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Why autologous hamstring tendon reconstruction should now be considered the gold standard for anterior cruciate ligament reconstruction in athletes
  1. L Pinczewski,
  2. J Roe,
  3. L Salmon
  1. North Sydney Orthopaedic and Sports Medicine Centre, Sydney, Australia
  1. Dr L J Salmon, North Sydney Orthopaedic and Sports Medicine Centre, 286 Pacific Hwy, Crows Nest, Sydney NSW 2065, Australia; lsalmon{at}

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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. …

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  • Competing interests: LP has received research funds from Johnson & Johnson, Smith+Nephew, Linvatec, Stryker. LP has received consultant fees and royalties from Smith+Nephew, Tuta, Australian Medical Technologies. JR has received research funds and consultancy fees from Stryker. LS position is funded by research funds as disclosed above.

  • Figures reprinted from American Journal of Sports Medicine. The final, definitive version of this paper has been published in American Journal of Sports Medicine 35(1) 2007[4] by SAGE Publications Ltd, All rights reserved. ©