Summary

Graft choice individualization according to sport requirements.

Abstract

Background

There is no consensus on the optimal graft choice for reconstructing the ruptured ACL in the athletic population. Most common options include bone-tendon-bone and hamstring autografts, each one with specific advantages and disadvantages - mostly failure risk and donor site morbidity. The effect of graft choice on the return to performance for a professional athlete after ACLR is less studied.
Objectives
To identify postoperative outcomes that influence athlete performance and are influenced by graft choice.

Methods

We tested 173 professional male athletes 7-9 months after ACLR using either bone-tendon-bone or hamstring autograft. We performed clinical assessment, jump testing using two ground-embedded force plates, and isokinetic strength assessment for the quadriceps and hamstrings at 60°/s. Posterior-to-anterior and rotational knee laxity was evaluated by instrumented measurement. Between-group differences were explored using mixed models analyses.

Results

Hamstrings strength was significantly less when using hamstrings graft (1.63 Nm/kg) compared to bone-tendon-bone (1.80 Nm/kg) (p<0.001) but there were no differences in quadriceps strength between the grafts. Conversely, athletes showed greater concentric (85%) and eccentric (86%) impulse asymmetries (p<0.001) during a two-leg vertical jump when a bone-tendon-bone graft was used compared to athletes with a hamstring graft (93% and 98%, respectively). There was a statistically but not clinically significant difference for posterior-to-anterior knee laxity between graft (p=0.032, 1mm).

Conclusions

Hamstrings muscle strength is not fully restored when using hamstrings graft for ACLR and jumping ability is affected when using bone-tendon-bone graft. These findings can help inform surgical choices.