title: Early post-operative morbidity following anterior cruciate ligament reconstruction: patellar tendon versus hamstring graft A 10-year comparison of anterior cruciate ligament reconstructions with hamstring tendon and patellar tendon autograft: a controlled, prospective trial. Comparison of Kneelax and KT-1000 knee ligament arthrometers. Comparison of Patellar Tendon and Hamstring Tendon Anterior Cruciate Ligament Reconstruction Long-term Comparison of Semitendinosus and Gracilis Tendon Versus Patellar Tendon Autografts for Anterior Cruciate Ligament Reconstruction: A 17-Year Follow-up of a Randomized Controlled Trial Assessment of Differences Between the Modified Cincinnati and International Knee Documentation Committee Patient Outcome Scores Anterior Cruciate Ligament Revision Surgery: Ipsilateral Quadriceps Versus Contralateral Semitendinosus-Gracilis Autografts. Autologous patellar tendon and quadrupled hamstring grafts in anterior cruciate ligament reconstruction: a prospective randomized multicenter review of different fixation methods There is no difference between quadriceps- and hamstring tendon autografts in primary anterior cruciate ligament reconstruction: a 2-year patient-reported outcome study Strength recovery after anterior cruciate ligament reconstruction with quadriceps tendon versus hamstring tendon autografts in soccer players: A randomized controlled trial. A Randomized Clinical Trial Comparing Patellar Tendon, Hamstring Tendon, and Double-Bundle ACL Reconstructions: Patient-Reported and Clinical Outcomes at a Minimal 2-Year Follow-up Patellar tendon or semitendinosus tendon autografts for anterior cruciate ligament reconstruction: a prospective, randomized study with a 7-Year follow-up. [Hamstring versus quadriceps tendon graft in double-bundle anterior cruciate ligament reconstruction]. Anterior cruciate ligament reconstruction: bone-patellar tendon-bone compared with double semitendinosus and gracilis tendon grafts. A prospective, randomized clinical trial. Technique of anatomical footprint reconstruction of the ACL with oval tunnels and medial portal aimers Is Quadriceps Tendon Autograft a Better Choice Than Hamstring Autograft for Anterior Cruciate Ligament Reconstruction? A Comparative Study With a Mean Follow-up of 3.6 Years Anterior cruciate ligament reconstruction using patellar tendon versus hamstring tendon: a prospective comparative study with 9-year follow-up. A Randomized Comparison of Patellar Tendon and Hamstring Tendon Anterior Cruciate Ligament Reconstruction * Is quadriceps tendon a better graft choice than patellar tendon? a prospective randomized study. Knee laxity after staircase exercise predicts radiographic disease progression in medial compartment knee osteoarthritis. Patellar Tendon Versus Hamstring Tendon Autografts for Anterior Cruciate Ligament Reconstruction
abstract: Abstract . This study documented postoperative morbidity during the first 4 months following  anterior cruciate ligament ( ACL ) reconstruction  using either patellar tendon or hamstring tendon autograft .  Sixty-five patients undergoing primary arthroscopically assisted single-incision ACL reconstruction  were r and omized to have a central third bone patellar tendon bone autograft ( PT ) or a doubled semitendinosus/doubled gracilis autograft ( HS ) . Postoperatively patients undertook a st and ard ' accelerated ' rehabilitation protocol . Patients were review ed after 2 weeks , 8 weeks , and 4 months . At each review the location and severity of general knee pain and the presence and severity of anterior knee pain ( AKP ) were recorded as were the presence and size of an effusion as well as the active and passive flexion and passive extension deficits compared to the contralateral limb . Pain on kneeling , KT-1000 measured side to side difference in anterior tibial displacement , isokinetic assessment of quadriceps and hamstring peak torque deficits , IKDC score and Cincinnati sports activity level were also recorded after 4 months . After 2 weeks more patients in the PT group complained of AKP and reported that the pain was more severe . After 8 weeks there was no significant difference between the groups for any variable . After 4 months the severity of general pain experienced and the incidence of pain on kneeling were greater in the PT group . The PT group also demonstrated a significantly greater quadriceps peak torque deficit at 240 ° /s . IKDC scores were higher in the HS group , but Cincinnati sports activity scores were higher in the PT group . Although we observed a lower morbidity in the HS group , primarily related to pain , the severity of pain in both groups was relatively low and , in light of the higher mean sports activity level observed in the PT group at 4 months the clinical impact of the difference may not be significant BACKGROUND There are no controlled , prospect i ve studies comparing the 10-year outcomes of anterior cruciate ligament ( ACL ) reconstruction using patellar tendon ( PT ) and 4-str and hamstring tendon ( HT ) autografts . HYPOTHESIS Comparable results are possible with HT and PT autografts . STUDY DESIGN Cohort study ; Level of evidence , 2 . METHODS One hundred eighty ACL-deficient knees that met inclusion criteria underwent ACL reconstruction ( 90 HT autograft , 90 PT autograft ) by one surgeon and were treated with an accelerated rehabilitation program . All knees were observed in a prospect i ve fashion with subjective , objective , and radiographic evaluation at 2 , 5 , 7 , and 10-year intervals . RESULTS At 10 years , there were no differences in graft rupture rates ( 7/90 PT vs. 12/90 HT , P = .24 ) . There were 20 contralateral ACL ruptures in the PT group , compared with 9 in the HT group ( P = .02 ) . In all patients , graft rupture was associated with instrumented laxity > 2 mm at 2 years ( P = .001 ) . Normal or near-normal function of the knee was reported in 97 % of patients in both groups . In the PT group , harvest-site symptoms ( P = .001 ) and kneeling pain ( P = .01 ) were more common than in the HT group . More patients reported pain with strenuous activities in PT knees than in HT knees ( P = .05 ) . Radiographic osteoarthritis was more common in PT knees than the HT-reconstructed knees ( P = .04 ) . The difference , however , was composed of patients with mild osteoarthritis . Other predictors of radiographic osteoarthritis were < 90 % single-legged hop test at 1 year and the need for further knee surgery . An " ideal " outcome , defined as an overall International Knee Documentation Committee grade of A or B and a radiographic grade of A at 10 years after ACL reconstruction , was associated with <3 mm of instrumented laxity at 2 years , the absence of additional surgery in the knee , and HT grafts . CONCLUSIONS It is possible to obtain excellent results with both HT and PT autografts . We recommend HT reconstructions to our patients because of decreased harvest-site symptoms and radiographic osteoarthritis Two commercially available knee ligament arthrometers ( KT-1000 MEDmetric Corporation , San Diego , California and Kneelax MR Systems , Haarlem , The Netherl and s ) were used to measure anterior tibial translation . In this study 91 subjects with no history of knee pathology were tested using both devices . Both normal knees were tested and comparison of recorded anterior translation ( millimeters ) was performed . Absolute numbers at forces of 67N , 89N , 134N , and manual maximum displacements were recorded . Side-to-side differences were calculated and data were compared . There was a significant difference found between the absolute values of each device . The KT-1000 was found to record greater values in millimeters of translation . Although the absolute values were significantly different , the side-to-side differences were not significantly different between devices Background : Numerous studies have compared patellar tendon ( PT ) and hamstring tendon ( HS ) anterior cruciate ligament ( ACL ) reconstructions in the short to midterm , but fewer long-term results have been published . Hypothesis : There will be no difference in functional outcome between ACL reconstruction performed with PT and HS grafts , but PT grafts will have more donor site morbidity . Study Design : R and omized controlled trial ; Level of evidence , 1 . Methods : Sixty-five patients undergoing ACL reconstruction were r and omized to receive either a PT graft or a 4-str and HS graft . Early results were reported at 4 , 8 , 12 , 24 , and 36 months . Forty-seven patients ( 22 of 31 PT and 25 of 34 HS ) were review ed at a mean of 15.3 years . Results : Four graft ruptures ( 1 PT , 3 HS ) and 6 contralateral ACL injuries ( 4 PT , 2 HS ) occurred in the group that was review ed . There was no statistically significant difference between the groups for any of the variables measured . There was a similar incidence of anterior knee pain and kneeling pain in both groups . The previously observed increased extension deficit in the PT group at 3 years was not present at 15 years , and there was no significant between-group difference in knee laxity . A higher proportion of patients in the PT group were participating in sport on a weekly basis ( 73 % PT , 48 % HS ; P = .05 ) . There was no difference in the degree of osteoarthritis between the groups . Conclusion : This r and omized controlled trial showed that HS and PT ACL reconstructions have comparable results at an average 15-year follow-up . Contrary to the study hypothesis , some of the graft differences seen at earlier review were not present at 15 years , and patients with PT grafts were more active in sport participation . Overall , both graft types provided good long-term subjective and objective outcomes Background : Short-term and mid-term differences between hamstring and patellar tendon autografts for anterior cruciate ligament ( ACL ) reconstruction are well documented . Systematic review s highlight the lack of long-term results between the two grafts . Hypothesis : Seventeen years after ACL reconstruction , no difference will be found in functional outcome , quality of life , and graft failure between patients with patellar tendon ( PT ) or semitendinosus and gracilis tendon ( STG ) autografts ;  however , a significant difference will be seen in the prevalence of osteoarthritis . Study Design : R and omized controlled trial ; Level of evidence , 2 . Methods : Sixty-four patients were included in this prospect i ve study ( 32 in each group ) . A single surgeon performed primary ACL reconstruction in alternating sequence . Forty-eight patients ( 24 in each group ) were evaluated 17 years after ACL reconstruction :  A clinical assessment was made based on the International Knee Documentation Committee ( IKDC ) form , instrumented laxity was measured with KT-1000 arthrometer , and radiography of the operated knee was conducted and assessed for degenerative disease . The Lysholm question naire and the Short Form–36 version 2 question naire were filled out by the patients . Results : At the 17-year follow-up , no statistically significant differences were seen with respect to graft failure ( 2 reruptures in the semitendinosus and gracilis tendon [ STG ] group [ 6.3 % ] and 3 reruptures in the PT group [ 9.4 % ] ) and functional outcome . Increased instrumented laxity ( > 3 mm ) measured with KT-1000 arthrometer was seen in