Summary
No differences in outcome but possibly gender differences in injury pattern when hamstring grafts are harvested from the contralateral leg
Abstract
Background
In an earlier randomized control trial (RCT), 140 patients were randomized to anterior cruciate ligament reconstruction (ACLR) with semitendinosus graft from either the injured or non-injured leg. This study compared differences between the groups in anterior cruciate ligament (ACL) rupture in the non-injured knee, or graft rupture in the operated knee, at six to eight year follow up.
Methods
All patients were asked about ipsilateral graft rupture or contralateral ACL rupture. They were asked to complete IKDC, tegner score, a follow up biodex measurement of hamstring strength and bilateral weight baring knee x-ray. A statistical analysis using SPSS was performed to identify differences between groups.
Results
Of the original 140 patients, 96 (69%) answered questions regarding subsequent graft or ACL rupture (n 48 from both groups), with 80 completing the full survey. The rate of graft rupture was not significantly different between groups (p = .404). More contralateral ACL rupture was seen in the contralateral graft group, with 7 ruptures compared to 4 in the ipsilateral group, though this was not statistically significant (p =0.082). Interestingly, 25% (4/16) of the females undergoing contralateral graft harvest had subsequently injured the contralateral ACL, compared to 7.4% (2/27) in the ipsilateral harvest group (p=0.10). This trend was not observed comparing males between groups (p=.38). No significant differences in activity level or IKDC scores were identified.
Conclusion
No statistically significant differences could be seen between groups, though a trend towards higher contralateral ACL rupture was noted in the contralateral graft group, particularly amongst females, when comparing ipsilateral vs contralateral graft harvest. No significant differences in secondary outcome measure were identified. The small sample size is a weakness of this study, increasing the risk of type 2 error.