Anatomic double-bundle anterior cruciate ligament reconstruction using bone-patellar tendon-bone and gracilis tendon graft: A comparative study with 2-year follow-up results of semitendinosus tendon grafts alone or semitendinosus-gracilis tendon grafts

Purpose: The purpose of this study was to assess the clinical results of anatomic double-bundle anterior cruciate ligament (ACL) reconstruction by use of bone-patellar tendon-bone and gracilis tendon (BPTB-G) grafts and to compare them with the results of double-bundle ACL reconstruction by use of semitendinosus tendon (ST) or semitendinosus-gracilis tendon (ST-G) grafts, with particular emphasis on the postoperative incidence of anterior knee pain. Methods: The study comprised 144 patients who underwent unilateral anatomic double-bundle ACL reconstruction with 3 graft types, including 55 BPTB-G, 56 ST, and 33 ST-G grafts. A traumatic graft rupture occurred within 2 years postoperatively in 5 patients (1 BPTB-G, 3 ST, and 1 ST-G). Clinical results and incidence and severity of anterior knee pain were assessed and compared among the 3 different graft groups at 2 years postoperatively. Potential variables influencing postoperative anterior knee pain development were subjected to univariate analysis, followed by logistic regression analysis to identify risk factors for anterior knee pain. Results: Both subjective and objective clinical results in anatomic double-bundle ACL reconstruction with BPTB-G graft were similar to those using ST or ST-G graft at 2 years postoperatively. The incidences of anterior knee pain at 2 years' follow-up were 18.5%, 9.4%, and 9.3% in the BPTB-G, ST, and ST-G groups, respectively, indicating no statistically significant difference among the 3 groups. Multivariate logistic regression analyses showed that BPTB graft harvest and patellofemoral cartilage defect failed to be significant factors for anterior knee pain whereas quadriceps peak torque at 60°/s was the only significant factor for anterior knee pain at 2 years. Conclusions: Clinical results including the incidence of anterior knee pain 2 years after anatomic double-bundle ACL reconstruction with BPTB-G grafts were comparable to those after ACL reconstruction with ST or ST-G grafts.