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Original ArticleOpen Access
Clinical Comparison between Six-Strand Hamstring Tendon and Patellar Tendon Autograft in Arthroscopic Anterior Cruciate Ligament Reconstruction: A Prospective, Randomized Clinical Trial
Laoruengthana A 
,
Pattayakorn S ,
Chotanaputhi T ,
Kosiyatrakul A
,
Pattayakorn S ,
Chotanaputhi T ,
Kosiyatrakul A Objective: Many randomized clinical trials demonstrated that 4-strand hamstring tendon grafts have
comparable results both subjectively and objectively with the patellar tendon grafts. The authors
hypothesized that the increment of hamstring tendons strength with 6-strand graft could improve the knee
stability compared to the result from using the gold standard patellar tendon.
Material and Method: Thirty-four patients were prospectively randomized into two groups for arthroscopic
anterior cruciate ligament reconstruction. Seventeen patients underwent reconstruction with 6-strand
hamstring tendons and the remaining seventeen were treated with bone-patellar tendon-bone graft. Patients
were followed-up under the similar rehabilitation protocol for at least 12 months. At the time of final
follow-up, all the patients in both groups were evaluated in terms of patient’s satisfaction, activity level, and
knee stability.
Results: Fifteen patients in bone-patellar tendon-bone graft (two lost to follow-up) and thirteen patients used
6-strand hamstring tendons(four were converted to 4-strand hamstring tendons) were evaluated at a mean of
19 months (range 12-31 months). The mean of KT-2000 side-to-side laxity measurement in 6-strand hamstring
group (0.96 mm) is less than BPTB group (1.22 mm) significantly (p < 0.05). Eleven of 13 patients (84.62%)
that received the 6-strand hamstring tendons could return to sport activities compared to 10 of 15 patients
(66.67%) that received BPTB graft. Hamstring group have a lower prevalence of donor-site morbidity resulting
in less difficult in kneeling.
Conclusion: The authors concluded that using 6-strand hamstring tendons could improve knee stability in the
early clinical outcomes. With no difference in subjective assessment, anterior cruciate ligament reconstruction
used hamstring tendons have less donor-site morbidity, which is more compatible to Asian life-style.
Keywords: Anterior cruciate ligament, Bone-patellar tendon-bone graft, Patellar ligament, Reconstructive
surgical procedures, Tendon transfer, Transplantation autologous
comparable results both subjectively and objectively with the patellar tendon grafts. The authors
hypothesized that the increment of hamstring tendons strength with 6-strand graft could improve the knee
stability compared to the result from using the gold standard patellar tendon.
Material and Method: Thirty-four patients were prospectively randomized into two groups for arthroscopic
anterior cruciate ligament reconstruction. Seventeen patients underwent reconstruction with 6-strand
hamstring tendons and the remaining seventeen were treated with bone-patellar tendon-bone graft. Patients
were followed-up under the similar rehabilitation protocol for at least 12 months. At the time of final
follow-up, all the patients in both groups were evaluated in terms of patient’s satisfaction, activity level, and
knee stability.
Results: Fifteen patients in bone-patellar tendon-bone graft (two lost to follow-up) and thirteen patients used
6-strand hamstring tendons(four were converted to 4-strand hamstring tendons) were evaluated at a mean of
19 months (range 12-31 months). The mean of KT-2000 side-to-side laxity measurement in 6-strand hamstring
group (0.96 mm) is less than BPTB group (1.22 mm) significantly (p < 0.05). Eleven of 13 patients (84.62%)
that received the 6-strand hamstring tendons could return to sport activities compared to 10 of 15 patients
(66.67%) that received BPTB graft. Hamstring group have a lower prevalence of donor-site morbidity resulting
in less difficult in kneeling.
Conclusion: The authors concluded that using 6-strand hamstring tendons could improve knee stability in the
early clinical outcomes. With no difference in subjective assessment, anterior cruciate ligament reconstruction
used hamstring tendons have less donor-site morbidity, which is more compatible to Asian life-style.
Keywords: Anterior cruciate ligament, Bone-patellar tendon-bone graft, Patellar ligament, Reconstructive
surgical procedures, Tendon transfer, Transplantation autologous
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