Long-term clinical and radiographic results of acl reconstruction. Retrospective comparison between three techniques (hamstrings autograft, hamstrings autograft with extra-articular reconstruction, bone patellar tendon autograft)

Background. There is no consensus in the current literature on which surgical options render the best long-term results after ACL reconstruction in terms of clinical outcomes and development of radiographic osteoarthritis (AO). The aim of this study is to investigate clinical and radiological results at long-term follow up after ACL reconstruction using hamstring tendons autograft (Group HT), hamstrings autograft with extra-articular reconstruction (Group HT-ER), and bone patellar tendon bone autograft (Group BPTB). Methods. All patients were evaluated at final follow-up using Lysholm, Internation- al Knee Documentation Committee (IKDC), and Tegner scores. An arthrometric KT-1000 evaluation was also done. Comparative weight bearing radiographs were taken, including a skyline view for patellofemoral joint and analyzed according to Fair- bank, Kellgren, and IKDC classification. Sixty patients were selected for this retrospective study, 20 for each group. The mini- mum final follow-up was 10 years for each group. All patients were male and involved in sport activities (Tegner pre-injury >7). Results. Subjective scores improved significantly in all groups, with no significative differences between groups (P<0,05). The number of patients classified as C or D at the IKDC objective activity score was higher in Group HT (2/20, 10%), than in Group BTB (1/20, 5%) and Group HT-E (0/20, 0%). In term of failure-rate, there were no difference between the three groups (P<0,05). Radiologic evaluation shoved more arthritic changes in Group-BT in the patello-fem- oral joint (PMJ). Conclusions. All the three techniques showed satisfactory results at long term follow up with no differences in term of subjective scores. Finally, there was a statistically significant higher incidence of arthritic changes in PFJ as evaluated with x-ray in the BPTP group respect to HT and HT + ER groups (p<0.05).