Outcomes Following Anterior Cruciate Ligament Reconstruction with Patellar Tendon vs Hamstring Autografts: A Systematic Review of Randomized Controlled Trials with a Mean Follow-up of 15 Years



1 Department of Orthopaedic Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA

2 Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, MI, USA


Background: The two most common surgical treatment modalities for anterior cruciate ligament reconstruction 
(ACL), patellar tendon (PT) and hamstring tendon (HS) autografts, have been shown to have outcomes that are both 
similar and favorable; however, many of these are short or intermediate-term. The objective of this systematic review 
is to evaluate randomized controlled trials (RCTs) with a minimum 10-year follow-up data to compare the long-term 
outcomes of ACL reconstructions performed using PT and HS autografts.
Methods: This systematic review followed the PRISMA (Preferred Reporting Items for Systematic Reviews and MetaAnalyses) guidelines. A search of three databases (PubMed, Cochrane and EMBASE) was performed to identify RCTs 
with a minimum of 10-year follow-up that compared clinical and/or functional outcomes between PT and HS autografts. 
Results: Four RCTs with a total of 299 patients were included in the study. The mean follow-up ranged from 10.2 to 17 
years (mean, 14.79 years). No significant differences in knee laxity or clinical outcome scores were demonstrated in 
any of the studies. One study found that PT autografts were significantly more likely to have osteoarthritis identified by 
radiographic findings. Two studies found that patients with PT autografts reported increase kneeling pain, while none of 
the four studies reported a difference in anterior knee pain. There were no significant differences in graft failure rates.
Conclusion: This review demonstrates no long-term difference in clinical or functional outcomes between PT and HS 
autografts. However, radiographic and subjective outcomes indicate that patients with PT autografts may experience 
greater kneeling pain and osteoarthritis. Therefore, orthopaedic surgeons should consider patient-centric factors when 
discussing graft options with patients.
Level of evidence: II


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