significantly more patients in the STG group ( 8 in the STG group compared with 2 in the PT group ; P = .03 ) with a mean side-to-side difference of 2.17 ± 1.86 mm in the STG group compared with 1.33 ± 1.93 mm in the PT group . A significant difference was found in frequency of knee osteoarthritis (OA)—100 % in the PT group compared with 71 % in the STG group ( P = .004 ) . Patients in the PT group tended to have higher grade OA according to the IKDC grading system , with an average grade of 1.46 in the PT group compared with 1 in the STG group ( P = .055 ) . The degenerative changes in the PT group were more common in the medial and patellofemoral compartments ( P = .003 and P = .04 , respectively ) . Conclusion : Both autografts provided good to excellent subjective outcomes . No significant differences were noted in graft failure and clinical instability . However , significantly more patients in the STG group had increased instrumented anteroposterior translation measured with KT-1000 arthrometer , and there was a greater prevalence of knee OA at 17 years after surgery in the PT group Background Functional outcome question naires have become a common part of patient follow-up in the orthopaedic community . The modified Cincinnati Knee Rating System and the International Knee Documentation Committee ( IKDC ) subjective scale were design ed to provide clinicians with information regarding a patient ’s functional and clinical status after knee surgery . Hypothesis The functional outcome data reported on the modified Cincinnati Knee Rating System and the IKDC subjective question naire are equivalent . Study Design Cohort study ( diagnosis ) ; Level of evidence , 2 . Methods Between 2000 and 2007 , all patients with complex knee disorders seen in our orthopaedic clinic were prospect ively followed and given simultaneously the modified Cincinnati Knee Rating System and the IKDC subjective question naires to report their functional outcomes . The total scores of each instrument were compared at each time of evaluation . As a measure of responsiveness , the st and ardized response means were calculated . A second within-patient analysis was also performed to determine if the results would be different when looked at by the patient . Results There were a total of 130 patients with a total of 444 modified Cincinnati Knee Rating System question naires and 462 IKDC subjective complete question naires included in the study .  Overall total scores on both the modified Cincinnati Knee Rating System and the IKDC subjective question naires were equivalent in a population analysis . Overall total scores showed improvement in function over time from preoperative measurement through the 2-year follow-up . The individual patient analysis demonstrated that , for a specific patient , it was possible that up to 34 % of the population would report a total score of more than 10 points difference , depending on the scale selected . Conclusion The modified Cincinnati Knee Rating System and the IKDC subjective rating question naires reported by patient population provide similar results . The practitioner who is not performing a population -based study but following individual patients for recovery will find that the individual question naires may offer different functional limitations . Individual differences were lost in the population means , with the approximate balance of positive and negative score differences masking the individual patient differences PURPOSE To evaluate the subjective outcomes , knee stability , and donor-site morbidity after  revision ACL reconstruction using either autologous ipsilateral quadriceps tendon or contralateral semitendinosus-gracilis tendon . METHODS A sample size calculation suggested that we needed 25 patients in each group to detect e quality between both groups . Therefore , we evaluated 30 consecutive patients who underwent an ACL revision surgery with ipsilateral bone-quadriceps tendon grafts and 30 consecutive patients with the contralateral semitendinosus-gracilis grafts between January 2010 and December 2012 . Because of follow-up and exclusion criteria , finally 51 patients were evaluated . All patients were followed prospect ively for at least 2 years with KT1000 arthrometer testing and the International Knee Documentation Committee ( IKDC ) objective grading . At the 24-month follow-up , additional clinical scores were evaluated : the Knee Injury Osteoarthritis Outcome Score ( KOOS ) , the Lysholm score , assessing pain during kneeling , and anterior knee pain . RESULTS The KT1000 postoperative arthrometer side-to-side difference was 2.0 ± 1.2 mm for the quadriceps group and 3.0 ± 2.9 mm for the semitendinosus-gracilis group . The difference was not statistically significant ( P = .461 ) . There was also no difference in the rate of positive pivot-shift tests between groups ( P = .661 ) . The Lysholm score was 82.5 ± 18 in the quadriceps group and 73.8 ± 19 in the semitendinosus-gracilis group . The difference was not statistically significant ( P = .060 ) . There was also no significant difference in the single KOOS subscores , assessing pain while kneeling and anterior knee pain ( included in the KOOS score ) . No rerupture occurred during follow-up . CONCLUSIONS Revision ACL reconstruction using the quadriceps tendon graft showed clinical outcomes similar to those of the contralateral semitendinosus-gracilis graft in terms of knee stability and function . Thus , the bone-quadriceps tendon graft may be a good alternative to the contralateral semitendinosus-gracilis tendon graft for revision ACL reconstruction . LEVEL OF EVIDENCE Level II , prospect i ve comparative study ACL reconstruction with