LONG TERM FOLLOW-UP RESULTS IN ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION: BONE PATELLAR TENDON BONE COMPARED WITH DOUBLE SEMITENDINOSUS AND GRACILIS TENDON GRAFT. Risultati a lungo follow-up della ricostruzione artroscopica del legamento crociato anteriore: tendine rotuleo versus tendine semitendinoso e gracile

ABSTRACT: Aim of the study: the purpose of the study was to evaluate the differences in post-operative results of ACL reconstruction using as graft semitendinosus and gracil tendons or bone patellar tendon. Materials and Methods: 160 patients who underwent ACL reconstruction between January 1998 and January 2007, in our department were analyzed at the follow-up from 1 to 10 years (mean follow-up 5 years). These patients were treated using random one of the two grafts. They were divided into two groups of 80 patients each. In group A we used the bone patellar tendon bone (BPTB), while in group B we used the semitendinosus and gracilis tendon graft (STGD). In group A there were 47 men and 33 females, aged from 19 to 49 years (mean age: 27years 7months), in second group there were 51 men and 29 females, aged from 19 to 41 years (mean age: 25 years 5 months). To evaluate this study we used the International Knee Documentation Committee (IKDC), AP and LL x–rays and MRI of the knee. Results: there was not a significant statistical difference between the two groups. Clinical results were normal or almost normal in more than 90% of cases. In the subjective evaluation there was a smaller incidence of pain and symptoms into the second group and an higher incidence of pain to kneel into the first group. Imaging results showed that when LCA injury is associated to condral or meniscal damage, there is a worsening of x-ray features above all if the LCA reconstruction has been performed a long time after injury, even if condral or meniscal lesions are treated in the same surgery. Conclusion: Arthroscopic LCA can be performed using both grafts. STGD graft is preferable because it seems to avoid patellar tendon graft pathology. The ACL reconstruction with graft cannot reproduce completely the complex biomechanics of the knee so, even if it gives stability to the knee joint, it cannot prevent degenerative changes. The ACL rupture associated to cartilaginous or meniscal injury promotes the arthrosis. For the prevention of osteoarthrosis it is important to preserve the homeostasis of the joint more than single ACL reconstruction with graft. Key Words: anterior cruciate ligament – bone patellar tendon bone – semitendinosus and gracilis tendon graft