Why bone-patella tendon-bone grafts should still be considered the gold standard for anterior cruciate ligament reconstruction
| Autor: | Mervyn J Cross, James R. Carmichael |
|---|---|
| Rok vydání: | 2009 |
| Předmět: |
medicine.medical_specialty
Anterior cruciate ligament reconstruction medicine.medical_treatment Physical Therapy Sports Therapy and Rehabilitation Bone-Patellar Tendon-Bone Grafting Quadriceps Muscle Bone patellar tendon bone medicine Humans Orthopedics and Sports Medicine Anterior Cruciate Ligament Reduction (orthopedic surgery) Fixation (histology) Pain Postoperative Wound Healing business.industry Anterior Cruciate Ligament Injuries Arthritis Gold standard General Medicine Surgery surgical procedures operative Treatment Outcome Knee laxity Athletic Injuries Cadaveric spasm business Hamstring |
| Zdroj: | British journal of sports medicine. 43(5) |
| ISSN: | 1473-0480 |
| Popis: | The patient population that will place the highest demand on the structural integrity and function of an ACL graft, whilst at the same time having the lowest tolerance for any donor site morbidity, is the professional sportsman or woman. The graft most appropriate for this group, regardless of technical difficulties, should therefore be considered the gold standard. We believe that the bone – patella tendon – bone (BPTB) graft best fits these criteria. Proponents of the hamstring-based reconstruction will often cite the morbidity of the patellar tendon harvest, rather than the merits of the hamstrings, as the principal reason for avoiding the use of BPTB. Concerns exist regarding quadriceps deficit, arthritis, postoperative stiffness, anterior knee pain and sensory disturbance. The complications associated with hamstrings grafts must not be forgotten. These include increased knee laxity, hamstrings deficit and pain, tunnel widening, anterior knee pain and sensory deficit. ### Graft laxity and fixation The stability of the hamstrings reconstruction when compared with the BPTB graft is frequently questioned. It is a common finding that there is a trend to increased laxity when hamstrings grafts are used.1–3 This has been confirmed in a meta-analysis by Goldblatt et al , who identified a marked reduction in side-to-side laxity difference with the use of the BPTB graft.4 A similar analysis by Forster et al identified a trend to increased chance of a positive pivot jerk in the hamstrings group.5 When laxity is identified in a BPTB graft it is usually associated with tunnel misplacement.6 The cause for the increased laxity with hamstrings has been studied. In 2002 Rittmeister et al analysed the components of postoperative laxity in a cadaveric study.7 They found that the majority of graft slippage occurred at the graft bone interface, with only 8% of elongation being due to plastic … |
| Databáze: | OpenAIRE |
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