A comparison of outcomes at 2 to 6 years after acute and chronic anterior cruciate ligament reconstructions using hamstring tendon grafts

Purpose: To compare short- to intermediate-term outcomes of patients in whom an acute or chronic anterior cruciate ligament (ACL) reconstruction was performed with a hamstring tendon graft. Type of Study: A consecutive case series of patients who had a-incision, arthroscopically assisted ACL reconstructions with a triple-strand hamstring tendon graft was retrospectively evaluated. Methods: A total of 120 patients were evaluated at a mean of 44 months. The Tegner Activity Scale, individual components of the Cincinnati Knee Rating System, and the modified Lysholm Score were administered to all patients, A total of 93 patients (78%) returned for examination, instrumented ligament laxity testing, radiographs, isokinetic strength testing, and completion of the IKDC Standard Knee Ligament Evaluation Form. Data from patients undergoing reconstructions for acute and chronic ACL deficiencies were compared. The acute group was defined as reconstruction within 6 weeks of injury without recurrent episodes of instability. Results: At surgery, significantly more (P < .05) cartilage abnormalities and partial medial menisectomies were found in the chronic group. At final follow-up, no significant differences (P > .05) were found between the acute and chronic groups for instrumented laxity, muscle strength, knee motion, or sports activity level. The acute group scored significantly higher (P < .05) on the Lysholm scale, Cincinnati Function scale, IKDC subjective assessment, and IKDC rating for pain at follow-up. The final IKDC grade resulted in significantly more (P = .039) normal knees for the acute group; however, 94.1% of acute and 92.9% of chronic knees were graded normal or nearly normal. Conclusions: Hamstring tendons are an excellent graft choice for ACL reconstruction in both acute and chronic injuries. According to the strict IKDC rating system, greater than 90% of all patients can be expected to have a normal or nearly normal knee at short- to intermediate-term follow-up; however, the chronic group will have fewer patients with a rating of normal.