Anterior cruciate ligament reconstruction with contralateral autogenous patellar tendon graft: Evaluation of donor site strength and subjective results

Abstract

Background: Few surgeons use a contralateral patellar tendon autograft for primary anterior cruciate ligament (ACL) reconstruction because of concern for donor site morbidity. Hypothesis: There will be no difference in quadriceps muscle strength or International Knee Documentation Committee (IKDC) subjective scores in patients with contralateral grafts compared with patients with ipsilateral grafts. Study Design: Cohort study; Level of evidence, 3. Methods: Between 2007 and 2009, a total of 279 patients who underwent primary ACL reconstruction with autogenous patellar tendon graft from the contralateral knee met the inclusion criteria of unilateral knee involvement, no arthritic changes preoperatively, and minimum 2-year follow-up objective and subjective evaluations. A control group was obtained of 58 patients who had the same inclusion criteria and were of the same age but who underwent surgery with ipsilateral graft. Patients underwent a goaldirected and sequential postoperative rehabilitation program that first emphasized controlling a hemarthrosis and obtaining full knee range of motion immediately after surgery, followed by increasing leg strength and performing functional activities. The rehabilitation for the contralateral donor site emphasized high-repetition/low-resistance exercises beginning the day after surgery. The IKDC subjective data were compared between surgery groups. Quadriceps muscle strength was evaluated in both knees compared with the preoperative values obtained in the noninvolved knee and between knees at 2 years postoperatively. Results: Quadriceps muscle strength compared with the preoperative normal value (mean 6 SD) was 105% ± 29% in the ipsilateral ACL-reconstructed knee versus 114% ± 28.4% in the contralateral donor knee (P