Different Approaches Offer Patients Improved Quality of Life after ACL Reconstruction

    The 3 most common surgical techniques used to repair a torn anterior cruciate ligament (ACL) offer patients improved quality of life 5 years after injury, according to research presented at the American Orthopaedic Society for Sports Medicine’s Annual Meeting in Toronto, Ontario, Canada.

    “Orthopaedic surgeons have a variety of surgical techniques available to reconstruct a torn ACL,” commented corresponding author and presenter Nicholas Mohtadi, MD, MSc, FRCSC, from the University of Calgary Sport Medicine Centre.

    “Our research showed patients overwhelmingly see improvements with the patellar tendon, hamstring tendon, and double-bundle surgical techniques, though re-injuries are more common in the hamstring tendon and double-bundle approach.”

    For the study, 330 patients (183 males, 147 females) ages 14 to 50 years old were randomly assigned to 1 of 3 surgical approaches:

    • Patellar tendon
    • Quadruple-stranded hamstring tendon
    • Double-bundle technique using hamstring tendons

    Postoperative follow-up was done at 3 and 6 months and 1, 2, and 5 years by an independent, trained examiner who was blinded to the surgical approach. The primary outcomes that were evaluated included the patient-reported Anterior Cruciate Ligament Quality of Life (ACL-QOL), a 32-item questionnaire.

    Of the original group, 315 patients completed the 5-year follow-up. The researchers found that ACL-QOL scores were similar among the groups, as were:

    • The proportion of patients with a Pivot Shift grade 2 or more
    • Mean International Knee Documentation Committee subjective scores
    • The proportion of Normal/Nearly Normal knees
    • 5-year Tegner activity levels
    • Cincinnati Occupational Scores

    Patients in the patellar tendon group had more kneeling pain at 5 years, while patients in the hamstring tendon and double-bundle groups had more traumatic graft ruptures.

    “Our research is exciting as it represents the only double-blind, randomized clinical trial with this large of a sample size, and a mid-term follow-up rate of 5 years,” Dr. Mohtadi said. “We hope this data can continue to help physicians manage patient care and treatment of ACL injuries.”


    Mohtadi NGH, Chan DS. A Randomized Trial Comparing Patellar, Hamstring and Double-bundle ACL Reconstruction at 5 Years (paper 139). Presented at the Annual Meeting of the American Orthopaedic Society for Sports Medicine, July 20-23, 2017, Toronto, Ontario, Canada. All abstracts from the meeting can be found here.