bone patellar tendon bone ( BPTB ) grafts has been shown to produce dependable results . Recently , reconstructions with double-looped semitendinosus gracilis ( DLSG ) grafts have become common . The prevailing opinion is that ACL reconstruction with patellar tendon graft produces a more stable knee with more anterior knee pain than DLSG grafts , while the functional results and knee scores are similar . The present study evaluates BPTB grafts fixed with metallic interference screws and DLSG grafts fixed with Bone Mulch Screw on the femur and WasherLoc fixation on the tibia . All else being the same , there is no difference in the outcome between the two grafts and fixation methods . This is a prospect i ve r and omized multicenter study . A total of 115 patients with isolated ACL ruptures were r and omized to either  reconstruction with BPTB grafts fixed with metal interference screws ( 58 patients ) or DLSG grafts ( 57 patients ) fixed with Bone Mulch Screws and WasherLoc Screws . Follow-up was at one and two years ; the latter by an independent observer . At two years , one ACL revision had been performed in each group . Eight patients in the DLSG group and one in the BPTB group underwent meniscus surgery in the follow-up period ( P = 0.014 ) . Mean Lysholm score at the two year follow-up was 91 ( SD ± 10.3 ) in the DLSG group and also 91 ( SD ± 10.2 ) in the BPTB group . Mean KT-1000 at two years was 1.5 mm in the BPTB group and 1.8 mm in the DLSG group ( n.s . ) . At two years , four patients in the BPTB group and three in the DLSG group had a Lachman test grade 2 or 3 ( n.s . ) . More patients in the BPTB group had pain at the lower pole of the patella ( P = 0.04 ) . Peak flexion torque and total flexion work were lower in the DLSG group at one year ( P = 0.003 and P = 0.000 ) and total flexion work also at two years ( P = 0.05 ) . BPTB ACL reconstruction fixed with interference screws and DLSG fixed with Bone Mulch Screws on the femur and WasherLoc Screws on the tibia produce satisfactory and nearly identical outcomes . Among our patients in the DLSG group , flexion strength was lower , and more patients underwent meniscus surgery in the follow-up period . The BPTB group has more anterior knee pain Purpose Graft choice for anterior cruciate ligament ( ACL ) reconstruction is crucial , however the optimal graft source remains a topic of controversy . The purpose of this study is to compare subjective and functional patient-reported outcomes ( PRO ) after single-bundle ACL reconstruction using quadriceps tendon ( QT ) or hamstring tendon ( HT ) autografts for single-bundle ACL reconstruction . We hypothesize that there is no difference in patient-reported functional outcomes after ACL reconstruction using either HT- or QT autograft . Methods All data were extracted from a prospect ively collected ACL registry . A total of 80 patients with at least 2-year follow-up were included in this study . A total of 40 patients with primary ACL reconstruction using a QT autograft harvested via a minimally invasive technique were matched by sex , age and pre-injury Tegner and Lysholm score to 40 patients who received HT autografts .  Subjective and functional PRO scores including Lysholm score , Tegner activity level and visual analogue scale for pain were obtained at 6 , 12 and 24 months after index surgery . Results No significant difference between the QT and the HT group was seen at any follow-up in regard to any of the PRO scores for function or pain . 24 months post-surgery the mean Tegner activity score of the HT group was significantly ( p = 0.04 ) lower compared to the pre-injury status . At final follow-up , 27 patients ( 67.5 % ) in the QT group and 32 patients ( 80.0 % ) in the HT returned to their pre-injury activity level ( n.s . ) . A total of 37 patients ( 92.5 % ) of the QT cohort and 35 patients ( 87.5 % ) of the HT cohort reported “ good ” or “ excellent ” results according to the Lysholm score ( n.s . ) . “ No pain ” or “ slight pain ” during severe exertion was reported by 33 patients ( 82.5 % ) with QT autograft and 28 patients ( 82.4 % ) with HT autograft ( n.s . ) . Conclusion There is no significant difference between PRO 2 years post-operative using either QT or HT autografts . Both QT and HT grafts show acceptable and comparable PRO scores making the QT a reliable graft alternative to HT for primary ACL reconstruction . Level of evidence III BACKGROUND The comparison between HT and QT grafts in strength recovery and function  after an ACLR is scarce in the literature . METHODS A total of 56 participants were enrolled in this r and omized controlled trial and placed into two groups : HT or QT .  The hamstring/quadriceps ( H/Q ) ratio was the primary end-point measured with a Genu-3 dynamometer . Peak torque , functional assessment ( Lysholm knee scoring scale and Cincinnati Knee Rating System ) , and anteroposterior laxity ( KT-2000 ™ arthrometer ) were also assessed . An intention-to-treat analysis was performed . RESULTS The results of the H/Q ratio analysis of the participants over time revealed significant differences at 60 , 180 , and 300 ° /s at three , six , and 12months of follow-up ( 60 ° /s : F=5.3 , p=0.005 ; 180 ° /s : F=5.5 , p=0.004 ; 300 ° /s : F=5.1 , p=0.005 ) . Furthermore , they revealed significant differences at 60 ° /s , 180 ° /s , and 300 ° /s in the participants over time for peak torque in the extensor muscle strength at three and six months of follow-up , with higher values in the hamstring tendon group but not at 12months of follow-up . There were no significant differences in functional endpoints or arthrometer assessment s at 24months of follow-up . CONCLUSION An ACLR with