British Journal of Sports Medicine 2009;43:323-325
Head to head
Why bone–patella tendon–bone grafts should still be considered the gold standard for anterior cruciate ligament reconstruction
North Sydney Orthopaedic and Sports Medicine Centre, 286 Pacific Highway, Crows Nest, NSW 2065, Australia
James R Carmichael, BMedSci, BMBS, MSc, FRCS (Tr. & Orth.), Orthopaedic Fellow, North Sydney Orthopaedic and Sports Medicine Centre, 286 Pacific Highway, Crows Nest, NSW 2065, Australia; orthojim@mac.com
Accepted 10 February 2009
| The first 150 words of the full text of this article appear below. |
The patient population that will place the highest demand on the structural integrity and function of an ACL graft, whilst at the same time having the lowest tolerance for any donor site morbidity, is the professional sportsman or woman. The graft most appropriate for this group, regardless of technical difficulties, should therefore be considered the gold standard. We believe that the bone – patella tendon – bone (BPTB) graft best fits these criteria.
Proponents of the hamstring-based reconstruction will often cite the morbidity of the patellar tendon harvest, rather than the merits of the hamstrings, as the principal reason for avoiding the use of BPTB. Concerns exist regarding quadriceps deficit, arthritis, postoperative stiffness, anterior knee pain and sensory disturbance. The complications associated with hamstrings grafts must not be forgotten. These include increased knee laxity, hamstrings deficit and pain, tunnel widening, anterior knee pain and sensory deficit.
ADVANTAGES OF BPTB
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