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Comparing Methods of Fixation in ACL Repairs

There are two main graft sources for anterior cruciate ligament (ACL) repairs. The first is a bone-patellar-bone (BPTB) graft. This is a piece of bone and tendon taken from the quadriceps tendon in front of the knee just below the patella (kneecap).

The second graft is taken from the hamstring muscle behind the knee. This graft called the quadruple-strand hamstring tendon graft is folded over to increase its strength.

Many studies have been done comparing these two methods of repair. In this study, 99 patients were divided into two groups by graft type. One surgeon did all the operations.

While using the two different tendon grafts, the method of fixation (bioabsorbable interference screws) was the same for all patients. Results were compared measuring strength, activity level, and range of motion. Follow-up measurements were taken at regular intervals over a period of two years.

The authors report good results with both methods. There were some small differences noted. For example, the BPTB patients were more likely to return to their preinjury level of activity and previous jumping ability. They also had greater flexion strength in the operated leg compared to the nonoperated leg.

The hamstring group had less trouble kneeling and better extension strength in the operated leg compared to the nonoperated leg. The best graft is one that is strong and heals quickly with no problems while providing a stable knee. Choosing the right graft method for each patient should take the small differences reported into consideration.


Gregory B. Maletis, MD, et al. A Prospective Randomized Study of Anterior Cruciate Ligament Reconstruction. In The American Journal of Sports Medicine. March 2007. Vol. 35. No. 3. Pp. 384-394.

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