) reconstruction using a bone–patellar tendon–bone (BPTB) autograft and a patellar bone–tendon (PBT) autograft.
Seventy-nine patients who underwent ACL reconstruction using either a BPTB autograft or a PBT autograft were retrospectively evaluated. The minimum follow-up period was 24 months after surgery. A graft selection was determined by the patellar tendon length as measured on preoperative magnetic resonance imaging. If the patellar tendon length was longer than or equal to 45 mm, a PBT graft attached with the EndoPearl device was used. Fifty-one patients used BPTB autografts (group B) and 28 patients used PBT autografts (group P). The Lachman test, pivot-shift test, and anterior translation tested with a KT2000 arthrometer were assessed. Functional outcomes were assessed with the use of the Lysholm score, International Knee Documentation Committee subjective score, and objective grade. Anterior knee pain including kneeling pain was assessed with the use of the Shelbourne and Trumper questionnaire.
There was no statistically significant difference between the 2 groups in the postoperative values of degree of anterior translation (P = .76), Lysholm score (P = .62), International Knee Documentation Committee subjective score (P = .91), and objective grade (P = .91). However, anterior knee pain assessed with the use of the Shelbourne and Trumper questionnaire (group B = 90 [range, 65 to 100], group P = 95 [range, 59 to 100], P = .02) and number of patients having kneeling pain (group B = 41%, group P = 18%, P = .04) differed significantly between the 2 groups.
ACL reconstruction using a PBT autograft provided reliable knee stability comparable to a BPTB autograft but with less kneeling pain. For patients who have a long patellar tendon that may cause graft-tunnel mismatch, a PBT can be an effective alternative graft option for arthroscopic ACL reconstruction.
Level of Evidence
Level III, retrospective comparative study.
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Published online: March 10, 2016
Accepted: October 12, 2015
Received: April 30, 2015
The authors report that they have no conflicts of interest in the authorship and publication of this article.
Investigation performed at the Arthroscopy and Joint Research Institute, Department of Orthopaedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
© 2016 by the Arthroscopy Association of North America