Reconstruction of the anterior cruciate ligament in females: A comparison of hamstring versus patellar tendon autograft

PURPOSE

To compare the clinical results of anterior cruciate ligament reconstruction in female patients using quadruple-looped hamstring autograft versus patellar tendon autograft at minimum 2-year follow-up.

TYPE OF STUDY

Case series.

METHODS

A prospective clinical review was performed to compare the results of ACL reconstruction with hamstring versus patellar tendon autograft in a group of female patients. Exclusion criteria included chronic injuries (greater than 3 months), associated collateral ligament injuries, Workers' Compensation or litigation cases, and bilateral anterior cruciate ligament injuries. There were 39 female patients in the hamstring group (average follow-up, 40.9 months) and 37 female patients in the patellar tendon group (average follow-up, 52 months). Both types of grafts were fixed with an EndoButton proximally and with sutures tied over a post or button distally. The postoperative rehabilitation regimen was identical for both groups. Objective parameters evaluated included preinjury and postoperative Tegner and Lysholm scores, side-to-side KT-1000 maximum-manual arthrometer differences, and clinical examination including Lachman and pivot-shift tests. Graft failure was defined by any one of the following: a KT-1000 difference of greater than 5 mm, a 2+ Lachman, a 1+ or greater pivot shift, or revision surgery.

RESULTS

The failure rate in the hamstring group was 23% versus 8% in the patellar tendon group, which was not statistically significant (P >.1). Comparison of preinjury Tegner activity scores to postoperative scores revealed that patients in the hamstring group did not return to their preinjury level of activity (preinjury 6.54 v postoperative 5.17) as well as patients in the patellar tendon group (preinjury 6.20 v postoperative 6.59). Patients in the hamstring group had a significant increase in pain compared with the patellar tendon group (P =.034).

CONCLUSIONS

Although not statistically significant, the hamstring group had more failures, more laxity on clinical examination, and more patients with larger KT-1000 arthrometer differences. These results indicate a trend toward increased graft laxity in female patients undergoing reconstruction with hamstring autograft compared with patellar tendon when evaluated by a single surgeon using similar fixation techniques at short- to medium-range follow-up. More studies with larger patient numbers using current fixation techniques are necessary to confirm these findings.

The effect of Workers' Compensation on clinical outcomes of arthroscopic-assisted autogenous patellar tendon anterior cruciate ligament reconstruction in an acute population

PURPOSE

To assess the effect of Workers' Compensation (WC) benefits on subjective outcomes of patients following anterior cruciate ligament (ACL) reconstruction.

TYPE OF STUDY

Prospective study of ACL reconstruction with bone-patellar tendon-bone in an acute population.

METHODS

From October 1991 through June 1997, 1,015 patients underwent ACL reconstruction, 769 with bone-patellar tendon-bone autografts; 235 met the criteria for this study. All chronic injuries, failed and/or bilateral reconstructions were excluded making the total population 139. The final populations included 115 patients in a non-WC group and 24 patients in a WC group. Average follow-up for was 34.5 months for the WC group and 33.6 months for the non-WC group. All patients had equal objective evaluations, which allowed the subjective criteria to be analyzed.

RESULTS

The results revealed a significant difference in the subjective data of patients with WC benefits. Uniformly, WC patients rated subjective criteria as far worse than the non-WC group in postoperative stages. The average of the 15-item visual analog scale showed statistically significant (P <.01) differences between the WC and non-WC groups. Average postoperative Tegner scores were 3.05 for the WC group and 6.02 for the non-WC group, which was statistically significant. The WC group did not return to their preinjury Tegner score.

CONCLUSIONS

The data show that the patients' perception of their knee function drastically differs from the objective findings on examination; therefore, it should be anticipated that the WC patient might have lower subjective outcomes from surgical treatment when compared with their non-WC counterparts.

Clinical comparison of intraarticular anterior cruciate ligament reconstruction using autogenous semitendinosus and gracilis tendons in men versus women

Reconstruction of the anterior cruciate ligament using a hamstring tendon autograft has often been recommended for female athletes. We compared the results of acute, isolated, intraarticular anterior cruciate ligament reconstructions using quadruple-looped hamstring autografts in 39 female and 26 male patients. All reconstructions were performed by the same surgeon using a similar surgical technique and the same postoperative management. In each case, patients had Endobutton femoral fixation and either post or button fixation for the tibial side. The average follow-up was 40.9 months for women and 39.0 months for men. Objective analysis of results included examination for the presence of effusion and crepitus, Lachman and pivot shift testing, and KT-1000 arthrometer testing for side-to-side differences. Subjective analysis consisted of a 15-item visual analog scale completed by patients postoperatively, and pre- and postoperative Tegner and Lysholm scores. The clinical failure rate was 23% (9 of 39) for the female patients and 4% (1 of 26) for the male patients, which was statistically significant. There was also a trend toward increased laxity in female patients. Subjectively, the women also reported a higher frequency and intensity of pain. Based on Tegner activity levels, more of the men returned to their preinjury level of activity than did the women. When compared with the male patients, female patients had a significantly higher failure rate after reconstruction.

Detection of proteins which recognize and bind oriC sequences

Extracts from E. coli capable of supporting in vitro oriC-dependent DNA replication have been examined with a protein blotting protocol to identify DNA-binding proteins. Four polypeptide chains with apparent affinity for oriC DNA were detected.

Characterization of transducin from bovine retinal rod outer segments. II. Evidence for distinct binding sites and conformational changes revealed by limited proteolysis with trypsin

The first stage of amplification in the cyclic GMP cascade in bovine retinal rod is carried out by transducin, a guanine nucleotide regulatory protein consisting of two functional subunits, T alpha (Mr approximately 39,000) and T beta gamma (Mr approximately 36,000 and approximately 10,000). Limited trypsin digestion of the T beta gamma subunit converted the beta polypeptide to two stable fragments (Mr approximately 26,000 and approximately 14,000). The GTPase and Gpp(NH)p binding activities were not significantly affected by the cleavage. Trypsin digestion of the T alpha subunit initially removed a small segment from the polypeptide terminus and resulted in the formation of a single 38,000-Da fragment. When this fragment was recombined with the intact T beta gamma subunit in the presence of membranes containing photolyzed rhodopsin, the reconstituted transducin exhibited greatly reduced GTPase and Gpp(NH)p binding activities. The loss in activities was due to the inability of the cleaved T alpha to bind to the photolyzed rhodopsin. Prolonged digestion converted the 38,000-Da fragment to a transient 32,000-Da fragment and then to two stable 23,000-Da and 12,000-Da fragments. The cleavage of the 32,000-Da fragment, however, can be blocked by bound Gpp(NH)p. The 32,000-Da fragment contains the Gpp(NH)p binding site and retains the ability to activate phosphodiesterase. These results indicate that the guanine nucleotide binding and rhodopsin binding sites are located in topologically distinct regions of the T alpha subunit and proved evidence that a large conformational transition of the molecule occurs upon the conversion of the bound GDP to GTP.