Date of Graduation

Summer 8-9-2014

Degree Type

Capstone Project

Degree Name

Master of Science in Physician Assistant Studies

Abstract

Background: Anterior cruciate ligament (ACL) injuries are common but devastating injuries. After ACL reconstruction there is an elevated risk of rupture to the contralateral ACL, and this risk may be increased over time with patellar tendon autografts. Does risk of rupture increase for the contralateral ACL 11 years or more after ACL reconstruction when using a patellar tendon versus a hamstring tendon autograft?

Methods: An exhaustive search of available medical literature was conducted using Medline-OVID, PubMed, and CINAHL using the keywords: anterior cruciate ligament, contralateral, rupture, and long term. Results were limited to human studies. Relevant article were assessed for quality using the GRADE criteria.

Results: Two studies met inclusion and exclusion criteria for this systematic review. One randomized controlled trial enrolled 64 patients who underwent arthroscopic anterior cruciate ligament reconstruction with either a hamstring tendon (HT) autograft or patellar tendon (PT) autograft and were followed for 11 years. After 11 years of follow-up, there were 6% (n=2) of patients with HT autograft ruptures and 12% (n=4) with PT graft ruptures. A cohort study of 180 patients underwent arthroscopic anterior cruciate ligament reconstruction with either a HT or PT autograft; they were followed for 15 years. After 15 years, patients receiving PT autografts (26% (n=23)) experienced twice as many contralateral ACL ruptures compared to those with HT autografts (12% (n=11)).

Conclusion: Hamstring tendon autografts appear to be superior to patellar tendon autografts with a reduced risk of contralateral anterior cruciate ligament rupture 11 or more years after ACL reconstruction.

Keywords: Anterior cruciate ligament, contralateral, 11 years, rupture, humans

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