ACL (anterior cruciate ligament) injuries are very common among athletes and non-athletes alike, but sports like basketball tend to have a very high incidence rate of ACL tears. Jumping and twisting both put unnatural strain on the knee ligaments, and if a basketball player lands incorrectly, he/she can be out for the season and will be faced with a series of complicated decisions. Some ACL tears do not require surgery, but in order to return to athletics, it is usually necessary to surgically reconstruct the ACL. ACL reconstruction surgery is done using one of three types of grafts to replace the torn ligament: a piece of the patient’s patellar tendon, a piece of the patient’s hamstring tendon, or an allograft (usually a cadaveric Achilles tendon). Autografts have become the go-to surgical option for numerous reasons, but there has been a longstanding discrepancy between the use of patellar and hamstring autografts.
In August of 2009, The American Journal of Sports Medicine published a meta-analysis on individual patient data entitled “Patellar Tendon Versus Hamstring Tendon Autografts for Reconstructing the Anterior Cruciate Ligament”. This study looked at data from 6 previously published clinical trials and used two different knee stability tests to analyze the effectiveness of both grafts. Dr. Blau et al used the positive pivot-shift test to characterize knee instability and the positive Lachman test for instability on a post-ACL reconstruction knee. The bone-patellar-tendon bone autograft had significantly fewer positive pivot-shift tests, even when adjusted for age and gender. Because there are so many factors contributing to how individual knees recover and perform, some surgical options work better for some, but this study determined that, despite differences, pattelar tendon autografts are superior to hamstring grafts.
Orthopedic surgeons advise their patients based on a variety of factors, but as research on graft superiority becomes more definitive, the reconstruction procedure should become more standardized. For athletes like basketball players in which these injuries are so common and for whom stability plays an important role in their sport, bone-patellar-bone tendon autografts may be the answer for ACL reconstruction.
http://ajs.sagepub.com/content/early/2009/08/18/0363546509333006.long
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