Anterior Cruciate Ligament reconstruction, hamstring versus bone–patella tendon–bone grafts: a systematic literature review of outcome from surgery Lee Herrington * , Charlotte Wrapson, Martyn Matthews, Helen Matthews School of Health Care Professionals, University of Salford, Allerton Annexe, Frederick Road, Salford, Greater Manchester M6 6PU, UK Received 28 September 2003; received in revised form 5 February 2004; accepted 25 February 2004 Abstract The Anterior Cruciate Ligament (ACL) is regarded as critical to the normal functioning of the knee, its disruption causing functional impairment. In recent years central third of the patellar tendon (PT) and combined Semitendinosis and gracilis tendons (HT) have become the most frequently used graft types for anterior cruciate knee ligament reconstruction. For the past two decades, the gold standard in ACL reconstructions has been the PT, but increasingly the HT graft has been used. This shift in popularity has occurred for several reasons, including concerns about damaging the knee extensor apparatus using the PT procedure, but potential complications also exist with HT techniques. Despite the vast amount of literature on ACL reconstruction and its outcome, there are very few controlled randomised studies directly comparing the two most commonly used tissue grafts. This review aimed to examine the data available from randomised trials, in order to combine and evaluate the best available evidence for choice between these two popular tissue grafts for use in ACL reconstruction. A literature search revealed 13 studies, which met the inclusion criteria of the review. The results of the 13 studies included in this review suggest that there is no significant evidence to indicate that one graft is superior. Both the PT and HT grafts appear to improve patients’ performance, and therefore both would be good choices for ACL reconstruction. D 2004 Elsevier B.V. All rights reserved. Keywords: ACL; Outcome; Systematic review 1. Introduction The Anterior Cruciate Ligament (ACL) is regarded as critical to the normal functioning of the knee, its disruption causing functional impairment, meniscal lesions, and the early onset of joint degeneration [1]. Injury of the ACL is now the most common ligamentous injury of the knee and accounts for about 30 injuries per 100,000 of the population [2], with greater than 100,000 new ACL injuries occurring each year [3]. No definitive management strategy exists for patients with this injury, a case particularly evident when deciding between conservative rehabilitation and recon- struction, and between methods of reconstruction [4]. With surgical intervention, several surgical procedures are available including mini-arthrotomy open technique; two-incision arthoscopically assisted techniques, and one incision endoscopic technique [5]. Currently, ACL recon- struction is most often performed using an arthroscopically assisted technique [2]. Both biological and non-biological tissues can be used to provide the donor graft; these include patella tendon, semitendinosus/gracilis tendon, distal ilioti- bial tract, fascia lata and synthetic ligaments [2]. The biological tissue grafts are available either as autografts or allografts. In recent years, central third of the patellar tendon (PT) and combined Semitendinosis and gracilis tendons (HT) have become the most frequently used graft types for anterior cruciate knee ligament reconstruction [6]. For the past two decades, the gold standard in ACL reconstructions has been the patellar tendon graft from the middle third of the patella tendon [7], but increasingly the HT graft has been used. This shift in popularity has occurred for several reasons, including, concerns about damaging the knee extensor apparatus using the patella tendon procedure and the potential for subsequent anterior knee pain, patella fracture, ligament rupture, and infra patella contraction [8]. 0968-0160/$ - see front matter D 2004 Elsevier B.V. All rights reserved. doi:10.1016/j.knee.2004.02.003 * Corresponding author. Tel.: +44-161-295-2326; fax: +44-161-295- 2395. E-mail address: L.C.Herrington@salford.ac.uk (L. Herrington). www.elsevier.com/locate/knee The Knee 12 (2005) 41 – 50