Clinical Comparison between Six-Strand Hamstring Tendon and Patellar Tendon Autograft in Arthroscopic Anterior Cruciate Ligament Reconstruction: A Prospective, Randomized Clinical Trial
Artit Laoruengthana MD*, Somsak Pattayakorn MD*, Thanainit Chotanaputhi MD*, Arkaphat Kosiyatrakul MD*
Affiliation : * Department of Orthopaedics, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
Objective : Many randomized clinical trials demonstrated that 4-strand hamstring tendon grafts have
comparable results both subjectively and objectively with the patellar tendon grafts. The authors
hypothesized that the increment of hamstring tendons strength with 6-strand graft could improve the knee
stability compared to the result from using the gold standard patellar tendon.
Material and Method: Thirty-four patients were prospectively randomized into two groups for arthroscopic
anterior cruciate ligament reconstruction. Seventeen patients underwent reconstruction with 6-strand
hamstring tendons and the remaining seventeen were treated with bone-patellar tendon-bone graft. Patients
were followed-up under the similar rehabilitation protocol for at least 12 months. At the time of final
follow-up, all the patients in both groups were evaluated in terms of patient’s satisfaction, activity level, and
knee stability.
Results : Fifteen patients in bone-patellar tendon-bone graft (two lost to follow-up) and thirteen patients used
6-strand hamstring tendons(four were converted to 4-strand hamstring tendons) were evaluated at a mean of
19 months (range 12-31 months). The mean of KT-2000 side-to-side laxity measurement in 6-strand hamstring
group (0.96 mm) is less than BPTB group (1.22 mm) significantly (p < 0.05). Eleven of 13 patients (84.62%)
that received the 6-strand hamstring tendons could return to sport activities compared to 10 of 15 patients
(66.67%) that received BPTB graft. Hamstring group have a lower prevalence of donor-site morbidity resulting
in less difficult in kneeling.
Conclusion : The authors concluded that using 6-strand hamstring tendons could improve knee stability in the
early clinical outcomes. With no difference in subjective assessment, anterior cruciate ligament reconstruction
used hamstring tendons have less donor-site morbidity, which is more compatible to Asian life-style.
Keywords : Anterior cruciate ligament, Bone-patellar tendon-bone graft, Patellar ligament, Reconstructive surgical procedures, Tendon transfer, Transplantation autologous