a QT graft showed similar functional results with a better isokinetic H/Q ratio compared to an ACLR with the HT at 12months of follow-up in soccer players . This higher H/Q ratio observed with the QT could be an advantage of this graft over the HT for an ACLR Objective : To compare 3 anatomically positioned autografts for anterior cruciate ligament ( ACL ) reconstruction , by measuring patient-reported disease-specific quality of life at 2 years postoperatively . Design : Double-blinded , r and omized clinical trial with intraoperative computer-generated treatment allocation . Patients and an independent trained evaluator were blinded . Setting : University-based orthopedic referral practice . Patients : Three hundred thirty patients ( 14 - 50 years ; 183 male patients ) with isolated ACL deficiency were equally r and omized to : ( 1 ) patellar tendon , PT : 28.7 years ( SD = 9.7 ) ; ( 2 ) quadruple-str and ed hamstring tendon , HT : 28.5 years ( SD = 9.9 ) ; and ( 3 ) double bundle using HT , DB : 28.3 years ( SD = 9.8 ) ; 322 patients completed 2-year follow-up . Intervention : Anterior cruciate ligament reconstruction using PT , HT , or DB autografts . Main Outcome Measures : Measured at baseline , 1 and 2 years postoperatively— primary : anterior cruciate ligament quality -of-life scores ; secondary : International Knee Documentation Committee ( IKDC ) scores , KT-1000 arthrometer , pivot shift , range of motion , Tegner activity , Cincinnati Occupational Scale , and single-leg hop . Proportions of correct graft type guesses by the patients and evaluator assessed blinding effectiveness . Results : Baseline characteristics were not different . Anterior cruciate ligament quality -of-life scores increased over time for all groups ( P = 0.001 ) but were not different at 2 years ( P = 0.591 ) : PT = 84.6 ( SD = 16.6 , 95 % confidence interval [ CI ] = 81.4 - 87.8 ) , HT = 82.5 ( SD = 17.7 , 95 % CI = 79.2 - 85.9 ) , and DB = 82.4 ( SD = 17.5 , 95 % CI = 79.1 - 85.7 ) . Two-year KT-1000 side-to-side differences ( PT = 1.86 mm ; HT = 2.97 mm ; DB = 2.65 mm ) were statistically significant between PT – HT ( P = 0.002 ) and PT – DB ( P = 0.044 ) . The remaining secondary outcomes were not statistically different . Correct graft type guesses occurred 51 % of the time for patients and 46 % for the evaluator . Conclusions : Two-year disease-specific quality -of-life outcome was not different between the ACL reconstruction techniques . The PT reconstructions had significantly lower side-to-side differences on static stability measures . Patient and evaluator blinding was achieved . Level of Evidence : Level 1 ( Therapeutic Studies ) . Clinical Relevance : This high- quality , large , double-blind r and omized clinical trial ( RCT ) addresses the insufficient evidence in the literature comparing PT , single-bundle hamstring , and DB hamstring reconstructions for ACL rupture in adults . In addition to the clinical and functional results , this RCT uniquely reports on the disease-specific , patient-reported quality -of-life outcome at 2 years postoperatively BACKGROUND The aim of the study was to compare the results after arthroscopic anterior cruciate ligament ( ACL ) reconstruction  using central -third bone-patellar tendon-bone ( BTB ) autografts and triple/quadruple semitendinosus ( ST ) autografts . HYPOTHESIS In the long-term , ACL reconstruction using BTB autografts will render more donor-site problems than ST autografts . STUDY DESIGN R and omized controlled trial ; Level of evidence , 1 . METHODS A r and omized series of 71 patients ( 22 women and 49 men ) with a unilateral ACL rupture who underwent reconstructive surgery were included in the study . The BTB graft was used in 34 patients ( BTB group ) and the ST-tendon graft was used in 37 patients ( ST group ) . The patients were examined a median of 86 months ( range , 68 to 114 months ) after the reconstruction . RESULTS Sixty-eight of 71 patients ( 96 % ) were examined at follow-up . The clinical assessment s at follow-up revealed no significant differences between the BTB group and the ST group in terms of the Lysholm score , Tegner activity level , International Knee Documentation Committee evaluation system , 1-legged hop test , KT-1000 arthrometer laxity measurements , manual Lachman test , and range of motion . A significant improvement was seen in both groups compared with the preoperative values in terms of most clinical assessment s. Donor-site morbidity in the form of knee-walking ability , kneeling ability , and area of disturbed anterior knee sensitivity revealed no significant differences between the groups . CONCLUSION Seven years after ACL reconstruction , the subjective and objective outcomes were similar after using the central -third BTB autograft and triple/quadruple ST autograft . Furthermore , no difference in terms of donor-site morbidity was found between the 2 groups PURPOSE OF THE STUDY The aim of this prospect i ve 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 ( semi-tendinosus 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 aKT-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 prospect i ve study comparing the outcomes of the methods reported here has been found in the internatio- nal 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 BACKGROUND The choice of graft for anterior cruciate ligament reconstruction is a matter of debate , with patellar and hamstring tendons being the two most popular autologous graft options . The objective of this study was to determine in a prospect i ve , r and omized clinical trial whether two grafts ( bone-patellar tendon-bone or doubled hamstring tendons ) fixed with modern devices affect the