Comparison of clinical outcomes of reconstruction of the anterior cruciate ligament: autogenous patellar tendon and hamstring grafts.

In this critical review, we summarize the literature comparing the 2 grafts most frequently used in reconstruction of the anterior cruciate ligament--patellar tendon and hamstring autografts. We evaluate the biomechanical properties, comorbidities, and clinical performance of the grafts and focus our review on clinical outcomes reported in prospective randomized studies. Although the overall profile of the autogenous hamstring graft with respect to biomechanics and side effects seems equal or superior to that of the patellar tendon graft, there is little difference in clinical outcomes. From review of prospective randomized trials and a large controlled retrospective study, the trend suggests if fixation is controlled, outcomes are similar with the 2 grafts, with the possible exception of when they are used with high-demand athletes, in whom patellar tendon grafts may show a slight disadvantage. Large-scale prospective randomized studies with careful data collection and control are needed to better define graft performance in vivo.