Bone-patellar tendon-bone graft vs hamstring graft

Meta-Analysis

Outcome of bone-patellar tendon-bone vs hamstring tendon autograft for anterior cruciate ligament reconstruction: A meta-analysis of randomized controlled trials with a 5-year minimum follow-up

Lilian Zhao et al. Medicine (Baltimore). 2020.

Free PMC article

Erratum in

• Outcome of bone-patellar tendon-bone vs hamstring tendon autograft for anterior cruciate ligament reconstruction: A meta-analysis of randomized controlled trials with a 5-year minimum follow-up: Erratum.

  [No authors listed] [No authors listed] Medicine (Baltimore). 2022 Aug 26;101(34):e29873. doi: 10.1097/MD.0000000000029873. Medicine (Baltimore). 2022. PMID: 36044668 Free PMC article. No abstract available.

Abstract

Background: Many systematic reviews have compared the short-term outcomes of anterior cruciate ligment (ACL)reconstruction with hamstring and patellar tendon autograft,but few differences have been observed. The purpose of this meta-analysis was to compare the medium-term outcome of bone-patellar tendon-bone and hamstring tendon autograft for anterior cruciate ligament reconstruction in terms of clinical function, knee stability, postoperativecomplications, and osteoarthritis changes.

Methods: This meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The PubMed, Embase, and the Cochrane Library databases were searched from inception to November 2, 2019. This meta-analysis included only randomized controlled trials that compared BPTB and HT autografts for ACL reconstruction with a 5-year minimum follow-up. The Cochrane Collaboration's risk-of-bias tool was used to estimate the risk-of-bias for all included studies. RevMan 5.3 software was used to performed statistical analysis of the outcomes.

Results: Fifteen RCTs, involving 1298 patients (610 patients in the BPTB group and 688 patients in the HT group) were included. In terms of clinical function, no significant difference was found in the objective International Knee Documentation Committee score (OR = 0.94, 95%CI: 0.64-1.37, P = .75), Lysholm knee score (MD = -2.26, 95%CI: -4.56 to 0.05, P = .06), return to preinjury activity level (OR = 1.01, 95%CI: 0.67-1.52, P = .96), and Tegner activity level (OR = 0.03, 95%CI: -0.36 to 0.41, P = .89). There was no statistically significant difference in the Lachman test (OR = 0.86, 95%CI: 0.5-1.32, P = .50), pivot-shift test (OR = 0.68, 95%CI: 0.44-1.06, P = .09), and side-to-side difference (MD = -0.32, 95%CI: -0.81 to 0.16, P = .19). As for postoperative complications and OA changes, there were no statistically significant difference in flexion loss (OR = 1.09, 95%CI: 0.47-2.54, P = .85) and OA changes (OR = 0.76, 95%CI: 0.52-1.10, P = .15), but we found significant differences in favor of the HT group in the domains of kneeling pain (OR = 1.67, 95%CI: 1.04-2.69, P = .03), anterior knee pain (OR = 2.90, 95%CI: 1.46-5.77, P = .002), and extension loss (OR = 1.75, 95%CI: 1.12-2.75, P = .01). There was a significant difference in favor of the BPTB group in the domain of graft failure (OR = 0.59, 95%CI: 0.38-0.91, P = .02).

Conclusions: Based on the results above, HT autograft is comparable with the BPTB autograft in terms of clinical function, postoperative knee stability, and OA changes, with a medium-term follow-up. The HT autograft for ACL reconstruction carries a lower risk of complications, such as anterior knee pain, kneeling pain, and extension loss, but an increased incidence of graft failure. Patients should be informed of the differences when deciding on graft choice with their physician.

Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) flowchart of the literature search.

Assessment of risk-of-bias.

Forest plot of comparison of the postoperative objective International Knee Documentation Committee (IKDC) score with grades C and D between the bone–patellar tendon–bone (BPTB) vs hamstring tendon (HT) autograft groups for anterior cruciate ligament reconstruction.

Forest plot of comparison of Lysholm knee score between the bone–patellar tendon–bone (BPTB) vs hamstring tendon (HT) autograft groups for anterior cruciate ligament reconstruction.

Forest plot of comparison of return to preinjury activity level between the bone–patellar tendon–bone (BPTB) vs hamstring tendon (HT) autograft groups for anterior cruciate ligament reconstruction.

Forest plot of comparison of postoperative Tegner activity level between the bone–patellar tendon–bone (BPTB) vs hamstring tendon (HT) autograft groups for anterior cruciate ligament reconstruction.

Forest plot of comparison of postoperative side-to-side difference between the bone–patellar tendon–bone (BPTB) vs hamstring tendon (HT) autograft groups for anterior cruciate ligament reconstruction.

Forest plot of comparison of the postoperative Lachman test results between the bone–patellar tendon–bone (BPTB) vs hamstring tendon (HT) autograft groups for anterior cruciate ligament reconstruction.

Forest plot of comparison of the postoperative pivot-shift test results between the bone–patellar tendon–bone (BPTB) vs hamstring tendon (HT) autograft groups for anterior cruciate ligament reconstruction.

Forest plot of comparison of the postoperative kneeling pain between the bone–patellar tendon–bone (BPTB) vs hamstring tendon (HT) autograft groups for anterior cruciate ligament reconstruction.

Forest plot of comparison of the postoperative anterior knee pain between the bone–patellar tendon–bone (BPTB) vs hamstring tendon (HT) autograft groups for anterior cruciate ligament reconstruction.

Forest plot of comparison of postoperative extension loss between the bone–patellar tendon–bone (BPTB) vs hamstring tendon (HT) autograft groups for anterior cruciate ligament reconstruction.

Forest plot of comparison of postoperative flexion loss between the bone–patellar tendon–bone (BPTB) vs hamstring tendon (HT) autograft groups for anterior cruciate ligament reconstruction.

Forest plot of comparison of postoperative graft failure between the bone–patellar tendon–bone (BPTB) vs hamstring tendon (HT) autograft groups for anterior cruciate ligament reconstruction.

Forest plot of comparison of osteoarthritis (OA) between the bone–patellar tendon–bone (BPTB) vs hamstring tendon (HT) autograft groups for anterior cruciate ligament reconstruction.

Funnel plot with 95% CL is showing mild publication bias for comparison of graft failure between BPTB and HT autograft.

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