A comparison of outcomes at 2 to 6 years after acute and chronic anterior cruciate ligament reconstructions using hamstring tendon grafts

Purpose: To compare short- to intermediate-term outcomes of patients in who m an acute or chronic anterior cruciate ligament (ACL) reconstruction was p erformed with a hamstring tendon graft. Type of Study: A consecutive case s eries of patients who had a-incision, arthroscopically assisted ACL reconst ructions with a triple-strand hamstring tendon graft was retrospectively ev aluated. Methods: A total of 120 patients were evaluated at a mean of 44 mo nths. The Tegner Activity Scale, individual components of the Cincinnati Kn ee Rating System, and the modified Lysholm Score were administered to all p atients, A total of 93 patients (78%) returned for examination, instrumente d ligament laxity testing, radiographs, isokinetic strength testing, and co mpletion of the IKDC Standard Knee Ligament Evaluation Form. Data from pati ents undergoing reconstructions for acute and chronic ACL deficiencies were compared. The acute group was defined as reconstruction within 6 weeks of injury without recurrent episodes of instability. Results: At surgery, sign ificantly more (P < .05) cartilage abnormalities and partial medial menisec tomies were found in the chronic group. At final follow-up, no significant differences (P > .05) were found between the acute and chronic groups for i nstrumented laxity, muscle strength, knee motion, or sports activity level. The acute group scored significantly higher (P < .05) on the Lysholm scale , Cincinnati Function scale, IKDC subjective assessment, and IKDC rating fo r pain at follow-up. The final IKDC grade resulted in significantly more (P = .039) normal knees for the acute group; however, 94.1% of acute and 92.9 % of chronic knees were graded normal or nearly normal. Conclusions: Hamstr ing tendons are an excellent graft choice for ACL reconstruction in both ac ute and chronic injuries. According to the strict IKDC rating system, great er than 90% of all patients can be expected to have a normal or nearly norm al knee at short- to intermediate-term follow-up; however, the chronic grou p will have fewer patients with a rating of normal.