To test whether changing the surgical algorithm from transtibial technique using hamstring to transportal technique using patellar tendon result not only in a more physiological knee laxity but also in higher activity levels and improved perceptions of life quality at 5-to-10 years follow-up.
Transtibial ACL reconstructions using autologous hamstring tendons performed between 2004 and 2010 were compared to transportal ACL reconstructions using autologous bone-patellar-tendon-bone performed between 2011 and 2016. Inclusion criteria were: age 18-35 years, male sex, sports trauma, 5-10 years follow-up. Exclusion criteria were: contra-lateral ACL tear, revision ACL reconstruction during follow-up, and concomitant lower limb surgery. Outcome measures were compared between the groups.
There were 55 patients eligible and available in the transtibial hamstring and 45 patients in the transportal patellar tendon group. At follow-up, KT-1000 was 2.8±2.3 vs. 1.4±1.9 (p<0.05), and high grade pivot shift (2+ or higher) was recorded in 34% vs. 4% of the cases (p<0.01). Decrease points in Marx score from preoperative to follow-up was 7.2±5.1 vs. 4.6±4.8, and in Tegner score was 2.1±2.1 vs. 1.2±1.5 (p<0.01 for both activity level scores). IKDC-subjective was 82±13 vs. 88±10 (p<0.01). Nevertheless, KOOS-ADL was 94±9 vs. 95±9, KOOS-sports 74±20 vs. 77±16, and KOOS- QOL 58±24 vs. 62±22 (p>0.05 for all comparisons).
Changing the ACLR algorithm from transtibial technique with hamstring tendons to transportal technique with bone-patellar tendon-bone results in maintaining a more physiological knee laxity at 5-to-10 year follow-up. However, substantial decrease in Marx scores and apparently similar KOOS sub-scores in both groups at follow-up imply that other factors than "just" knee laxity by itself deserve further exploration in order to dramatically improve sports activities maintenance and quality of life at this time frame after surgery.