two-year minimum clinical and radiographic outcomes of anterior cruciate ligament reconstruction . METHODS One hundred and twenty patients with a chronic unilateral rupture of the anterior cruciate ligament underwent arthroscopically assisted reconstruction with use of either autologous bone-patellar tendon-bone or doubled hamstring tendon grafts  , in a strictly alternating manner . Both groups were comparable with regard to demographic data , preoperative activity level , mechanism of injury , interval between the injury and the operation , and the amount of knee laxity present preoperatively . The same well-proven surgical technique and aggressive controlled rehabilitation was used . An independent observer , who was blinded with regard to the involved leg and the type of graft , performed the outcome assessment with use of a visual analog scale , the new International Knee Documentation Committee form , the Knee Injury and Osteoarthritis Outcome Score , the Functional Knee Score for Anterior Knee Pain , and an arthrometric and an isokinetic dynamometric evaluation . Radiographs were also made . RESULTS At the two-year follow-up evaluation , no differences were found in terms of the visual analog score , the Knee Injury and Osteoarthritis Outcome Score , the new International Knee Documentation Committee subjective and objective evaluation scores , the KT-1000 side-to-side laxity measurements , the Functional Knee Score for Anterior Knee Pain , muscle strength recovery , or return to sports activities . In the bone-patellar tendon-bone group , we found a higher prevalence of postoperative kneeling discomfort ( p < 0.01 ) and an increased area of decreased skin sensitivity ( p < 0.001 ) . In the hamstring tendon group , we recorded a higher prevalence of femoral tunnel widening ( p < 0.01 ) . In this group , a correlation was also found between medial meniscectomy and an increased prevalence of pivot-shift glide ( p = 0.035 ) . CONCLUSIONS We believe that , with use of accurate and proven surgical and rehabilitation techniques , both grafts are an equivalent option for anterior cruciate ligament reconstruction Purpose The purpose of this article was to demonstrate an  anterior cruciate ligament ( ACL ) reconstruction technique using oval tunnels . Aim of this single bundle technique is to fit the footprint anatomy of the ACL as closely as possible . Technique and patients The presented technique is a single bundle technique using a semitendinosus graft . For femoral tunnel placement , a specific medial portal aim er ( Karl Storz , Tuttlingen , Germany ) is used . Aim ing and drilling of the femoral tunnel are performed via the medial portal . Oval tunnels are created by stepwise dilatation with ovally shaped dilatators . The position of the femoral tunnel is visualized and controlled with the arthroscope via the medial portal . For the tibial tunnel placement , a specific aim er was used as well . With this technique , 24 patients were operated and all intra- and postoperative complications were analyzed prospect ively . The tunnel position was documented postoperatively by CT scan . Results There were no significant intra- and postoperative complications associated with the oval tunnel technique . The postoperative 3D CT scan revealed that all femoral and tibial tunnels were located within the area of the anatomical ACL insertions . Conclusions This article presents an ACL reconstruction technique using oval dilatators and medial portal aim ers to create oval tunnels . These oval tunnels match the insertion site anatomy much closer than round tunnels do . Level of Evidence Level IV , case series Background : The quadriceps tendon ( QT ) autograft is known as an effective graft for anterior cruciate ligament ( ACL ) reconstruction and shows a similar functional outcome to the bone-patellar tendon-bone ( BPTB ) in r and omized controlled trials , with a lesser incidence of complications . Up until now , only 2 studies have compared QT to hamstring tendon ( HT ) autograft . Hypothesis : The functional outcomes of the QT technique are at least as good as those of the HT technique , with the same morbidity . Study Design : Cohort study ; Level of evidence , 3 . Methods : Ninety-five patients underwent isolated ACL reconstruction between January 1 and December 31 , 2012 . Fifty underwent ACL reconstruction with the QT and 45 with the HT .  The same surgical technique , fixation method , and postoperative protocol were used in both groups . The following parameters were evaluated : surgical revisions , functional outcome ( Lysholm , Knee injury and Osteoarthritis Outcome Score [ KOOS ] , Tegner , subjective International Knee Documentation Committee ) , joint stability ( KT-1000 , Lachman , pivot shift ) , anterior knee pain ( Shelbourne-Trumper score ) , and isokinetic strength . Descriptive statistics are presented for these variables using the Student t test . Results : Eighty-six patients ( 45 QT , 41 HT ) were review ed with a mean follow-up of 3.6 ± 0.4 years ; minimum follow-up was 3 years . There were 4 reoperations in the QT group ( including 1 ACL revision ) and 3 in the HT group ( including 2 ACL revisions ) ( P > .05 ) . The Lysholm ( 89 ± 6.9 vs 83.1 ± 5.3 ) , KOOS Symptoms ( 90 ± 11.2 vs 81 ± 10.3 ) , and KOOS Sport ( 82 ± 11.3 vs 67 ± 12.4 ) scores were significantly better in the QT group than in the HT group . In terms of stability , the mean side-to-side difference was 1.1 ± 0.9 mm for the QT group and 3.1 ± 1.3 mm for the HT group based on KT-1000 measurements ( P < .005 ) . The negative Lachman component was higher in the QT group than in the HT group ( 90 % vs 46 % , P < .005 ) . There was a trend for