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Patellar Or Hamstring tendon for ACL Reco?
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Patellar Or Hamstring tendon for ACL Reco? - June 3, 2002 3:03:00 AM
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zlat
Posts: 2
Joined: June 2, 2002
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Hi everyone im about to undergo knee reconstruction on my left knee in a months time. I am a soccer player and injured my knee about a year ago. I am a short and an athletic player with natural explosive power. My consern is will i lose this explosivness?
And also my surgeon has decided that he will perform the surgery using the hamstring tendon. He never mentioned anything about the patella tendon until i done a bit of research and brought it up. He beleives many docters used to use that tendon alot many years ago but not alot now a days days. He told me that ill have less knee problems later on if i used the hamstring tendon. Will having a knee reco using the hamstring tendon affect my soccer performance or will using the patella be a better option?
Any help would be greatly appreciated.
Thank You
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Re: Patellar Or Hamstring tendon for ACL Reco? - June 3, 2002 2:00:00 PM
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Bournephysio
Posts: 585
Joined: April 25, 2002
From: Calgary
Status: offline
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I was at an arthroscopic surgery conference a couple of weeks ago. The studies presented suggested that the outcomes were the same between the two. That also seemed to be the general opinion of the surgeons there. I don't remember the studies they quoted or the outcomes measured.
Your surgeon is going to better at the surgery he usually does.
A web page off the top of my head: [URL=http://www.carletonsportsmed.com]www.carletonsportsmed.com[/URL]
As for specifics of your condition, it is better to ask the surgeon, doctor, or physio who has assessed you.
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Re: Patellar Or Hamstring tendon for ACL Reco? - June 3, 2002 10:25:00 PM
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yves
Posts: 32
Joined: October 1, 1999
From: Nanaimo, Vancouver Island BC Canada
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I worked with a surgeon who did a lot of Anterior Cruciate reconstruction. He used the patella tendon on mostly males as he felt that it was a stronger reconstruction, ie. bone plugs at both ends, screwed into place with disolving screw.
He used the hamstring tendon, and like to get 4 filaments for a stronger anchor and used them mostly in females for a more cosmetic appearance.
I beleive he felt that there was a difference in strenght. PS. by taking away from the hamstring muscle, would you not lose some power in this muscle.
yves
Calgary, Can.
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Re: Patellar Or Hamstring tendon for ACL Reco? - June 4, 2002 6:27:00 AM
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PTupdate.com
Posts: 1478
Joined: October 8, 2001
From: Pittsburgh, PA USA
Status: offline
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Most studies have indicated that 1 year down the road, if everything goes fine, there really is no significant difference between the two. As a treating pracitioner, I prefer the double looped semitendinosis/gracilis graft, especially with the new Arthrotec bone mulch screw for fixation. Too many times with patellar tendon grafts I have had to deal with stiffness, extension problems, patellar pain, etc.
Even though some studies have shown residual hamstring weakness, I have found that with proper and aggressive (yet safe) rehab, hamstring weakness is never a problem for me. The graft stays tight and function returns successfully.
Either way, one year down the road, you won't give a darn, you will most likely be happy either way.
Regards,
John Duffy, PT OCS
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Re: Patellar Or Hamstring tendon for ACL Reco? - June 4, 2002 6:57:00 AM
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mcap
Posts: 652
Joined: February 8, 2000
Status: offline
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zlat:
Beleive it or not.....graft selection most often has to do with surgeons' perference and comfort level. Bone-patella bone is still the most common graft and it seems like most professional athletes receive this one. But with the double looped hamstring graft and newer fixation techniques this is changing.
A recent article in Am J Sports med compared the two. The differences were not tremendous but they were significant. The P.Tend group had less quad strength at 6 months and a year. The HS group had residual hamstring weakness that persisted at two year follow-up. However, rehab had ended after 6 months. So, perhaps with strengthening and careful long-term rehab, this would not be an issue (as pointed out by PT update). The biggest concern is graft failure. There was no significant difference between the two groups in failure.
You should do well either way.....so the decision for you should be based on a few factors.......
1. How much experience does your surgeon have with this technique?
2. The HS graft has to be double looped or it will not be as strong as a PTend.
3. Is the surgeon using the best fixation techniques?
4. Do you have a history of anterior knee pain. If so.....then you might consider the HS graft.
Good luck and remember........choose your PT wisely. It will make a difference. I don't seem to have the article handy. If I find it, then I will post the cite.
If you have an acutely injured ACL and it is still intact somewhat.....you may be a candidate for thermal shrinkage. This is a newer procedure and the results are mixed. It doens't seem to work on old injuries, reconstructions that have loosened or of course, complete ruptures. But on acute injuries with some of the ligament still intact, the results seem to be O.K. (jury is still out long term). Talk to your doctor.
And...by the way....if you are an outpatient ortho PT, I think you should be reading AM J Sports Med. I find it infinitely more useful than JOSPT [IMG]http://www.rehabedge.com/forums/smile.gif[/IMG]
mcap
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