A randomized clinical trial comparing patellar tendon, hamstring tendon, and double-bundle ACL reconstructions: patient-reported and clinical outcomes at 5-year follow-up

Review written by Dr Christina Le info

Key Points

  1. There are no significant differences in quality of life among patellar tendon, single-bundle hamstring tendon, and double-bundle hamstring tendon groups 5 years after ACL reconstruction.
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There has been a longstanding debate regarding which graft type for anterior cruciate ligament (ACL) reconstruction provides the best clinical outcomes. A previous Cochrane review could not support double- over single-bundle ACL reconstruction (or vice versa) and called for more randomized clinical trials to assess long-term outcomes such as re-injury, revision surgery, and osteoarthritis (1).

The primary objective of this double-blinded randomized clinical trial was to compare the use of patellar tendon, single-bundle hamstring (semitendinosus and gracilis) tendon, and double-bundle hamstring (2-stranded semitendinosus and 2-stranded gracilis tendon) graft selection for primary ACL reconstruction. This study reported its 5-year data on various clinical, patient-reported, and functional outcomes.

A previous Cochrane review could not support double- over single-bundle technique for ACL reconstruction (or vice versa).
Significantly fewer patients in the patellar tendon group suffered a traumatic re-injury (complete or partial) to the ipsilateral knee.


All patients (14-50 years old) who had a confirmed ACL tear and presented to a sports medicine clinic were screened for study eligibility. Exclusion criteria consisted of concomitant grade ≥2 ligamentous injuries, chondral lesion >1 cm2, previous knee ligament surgery,

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