the negative pivot-shift component to be higher in the QT group than in the HT group ( 90 % vs 64 % , P = .052 ) . The Shelbourne-Trumper score was the same in both groups . There was no difference between groups in terms of isokinetic strength . Conclusion : The use of a QT graft in ACL reconstruction leads to equal or better functional outcomes than does the use of an HT graft , without affecting morbidity PURPOSE To analyze the long-term evaluation of clinical , functional , and magnetic resonance imaging ( MRI ) results after implant-free press-fit anterior cruciate ligament ( ACL ) reconstruction with bone-patella tendon ( BPT ) versus quadrupled hamstring tendon ( HT ) grafts . METHODS Sixty-two ACL-insufficient patients were included in a prospect i ve , r and omized study ( 31 BPT and 31 HT ) . Both surgical procedures were performed without any implants by a press-fit technique by the senior author . The femoral tunnel was drilled through the anteromedial portal for anatomic placement . At 8.8 years after reconstruction , 53 patients ( 28 BPT and 25 HT ) were examined by different clinical and functional tests . Bilateral MRI scans were performed and interpreted by an independent radiologist . RESULTS On follow-up , the score on the International Knee Documentation Committee evaluation form was significantly better in the HT group . The clinical examination including range of motion , KT-1000 test ( MEDmetric , San Diego , CA ) , and pivot-shift test showed no significant differences . On isokinetic testing , the mean quadriceps strength was close to normal ( 96 % ) in both groups , but the hamstring strength was lower in the HT group ( 100.3%/95.1 % ) . Kneeling ( 1.5/1.1 , P = .002 ) , knee walking ( 1.72/1.14 , P = .002 ) , and single-leg hop test ( 95.8%/99.1 % , P = .057 ) were better in the HT group . The MRI findings about the mean degree of cartilage lesion ( International Cartilage Repair Society protocol ) of the operated ( 2.1/2.1 ) and nonoperated ( 1.4/1.8 ) knee showed no significant differences . No significant difference was found in the grade of medial or lateral meniscal lesion or the number of patients having meniscal lesions when the operated and nonoperated knees were compared . Tunnel measurements , Caton-Deschamps Index , and the sagittal ACL angle were similar . CONCLUSIONS The implant-free press-fit technique for anterior cruciate ligament reconstruction by use of bone-patellar tendon and hamstring grafts with anatomic graft placement is an innovative technique to preserve the cartilage and meniscal status without significant differences between the operated and nonoperated knees in the long term . Significantly less anterior knee pain was noted in the hamstring group , when testing for kneeling and  knee walking  . LEVEL OF EVIDENCE Level II , prospect i ve comparative study Background Patellar and hamstring tendon autografts are the most frequently used graft types for anterior cruciate ligament reconstruction , but few direct comparisons of outcomes have been published . Hypothesis There is no difference in outcome between the two types of reconstruction . Study Design Prospect i ve r and omized clinical trial . Methods After isolated anterior cruciate ligament rupture , 65 patients were r and omized to receive either a patellar tendon or a four-str and hamstring tendon graft reconstruction  , and results were review ed at 4 , 8 , 12 , 24 , and 36 months . Results Pain on kneeling was more common and extension deficits were greater in the patellar tendon group . There were greater quadriceps peak torque deficits in the patellar tendon group at 4 and 8 months but not thereafter . In the hamstring tendon group , active flexion deficits were greater from 8 to 24 months , and KT-1000 arthrometer side-to-side differences in anterior knee laxity at 134 N were greater . Cincinnati knee scores , International Knee Documentation Committee ratings , and rates of return to preinjury activity levels were not significantly different between the two groups . Conclusions Both grafts result ed in satisfactory functional outcomes but with increased morbidity in the patellar tendon group and increased knee laxity and radiographic femoral tunnel widening in the hamstring tendon group PURPOSE The purpose of this r and omized controlled study was to compare knee stability , kneeling pain , harvest site pain , sensitivity loss , and subjective clinical outcome after primary anterior cruciate ligament ( ACL ) reconstruction with either bone-patellar tendon-bone ( BPTB ) or quadriceps tendon-bone ( QTB ) autografts  in a noninferiority study design . METHODS From 2005 to 2009 , a total of 51 patients were included in the present study . Inclusion criteria were isolated ACL injuries in adults . Twenty-five patients were r and omized to BPTB grafts and 26 to QTB grafts .  