Comparison between Patellar Tendon Bone and Hamstring Tendon in Anterior Cruciate Ligament Reconstruction: Systematic Review


  • Fuad Iqbal Elka Putra Cileungsi Regional Hospital, Bogor, West Java, Indonesia
  • Hanifah Hanum General Practitioner, Kartika Hospital, Jakarta, Indonesia



Anterior Cruciate Ligament Injury, autograft, bone patellar tendon bone, hamstring tendon


Anterior Cruciate Ligament is a ligament injury is the most common injury around knee and divided into partial tear or complete tear. The aim of this study is to compare the outcome between Bone Patellar Tendon Bone (BPTB) autograft versus Hamstring Tendon (HT) for ACL reconstruction. The outcomes were assessed with International Knee Documentation Committee (IKDC), Lysholm score, Tegner activity scale and donor site morbidity. This  systematic  review  uses  Preferred  Reporting  Items  for  Systematic  Reviews  and  Meta-Analyses  (PRISMA)  guidelines.  The articles  were  searched  for  studies  that  compared  functional  outcomes  of ACL  reconstruction  between BPTB autograft versus hamstring tendon autografts with a  minimum 6 months follow-up. We analayzed 8 studies that compare outcomes of BPTB autograft (862 patient) vs HT autograft (4.991  patient). There was no significant differences in a patient underwent ACL reconstruction with BPTB autograft vs HT autograft the outcomes by IKDC score, Lysholm score and Tegner activity scale. In one study showed was significant in donor site morbidity where BPTB autograft makes postoperative pain during kneeling higher than HT autograft in 10 years follow up (BPTB 64%, HT 33%, p value 0.019) and the prevalence in pain during squatting BPTB was higher than HT autograft in 10 years follow up (BPTB 55%, HT 29%, p value 0.046). This study concluded there was no significant difference of comparison between BPTB autograft and HT autograft group after ACL reconstruction. Donor site morbidity most commonly occured in BPTB group than HT gorup.

Keywords : Anterior Cruciate Ligament Injury, autograft, bone patellar tendon bone, hamstring tendon

Author Biography

Fuad Iqbal Elka Putra, Cileungsi Regional Hospital, Bogor, West Java, Indonesia




Raines BT, Naclerio E, Sherman SL. Management of Anterior Cruciate Ligament Injury: What's In and What's Out? Indian J Orthop. 2017 Sep-Oct;51(5):563-575

DeFazio MW, Curry EJ, Gustin MJ, Sing DC, Abdul-Rassoul H, Ma R, Fu F, Li X. Return to Sport After ACL Reconstruction With a BTB Versus Hamstring Tendon Autograft: A Systematic Review and Meta-analysis. Orthop J Sports Med. 2020 Dec 15;8(12)

Herbawi F, Lozano-Lozano M, Lopez-Garzon M, Postigo-Martin P, Ortiz-Comino L, Martin-Alguacil JL, Arroyo-Morales M, Fernandez-Lao C. A Systematic Review and Meta-Analysis of Strength Recovery Measured by Isokinetic Dynamometer Technology after Anterior Cruciate Ligament Reconstruction Using Quadriceps Tendon Autografts vs. Hamstring Tendon Autografts or Patellar Tendon Autografts. Int J Environ Res Public Health. 2022 Jun 1;19(11):6764

Smith AH, Capin JJ, Zarzycki R, Snyder-Mackler L. Athletes With Bone-Patellar Tendon-Bone Autograft for Anterior Cruciate Ligament Reconstruction Were Slower to Meet Rehabilitation Milestones and Return-to-Sport Criteria Than Athletes With Hamstring Tendon Autograft or Soft Tissue Allograft : Secondary Analysis From the ACL-SPORTS Trial. J Orthop Sports Phys Ther. 2020 May;50(5):259-266

Gupta PK, Acharya A, Mourya A, Mahajan P. Comparison of patellar tendon versus hamstrings autografts for anterior cruciate ligament reconstruction in Indian population: A randomised control trial study. J Clin Orthop Trauma. 2019 May-Jun;10(3):581-585

