A Systematic Approach for Stronger Documentation of Anterior Cruciate Ligament Graft Choice

Abstract

Numerous studies have focused on determining the optimal choice between the two most used anterior cruciate ligament (ACL) reconstruction autografts. In order to address this matter, we performed a systematic review of every meta-analysis published on the PubMed platform between 2001 and 2020, comparing the functional outcomes, the static stability parameters, as well as the postoperative and longterm complications of the patellar tendon (BPTB) autograft and hamstrings (HT). We retrieved a total of 26 meta-analyses that met our criteria, and the characteristics and outcomes of every meta-analysis, as well as subgroup analysis regarding the type of the study design, number of strands of HT autograft, and fixation method, were extensively recorded. The majority of the meta-analyses showed that there were no significant differences between BPTB and HT in terms of functional outcomes and static stability parameters while HT autografts seem to be superior to BPTB regarding kneeling pain and anterior knee pain. Other outcomes seem to be affected by the number of strands of the HT autograft, the fixation technique, and the type of study design, indicating superiority of the four-strand HT autograft with the use of an extra-cortical button fixation. Overall, there is no clear superiority of BPTB over HT autografts for ACL reconstruction, as both types present similar outcomes in the majority of postoperative parameters. Autograft selection should be individualized according to each patient's needs and more RCTs are warranted in order to reach safer results on the appropriate autograft type.

Creating an Optimal In Vivo Environment to Enhance Outcomes Using Cell Therapy to Repair/Regenerate Injured Tissues of the Musculoskeletal System

“…After skeletal maturity, injury to load bearing connective tissues, such as some ligaments, tendons and menisci can lead to the host attempting to initiate repair using the wound healing apparatus, or a failure to initiate such a response as in the case of complete rupture of the anterior cruciate ligament (ACL) of the knee, or after generation of a defect in articular cartilage. In the case of the ruptured ACL, the two ends of the ligament cannot find each other and thus a reconstruction with an autologous tissue section of a tendon [ 40 , 41 ] or an allogeneic tissue is required. In this circumstance, the reconstruction operation is another inflammatory stimulus with additional tissue damage due to the drilling of bone and cutting to gain access to the interior of the joint.…”

An Efficient Needleless Grasping Suture Technique for Graft Preparation in Anterior Cruciate Ligament Reconstruction

“…The estimated number of ACL injuries per year in the United States has increased to over 200,000 annually, and the number of ACL reconstruction (ACLR) performed has reached 120,000 per year ( 1 , 2 ). For the graft, several choices are available, including autograft [bone-patella tendon-bone (BTB), hamstring tendon (HT)] or allograft tendon, and artificial ligament ( 3 ). Among them, the autograft tendon is the most popular graft used.…”

Revision Rates After Primary Allograft ACL Reconstruction by Allograft Tissue Type in Older Patients

“… 7 These studies almost universally pool all allograft tissue types together or examine a single allograft type. There is also considerable literature guiding surgeons on autograft type, with 26 meta-analyses of bone–patellar tendon–bone (BTB) versus hamstring tendon, 2 over 28,000 patients in quadriceps tendon versus hamstring tendon comparisons, 34 and over 27 studies comparing BTB versus quadriceps tendon. 23 …”