An independent examiner performed follow-up evaluations 1 and 2 years postoperatively . Anteroposterior knee laxity was measured with a KT-1000 arthrometer ( MEDmetric , San Diego , CA ) . Anterior knee pain was assessed clinical ly and by knee-walking ability . Knee Injury and Osteoarthritis Outcome Score ( KOOS ) and subjective International Knee Documentation Committee ( IKDC ) score were used for patient-evaluated outcome . RESULTS Anterior knee laxity was equal between the 2 groups with KT-1000 values of 1.1 ± 1.4 mm and 0.8 ± 1.7 mm st and ard deviation ( SD ) at follow-up in QTB and BPTB groups , respectively ( P = .65 ) , whereas positive pivot shift test results were seen less frequently ( 14 % compared with 38 % , respectively ; P = .03 ) . Anterior kneeling pain , evaluated by the knee walking ability test , was significantly less in the QTB group , with only 7 % of patients grading knee walking as difficult or impossible compared with 34 % in the BPTB group . At 1 and 2 years ' follow-up , there was no difference between the 2 groups in subjective patient-evaluated outcome . The IKDC score was 75 ± 13 patients and 76 ± 16 SD at 1-year follow-up in QTB and BPTB groups , respectively ( P = .78 ) . At 2 years , 12 patients were lost to follow-up , result ing in 18 in the BPTB group and 21 in the QTB group . CONCLUSIONS The use of the QTB graft results in less kneeling pain , graft site pain , and sensitivity loss than seen with BPTB grafts ; however , similar anterior knee stability and subjective outcomes are seen . The results of this study show that QTB is a viable option for ACL reconstruction . LEVEL OF EVIDENCE Level II , r and omized controlled clinical trial OBJECTIVE To evaluate whether increased laxity of the knee during daily physical activities such as stair climbing is associated with progression of knee joint osteoarthritis ( OA ) . METHODS During the years 2001 - 2003 , 136 patients with bilateral primary medial compartment knee joint OA were enrolled in this prospect i ve study . Baseline data collected were body mass index ( BMI ) , muscle power , radiographic joint space width , mechanical axis on st and ing radiography , and anteroposterior ( AP ) knee laxity before and after physical exercise . After 8 years of followup , 84 patients were reexamined to assess radiographic changes . Radiographic disease progression was defined as progression of > 1 grade on the Kellgren/Lawrence scale . RESULTS AP knee laxity increased significantly after stair climbing . Patients with OA progression and those without progression did not differ significantly in age , sex , baseline quadriceps muscle strength , mechanical axis , joint space width , and AP knee laxity before exercise . The 2 groups of patients did , however , differ significantly in baseline BMI and change in AP knee laxity due to exercise . The risk of progression of knee OA increased 4.15-fold with each millimeter of increase in the change in AP knee laxity due to exercise and 1.24-fold with each point increase in the BMI . CONCLUSION Our results indicate that patients with OA progression have significantly greater changes in knee joint laxity during physical activities and a higher BMI than patients without OA progression . These findings suggest that larger changes in knee laxity during repetitive physical activities and a higher BMI play significant roles in the progression of knee OA Background Controversy remains over the most appropriate graft for anterior cruciate ligament reconstruction . Hypothesis There is no significant difference in outcomes after 4-str and hamstring and patellar tendon autograft anterior cruciate ligament reconstructions using similar fixation techniques . Study Design R and omized controlled trial ; Level of evidence , 1 . Methods Between August 2000 and May 2003 , 64 Keller Army Hospital patients with complete anterior cruciate ligament tears were r and omized to hamstring ( n = 32 ) or patellar tendon ( n = 32 ) autograft anterior cruciate ligament reconstruction .  Operative graft fixation and rehabilitative techniques were the same for both groups . Follow-up assessment s included the Single Assessment Numeric Evaluation score , Lysholm score , International Knee Documentation Committee score , and Knee Injury and Osteoarthritis Outcome Score . Postoperative radiographs were analyzed for tunnel location and orientation . Results Eleven women and 53 men were r and omized . Eighty-three percent of the patients ( 53 of 64 ) had follow-up of greater than 2 years , or to the point of graft rupture or removal ( average follow-up , 36 months ) . Four hamstring grafts ( 12.5 % ) and three patellar tendon grafts ( 9.4 % ) ( P = .71 ) ruptured . One deep infection in a hamstring graft patient necessitated graft removal . Forty-five of the 56 patients with intact grafts had greater than 2-year follow-up . Patients with patellar tendon grafts had greater Tegner activity scores ( P = .04 ) . Single Assessment Numeric Evaluation scores were 88.5 ( 95 % confidence interval : 83.1 , 93.8 ) and 90.1 ( 95 % confidence interval : 85.2 , 96.1 ) for the hamstring and patellar tendon groups , respectively ( P = .53 ) . Lysholm scores were 90.3 ( 95 % confidence interval : 84.4 , 96.1 ) and 90.4 ( 95 % confidence interval : 84.5 , 96.3 ) for the hamstring and patellar tendon groups , respectively ( P = .97 ) . There were no significant differences in knee laxity , kneeling pain , isokinetic peak torque , International Knee Documentation Committee score , or Knee Injury and Osteoarthritis Outcome Scores . Postoperative graft rupture correlated with more horizontal tibial tunnel orientation . Conclusion Hamstring and patellar tendon autografts provide similar objective , subjective , and functional outcomes when assessed at least 2 years after anterior cruciate ligament reconstruction
target: The QT autograft detected comparable rate of Lachman test > 3 mm , Pivot shift test > 3 m and instrumental laxity > 3 mm .
  The QT autograft showed a lower rate of autograft failure above all .
  The QT autograft detected the reduced rate of AKP than the PT .
  Quadriceps tendon autograft may represent a feasible option for primary ACL reconstruction .
background: The purpose of the current study was to clarify the role of the quadriceps tendon ( QT ) autograft for primary ACL reconstruction .
  Thus , a Bayesian network meta- analysis comparing patients undergoing a primary ACL reconstruction with QT versus patellar tendon ( PT ) and hamstring tendon ( HT ) autografts  was conducted .