| Objective: The purpose of this study was to compare the clinical effect and the differences of the knee function through the follow-up of the patient who underwent anterior cruciate ligament (ACL) double-bundle reconstruction with autologous hamstring tendon or anterior tibial tendon allograft, and to provide clinical evidence for the choice of autograft or allograft in the ACL reconstruction.Methods: A retrospective analysis was performed of 44 patients who had underwent arthroscopic ACL double-bundle reconstruction with autologous hamstring tendon or anterior tibial tendon allograft and endo-button system. The patients were divided into 2 groups according to autograft or allograft, and each group included 22 cases. In both groups continuous epidural anesthesia and regular anteromedial and anterolateral approach were performed, the intra-articular structures were explored. Make sure that the ACL was ruptured, and then prepare the autologus or allograft tendon with surgical suture. If necessary, proliferative membrana synovialis were cleared and damaged meniscus were sutured or repaired. Try to remain the tibial stump of the ligament. Drill the femoral anteromedial and posterolateral bundle bone tunnel, and then create the tibial anteromedial and posterolateral bundle bone tunnel. Draw the prepared ligament with endo-button loop into the corresponding bone tunnel.Intraoperative X-ray examination confirmed after the plate has passed through femoral cortical line and pull the traction cable to flip button plate. Flex the knee at 30 degrees and then fix the tibial bone tunnel tendon with absorbable interference screw while posterior drawer test were taken. Check the ligament was fixed firmly with arthroscope while anterior and posterior drawer test were taken. Suture the incision after the joint cavity was washed ,drainage built. Bandage the incision with compression. Fix the knee with brace for 3 months. The rehabilitation began 3 weeks after the surgery. Flex the knee to 45 degrees after 3 weeks, to 90 degrees after 4 weeks and 120 degrees after 6 weeks. The patient could return to nomal life and non-heavy manual labor, and intense activity was banned in the 1st year postopertion. The knee examination of postoperative follow-up was conducted by the same senior doctor, including Lachman test and anterior drawer test (ADT), and in accordance with the IKDC, Lysholm, Tegner knee score criteria to grade their knee function.Results: The follow-up time of 44 patients was 23-29 months (mean 27 months). One patient in autologous group happened with tibial incision swelling and effusion because of rejection.The wound turned out fine after cleaning and changing dressing.2 cases in autograft group were found venous thrombosis between muscles in lower extremity and were given low molecular weight heparin for 1 week, and the venous thrombosis disappered finally under ultrasound scan. The function of knee of was good in the rest patients. The score of allograft group was as follows: IKDC (%) score (80.55±2.74), Lysholm score (86.68±3.90), Tegner score (5.86±0.99). The score of autograft group was as follows: IKDC (%) score (82.27±2.99), Lysholm score (88.09±3.74), Tegner score (6.05±1.00). Difference between the two groups was not significant (P> 0.05). The result of Lachmann test was as follows: allograft group negative (13), positive I degree (8), positive II degree (1), positive III degree (0); The result of ADT check was as follow: negative (15), positive I degree (6), positive II degrees ( 1), positive level III (0). Neutral anterior drawer test: Autologous groups: negative (18), positive I degree (3), positive II degree (1), positive III degree (0); allograft groups: negative (17), positive I (4), degree of positive II (1), positive III degree (0). Both groups were tested by two groups were non-parametric test, and no significant difference was found between the two groups (P> 0.05). Autologous hamstring tendon group were companied with varying degrees of internal rotation weakness and flexor muscle weakness due to the absence of hamstring tendon. The positive function improved after training, but did not reach the contralateral level.Conclusion: Both ACL double-bundle reconstruction with autologous hamstring tendon and the anterior tibial tendon allograft with endo-button system have good clinical efficacy. Autologous group were accompanied with varying degrees of flexion and internal rotation fatigue, But the function could be improved by active exercise.Venous thrombosis were found in 2 cases in autograft group due to less functional exercise. The incidence is higher than the allograft group.Allograft group was higher risk of rejection reaction. There was no significant difference between autograft and allograft group.
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