Hamstring (HT) autografts vs Bone-Patellar-Tendon

Anterior cruciate ligament reconstruction :
Comparison of Hamstring Tendon autograf vs Bone Patellar
Tendon Bone autograf : a retrospective cohort study of 111
patients.
Baur C.*, Mathieu N.***, Delamorclaz S.*, Hilfiker R.***, Siegrist O.**, Blatter S**., Fournier S.*
*
Physical and rehabilitation department, Hôpital du Valais, Martigny, Switzerland
** Orthopedic department, Hôpital du Valais , Martigny, Switzerland
*** University of applied Sciences HES SO Valais Sion, Switzerland
Introduction
Introduction
 ACL: the most common complete ligamentous
injuries that occur in the knee joint.
 In Switzerland:
 most patients with ACL injuries




sportsmen & athletes aged about 30 years
Amateur
Recreational
And often professional sports.
Richard DF et al., 2010
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Introduction
 The most commonly used autografts : BPTB
graft and HT graft
Bizzini M. et al., 2006
Fu et al., 2000
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Introduction
BUT ...
 The graft choice for ACL reconstruction
continues to be controversial
Dheerendra SK et al., 2012
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Goals of the reconstruction
 to stabilize the knee
 to allow a safe and powerful return to the
previous level of sports or recreational activity.
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Introduction
 Postoperative rehabilitation plays a crucial role
in returning patients to athletic or demanding
occupational activities.
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Introduction
 It is very important to restore:
 normal muscle strength
 balance
 proprioception
 other neuromuscular indices required for
high-risk activities (cutting, twisting, turning,
jumping and pivoting)
Wilk KE et al., 1994
Barber-Westin SD, 2011
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Introduction
 The orthopaedic surgeons of our institution tend
to prefer (without any strong argument) the HT
autografts.
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Key issue
 Is there a relevant difference in
muscular properties after ACLreconstruction regarding graft choice?
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Literature review
 Extensor muscles :
 No difference in strength for both grafts (BPTB – HT)
 Flexor muscles :
 HT group weaker than BPTB group
Condouret et al., revue chir orth., 2008
 Mean peak flexion torque and extension work :
 No difference between both groups (BPTB – HT)
 Overall flexion work lower in HT group
Gifstad et al., KSSTA, 2013
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LITTERATURE REVIEW : META-ANALYSIS
 HT autografts vs BPTB autografts
- similar postoperative effects in terms of
restoring knee joint function
Li et al., Arch. of Ortho. and Trauma Surg., 2012
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Aim of the study
to assess muscular properties after ACLreconstruction in both techniques with functional
outcomes
(BPTB vs HT grafts)
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Hypothesis
 Power,
 Strength
 Velocity
of HT muscles = less altered
after BPTB-graft than HT-graft
Ageberg E et al., 2009
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Method
Study Design
 Design
 Retrospective cohort study (2007 - 2010)
 Non-randomized
 Data acquisition by 3 physiotherapists and a
surgeon
 Follow-up
 45 months (23.0 - 71.1 months)
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Inclusion’s criteria
 ACL tear operated at “Hôpital du Valais”
 no previous ligamentous injury and/or surgery
of either knee
 no previous meniscal pathology treated with
resection or repair
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Flowchart
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4ceps & HT muscle capacities
 assessed with maximal isotonic contraction
 assessed with an accelerometer (Myotest®)
 Power (W/Kg)
 Strength (Nm/Kg)
 Velocity (m/sec.)
 open - and closed kinetic chain
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Dynamic knee stability
 evaluated with two functional tests
 the single-leg hop (Bosco 1983)
 “the Olympic-test” (n.v. 2012)
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Self-assessed knee function
 reported using :
 Tegner scale
 Lysholm score
 KOS-SAS (Knee Outcome Survey Sports Activities Scale)
 Tampa-scale Q
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Statistical analyses
 Data expressed as means and standard
deviations.
 Samples t-test
 level of significance set at P<0.05.
 Effect size index (Cohen 1992) (t-test):
 0.2 = small effect
 0.5 = moderate effect
 0.8 = large effect
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Results
Descriptive Data
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Objective Outcomes
Isotonic test
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Objective Outcomes
Single-Hop-test (Bosco)
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Objective Outcomes
Dynamic Knee Stability
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RESULTS (n = 111; f/up 45 mts)
13 observations and analyzis – 4 statistically sign. differences
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Subjective Outcomes
Self reported Questionnaire
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RESULTS (n = 111; f/up 45 mts)
5 observations and analyzis – 1 statistically sign. difference
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Discussion
 BPTB group performed better in 14 of the 18
observed outcomes
 6 were statistically and clinically significant
 velocity in 4ceps & HT
 hamstring power-max and mean-power
 functional score (Tegner & KOS-SAS)
 4 outcomes were in favor of HT group but none
was statistically significant.
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Discussion
 Following ACL surgery, a safe return to full activity
and prevention of re-injury require advanced
physical therapy rehabilitation based on the
specific sport or activity with an individualised
program .
Kvist J, 2004
Dheerendra SK. Et al., 2012
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Strenght of the study
 Functional outcomes observed
 Length of the follow-up (mean: 45.4 months).
 Same surgeon in the same hospital
 Same procedure for both types of grafts
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Limits
 Retrospective cohort not randomized with regard to
the surgical interventions.
 Confounding factors with non-measured variables ?
 Power testing of hamstring muscle
 90° flex.
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Conclusion
 Side to side differences
 statistically significant difference in favour of BPTB for
 Hamstring & 4-ceps acceleration
 Hamstring mean-power & power max
 Grafts differences
 statistically significant difference in favour of BPTB for
 Tegner score
 KOS- SAS
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for your attention
Baur C.
Mathieu N.
Delamorclaz S.
Hilfiker R.
Blatter S.
Siegrist O.
Fournier S.
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Thank you!
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[email protected]
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