Patellar tendon or semitendinosus tendon autografts for anterior cruciate ligament reconstruction? A prospective randomized study with a two-year follow-up

Background: There are well-known problems with the use of bone-patellar tendon-bone autografts for anterior cruciate ligament reconstruction, especially in terms of donor site morbidity. Hamstring tendon grafts have been increasingly used as an alternative, but there are very few controlled studies comparing the methods. Hypothesis: Use of semitendinosus tendon grafts will cause less donor site morbidity and result in better knee-walking ability. Study Design: Prospective randomized clinical trial. Methods: Seventy-one patients who had a unilateral anterior cruciate ligament rupture underwent arthroscopic reconstruction with interference screw fixation and use of either bone-patellar tendon-bone or semitendinosus tendon graft. Outcome assessment was performed by physiotherapists not involved in the patients' care. Results: At the 2-year follow-up, no differences were found in terms of the Lysholm score, Tegner activity level, KT-1000 arthrometer side-to-side laxity measurement, single-legged hop test, or International Knee Documentation Committee classification results. The knee-walking test was rated difficult or impossible to perform by 53% of the bone-patellar tendon-bone group and by only 23% of the semitendinosus graft patients, a significant difference. Conclusions: The semitendinosus tendon graft is at least an equivalent option to the bone-patellar tendon-bone graft for anterior cruciate ligament reconstruction, and we recommend its use. (C) 2003 American Orthopaedic Society for Sports Medicine.