Bone-patellar tendon-bone autograft could be recommended as a superior graft to hamstring autograft for ACL reconstruction in patients with generalized joint laxity: 2- and 5-year follow-up study.
PURPOSE
The present study aimed to compare 2- and 5-year outcomes of ACL reconstruction between patients with and without generalized joint laxity and to perform comparative evaluation between two types of grafts used for ACL reconstruction in patients with generalized joint laxity.


METHODS
Two hundred and thirty-seven patients who underwent ACL reconstruction from 2001 to 2008 were included. Patients were classified into two groups according to the presence or the absence of generalized joint laxity, and further subdivided into two subgroups based on the type of graft used: bone-patellar tendon-bone (BPTB) or hamstring. Generalized joint laxity was assessed with the Beighton and Horan criteria using a point scoring system. Stability reflected by the Lachman test, pivot-shift test, and anterior translation measured with KT-2000, and functional outcomes reflected by Lysholm knee score, and International Knee Documentation Committee (IKDC) subjective score were investigated. IKDC objective grade and radiographic grade were also assessed. Clinical assessments were conducted preoperatively and at 2 and 5 years after operation.


RESULTS
Two-year follow-up results showed that patients with generalized joint laxity receiving hamstring grafts had poorer outcomes than those without generalized joint laxity. Five-year follow-up results showed that patients with generalized joint laxity experienced poorer outcomes than patients without generalized joint laxity, irrespective of the type of graft. Comparison of grafts used showed that, in patients with generalized joint laxity, BPTB graft provided significantly better stability and functional outcomes than hamstring graft at both 2- and 5-year follow-ups. Comparisons between serial outcomes measured at 2 and 5 years demonstrated that stability and functional outcomes deteriorated over time in patients with generalized joint laxity.


CONCLUSIONS
Less satisfactory stability and functional outcomes were noted in patients with generalized joint laxity, compared to patients without generalized joint laxity. Comparisons of stability and functional outcomes after ACL reconstruction in patients with generalized joint laxity between two different grafts demonstrated that BPTB graft achieves better results than hamstring graft.


LEVEL OF EVIDENCE
III, a retrospective cohort study.
['Kim|Sung-Jae|SJ|', 'Choi|Chong Hyuk|CH|', 'Kim|Sung-Hwan|SH|', 'Lee|Su-Keon|SK|', 'Lee|Wonyong|W|', 'Kim|Taeyup|T|', 'Jung|Min|M|']
D016118:Anterior Cruciate Ligament D000070598:Anterior Cruciate Ligament Injuries D059549:Anterior Cruciate Ligament Reconstruction D064592:Autografts D016025:Bone Transplantation D050376:Bone-Patellar Tendon-Bone Grafting D005500:Follow-Up Studies D000070633:Hamstring Muscles D006801:Humans D007593:Joint Instability D007717:Knee D007719:Knee Joint D065466:Lysholm Knee Score D017847:Patellar Ligament D012189:Retrospective Studies D013710:Tendons D014182:Transplantation, Autologous D016896:Treatment Outcome
Graft Hamstring Generalized joint laxity Anterior cruciate ligament reconstruction Bone–patellar tendon–bone Risk factor