Collins NJ, Misra D, Felson DT, Crossley KM, Roos EM. Measures of knee function: International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, Knee Injury and Osteoarthritis Outcome Score (KOOS), Knee Injury and Osteoarthritis Outcome Score Physical Function Short Form (KOOS-PS), Knee Outcome Survey Activities of Daily Living Scale (KOS-ADL), Lysholm Knee Scoring Scale, Oxford Knee Score (OKS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Activity Rating Scale (ARS), and Tegner Activity Score (TAS). Arthritis Care Res (Hoboken). 2011 Nov;63 Suppl 11(0 11):S208-28

Arida C, Tsikrikas CG, Mastrokalos DS, Panagopoulos A, Vlamis J, Triantafyllopoulos IK. Comparison of Bone-Patella Tendon-Bone and Four-Strand Hamstring Tendon Grafts for Anterior Cruciate Ligament Reconstruction: A Prospective Study. Cureus. 2021 Nov 2;13(11):e19197.

Barié A, Sprinckstub T, Huber J, Jaber A. Quadriceps tendon vs. patellar tendon autograft for ACL reconstruction using a hardware-free press-fit fixation technique: comparable stability, function and return-to-sport level but less donor site morbidity in athletes after 10 years. Arch Orthop Trauma Surg. 2020 Oct;140(10):1465-1474.

Guglielmetti LGB, Salas VER, Jorge PB, Severino FR, Duarte A, de Oliveira VM, Cury RPL. Prospective and Randomized Clinical Evaluation of Hamstring Versus Patellar Tendon Autograft for Anterior Cruciate Ligament Reconstruction in Soccer Players. Orthop J Sports Med. 2021 Sep 24;9(9):23259671211028168.

E Albuquerque RP, Giordano V, Calixto A, Malzac F, Aguiar C, do Amaral NP, Carvalho AC. Analysis On The Modified Lysholm Functional Protocol Among Patients With Normal Knees. Rev Bras Ortop. 2015 Nov 16;46(6):668-74.

Sanada T, Iwaso H, Fukai A, Honda E, Yoshitomi H, Inagawa M. Anatomic Anterior Cruciate Ligament Reconstruction Using Rectangular Bone-Tendon- Bone Autograft Versus Double-Bundle Hamstring Tendon Autograft in Young Female Athletes. Arthrosc Sports Med Rehabil. 2021 Feb 4;3(1):e47-e55

Britt E, Ouillette R, Edmonds E, Chambers H, Johnson K, Bastrom T, Pennock A. The Challenges of Treating Female Soccer Players With ACL Injuries: Hamstring Versus Bone-Patellar Tendon-Bone Autograft. Orthop J Sports Med. 2020 Nov 30;8(11)

Cristiani R, Sarakatsianos V, Engström B, Samuelsson K, Forssblad M, Stålman A. Increased knee laxity with hamstring tendon autograft compared to patellar tendon autograft: a cohort study of 5462 patients with primary anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2019 Feb;27(2):381-388.

Itthipanichpong T, Moonwong S, Thamrongskulsiri N, Prasathaporn N, Kuptniratsaikul S, Tegner Y, Lysholm J, Tanpowpong T. Validity and Reliability of the Thai Versions of the Lysholm Knee Scoring Scale and Tegner Activity Scale. Orthop J Sports Med. 2023 Feb 15;11(2)

Stańczak K, Zielińska M, Synder M, Domżalski M, Polguj M, Sibiński M. Comparison of hamstring and patellar tendon grafts in anterior cruciate ligament reconstruction: A prospective randomized study. J Int Med Res. 2018 Feb;46(2):785-791



How to Cite

Putra, F. I. E., & Hanum, H. (2023). Comparison between Patellar Tendon Bone and Hamstring Tendon in Anterior Cruciate Ligament Reconstruction: Systematic Review. Medical Profession Journal of Lampung, 13(7), 1112-1119.