Hamstring versus Quadriceps Tendon Graft in Double-Bundle Anterior Cruciate Ligament Reconstruction

PURPOSE OF THE STUDY The aim of this prospective study was to evaluate functional outcomes and knee joint stability after double-bundle anterior cruciate ligament reconstruction using three-tunnel quadriceps tendon-bone graft and four-tunnel hamstring graft (semitendinosus and gracilis muscles). MATERIAL Group 1 included 20 patients undergoing reconstruction with quadriceps tendon- bone graft group; 2 comprised of 20 patients treated by hamstring graft. There were 26 men and 14 women, with an average age of 27 (range, 16 to 44) years. The minimum follow-up period was one year. METHODS In group 1 patients, semi-anatomic anterior cruciate ligament reconstruction was performed by a three-tunnel technique (two tunnels in the femur and one in the tibia) using quadriceps femoris muscle graft. Group 2 patients were treated by anatomic four-tunnel reconstruction (two tunnels in the femur and two in the tibia) with the use of hamstring graft. Functional outcomes were evaluated on the basis of Lysholm and IKDC scores. Antero-posterior stability was measured with a KT-1000 arthrometer and rotational stability was assessed by the pivot-shift test. For statistical evaluation, the level of significance (p) was set at < 0.05. RESULTS The final evaluation showed an average Lysholm score of 88.9 +/- 12 (76-100) points for group 1, and 87.9 +/- 11(62-100) points for group 2; there was no statistically significant difference. The rounded average result of the functional IKDC score after surgery was the same in the two groups (80 +/- 10). The joints treated by the three-tunnel technique had on average better antero-posterior stability, but this was not statistically significant. The pivot-shift phenomenon was not seen in either of the groups. Operative times in both groups were comparable. An intra-operative fracture of the patella occurred in two patients of group 1. DISCUSSION No similar prospective study comparing the outcomes of the methods reported here has been found in the international literature. The studies so far published have not included any such comparison or they compared other techniques, such as single- versus double-bundle reconstructions. CONCLUSIONS Based on Lysholm and IKDC score evaluation and antero-posterior and rotational stability assessment, it can be concluded that both the three- and the four-tunnel technique of anterior cruciate ligament reconstruction gave similar results, with no significant differences, at one-year follow-up. However, these are only short-term results and only a long-term follow-up can prove or disprove the validity of this conclusion.