Background

Utilizing an autograft from a patient’s contralateral leg has been shown to have benefits in patients undergoing ACL reconstruction (ACLR) with bone-patellar tendon-bone autografts, however few studies have examined the use of a contralateral hamstring tendon autograft. Theoretically, this strategy has the benefit of avoiding additional damage to the injured leg, whilst the uninjured leg is better equipped for hamstring rehabilitation following surgery.

Purpose

To compare muscle strength and patient reported outcomes following ACLR using a semitendinosus (ST) graft from the ipsilateral (IL) leg compared to a graft from the contralateral (CL) leg.

Methods

140 patients with an acute ACL injury were randomized to IL or CL ACLR. Patients were assessed at 6, 12 and 24 months with isokinetic and isometric muscle strength measured using Biodex.. Patient-reported outcomes and manual stability measurements were also recorded.

Results

Patient related outcomes improved over time for both groups with no significant differences between groups at any time point. No differences between groups in objective knee assessment scores or rerupture rates were found.
The IL group was significantly weaker in knee flexion strength at all time points compared to the CL group, additionally the IL group did not recover flexor strength within 2 years.

Conclusion

Utilizing a ST graft harvested from the uninjured limb for ACLR facilitates early isokinetic and isometric strength recovery, with no significant adverse outcomes demonstrated in other measurements. CL graft harvest was not associated with an increased risk of reinjuries or ruptures of the contralateral ACL at 24 months.
Level of evidence: II