A recently published scientific study from the Journal of Clinical Orthopaedics and Trauma has shed new light on the effectiveness of different grafting techniques used in anterior cruciate ligament (ACL) reconstruction. The ACL is a critical ligament in the knee, and its rupture is a prevalent injury among both athletes and the general public. The prospective randomized clinical trial compared two commonly used grafts – the bone-patellar tendon-bone (BPTB) and the four-strand semitendinosus-gracilis (QHT) – and evaluated their functionality over a one-year follow-up period in the Indian population.
The study, conducted by a team of surgeons from Sir Gangaram Hospital, New Delhi, India, followed 42 patients with ACL injuries. Published with the DOI: 10.1016/j.jcot.2018.04.018, the research involved dividing patients into two groups, each with 21 patients. Group A received the BPTB graft, while Group B was treated with the QHT autograft.
Patients were monitored for a minimum of one year, with regular follow-ups and assessments using standardized scoring systems such as the Cincinnati score and the Lysholm score, which measure various aspects of knee function including pain levels, ability to perform activities, and symptoms such as instability or locking.
After one year, the study concluded no significant difference in scores between the two groups regarding pain, overall activity level, and running. The Cincinnati score averaged 91 ± 4.117 for the BPTB group and 89.29 ± 5.371 for the QHT group, with a p-value of 0.282, indicating no statistical significance. Similarly, the Lysholm score, which also takes into account knee instability and locking symptoms, did not show a significant difference with averages of 92.84 ± 2.630 for BPTB and 90.55 ± 2.395 for QHT (p-value=0.842).
These scores showed that patients experienced similar levels of functionality and comfort regardless of the graft type used. Notably, the study acknowledged that patients with QHT grafts fared better functionally at the 6-month mark, suggesting that the QHT autograft could facilitate an earlier return to sports.
References and Previous Research
The debate over the best graft choice for ACL reconstruction has been ongoing in orthopedics for many years. References [1-10] demonstrate the various angles from which this subject has been approached, with contrasting results supporting both BPTB and hamstring autografts in different contexts.
Previous outcomes have raised concerns over issues such as graft harvest site morbidity, long-term stability, re-rupture rate, and the development of osteoarthritis post-surgery. Studies like those by Freedman et al.  and Jansson et al.  have conducted meta-analyses and randomized studies to determine the superiority of one graft over the other, with mixed conclusions. The present study, therefore, adds to this body of literature, particularly focusing on the Indian population, which had not been previously extensively studied.
Implications for ACL Reconstruction
The findings of this study are significant for clinicians and patients alike, as they provide reassurance of comparable outcomes between the two graft sources. This empowers surgeons and patients to make informed decisions based on individual circumstances, preferences, and potential risks.
Surgeon and Patient Perspectives
Lead researcher, Dr. Prateek Gupta, stressed the importance of personalized medicine in ACL reconstruction, stating, “Our study indicates that there is no one-size-fits-all approach. Both graft types have shown equivalent outcomes, and this gives us the confidence to recommend the best course of action tailored to the patient’s unique situation.”
Patients have also expressed appreciation for the transparency and clarity that such studies offer. Amit, a former trial participant, shares, “Knowing that the type of graft wouldn’t dramatically change my chances of getting back to sports helped reduce the anxiety around my surgery decision.”
Future Research Directions
While this study provides key insights, it does open doors for further research. A longer follow-up period would shed light on the long-term implications of graft choice, considering the development of degenerative changes and the full return to pre-injury activity levels.
1. ACL reconstruction India
2. Patellar tendon graft vs. hamstring
3. ACL surgery outcomes
4. Knee injury treatment
5. Sports injury recovery
The study on ACL reconstruction in the Indian population offers a valuable contribution to ongoing medical debates, especially relevant for an ailment that significantly impacts an active lifestyle. Patients and surgeons can now consider these findings as they discuss options for surgery, with the assurance that both BPTB and QHT grafts offer similar outcomes particularly in the short-to-medium term.
Future research will continue to unlock more insights, but for now, the path to ACL recovery in India has been made clearer, thanks to the dedicated efforts of medical professionals at Sir Gangaram Hospital, New Delhi, and the rich array of existing studies that have paved the way.
For further information and a more in-depth look at the study, readers are directed to the original publication: DOI: 10.1016/j.jcot.2018.04.018
1. Daniel D., et al. Am J Sports Med. 1994.
2. Fu R.Z., Lin D.D. Open Orthop J. 2013.
3. Ferretti A., et al. Int Orthop. 1991.
4. Jorgensen U., et al. J Bone Jt Surg Br. 1987.
5. Mandal A., et al. J Indian Med Assoc. 2012.
6. Keays S., et al. Knee. 2001.
7. Beard D., et al. Knee. 2001.
8. Ibrahim S.A.R., et al. Arthroscopy. 2005.
9. Eriksson E., et al. J Bone Jt Surg. 2001.
10. Freedman K.B., et al. Am J Sports Med. 2003.