Why autologous hamstring tendon reconstruction should now be considered the gold standard for anterior cruciate ligament reconstruction in athletes

The aim of anterior cruciate ligament (ACL) reconstructive surgery is to provide the patient with a timely return to sport allowing them to participate without any further meniscal damage and having a normal knee function which results in neither clinical nor radiologic evidence of osteoarthritis later in life. Long term study of both endoscopically performed patellar tendon and hamstring tendon graft reconstructions show that this is more likely to be achieved with hamstring tendon graft rather than patellar tendon graft. ACL reconstruction carried out endoscopically with the patellar tendon graft was popularised last century in the late 1980s and early 1990s due to the advent of easily performed interference screw fixation, and the rapid bone to bone healing of the graft. However donor site morbidity was common, persistent, occasionally severe and particularly disabling in females and trades people who knelt. Longitudinal follow-up demonstrated the development of fixed flexion deformities at the 2 and 5 year post-operative mark associated with the development of Grade B changes in the patellofemoral and medial compartments.1 2 These changes were noted on side to side comparative radiographs. …