Hi everyone,
When I was on my musculoskeletal placement in Curtin Physiotherapy Clinic, I had two patients with ACL reconstruction, one with bone-patellar tendon-bone (BTB) graft and another with hamstring graft. The interesting thing was, they were operated by the same surgeon, so I would like to use this chance to have a look on different types on ACL reconstruction.
There were four types of ACL reconstruction:
1) BTB reconstruction
2) Quadruple hamstring reconstruction
3) Quadriceps tendon reconstruction
4) Allograft reconstruction: BTB, hamstrings, Achilles tendon, quadriceps
Of the above, Quadriceps tendon is not an acceptable way of treatment and allograft reconstruction is rarely done in Australia, but more common in United Kingdom and the United State.
Chapman et al (2006) had done a systematic review to compare the pros and cons of different types of ACL reconstruction (BTB vs. hamstring) and he suggested BTB graft offered the most stable knee post reconstruction and therefore was the most appealing in the elite athlete and the general population.
Characteristics of BTB graft:
- More sturdy and quads strength will not be compromised in a long run
- Take less time to heal
- Have a higher chance to develop anterior knee pain
Characteristics of hamstring graft:
- Less Sturdy
- Take longer time to heal
- Fewer complications than BTB graft
Both of my patients were young (both in their late 20’s) and had a very active life style, I had consulted my supervisors and we were not quite sure why they had a different type of reconstruction since most surgeon would have a preference when performing an ACL reconstruction. The only thing I could pinpoint was one patient was a private patient and another was a public hospital patient, I assumed the difference was related to hospital policy. Any thought on this?
Warm Regards
Kent
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1 comment:
Hi Kent,
I'm not really sure why the same surgeon would have done two different techniques either, i just came from ortho inpts @ Hollywood and found each surgeon had a "preference" for types of surgery, and they rarely used >1 type of approach. Perhaps the public/private system did play a part. I remember Evan told us that a BTB graft was more sturdy and more likely to be used on a "blue-collar worker" type pt as they are potentially non compliant and keen to get back to their job ASAP. Perhaps this surgeon based his decision on the profile of the pt. Private pts would probably have more money for rehab and are more able to take time off work to rehab their knee properly. These of course are all generalisations! In the long run i guess it depends on the pt and how likely the surgeon thinks they are to rehab properly. If they are likely to rehab properly then the choice is generally HS graft due to less complications and at Hollywood i only saw HS grafts.
Hope that helps a little!
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