Bone-patellar tendon-bone versus two- and four-strand hamstring tendon autografts for ACL reconstruction in young adults: a Bayesian network meta-analysis

Abstract

Bone-patellar tendon-bone (BPTB), two- and four-strand hamstring tendon (4SHT and 2SHT, respectively) are the most common autografts used for anterior cruciate ligament (ACL) reconstruction. The present study compared BPTB, 2SHT, and 4SHT for ACL reconstruction in terms of joint laxity, patient reported outcome measures (PROMs), rate of failure and anterior knee pain (AKP). The time to return to sport and the peak torque between the autografts were also compared. Finally, prognostic factors leading to worse outcomes were also investigated. It was hypothesized that all grafts yield similar proprieties in terms of joint laxity, patient reported outcome measures (PROMs) and rate of failure, but that the BPTB autograft causes a greater rate of anterior knee pain (AKP). The literature search was conducted. All clinical trials comparing BTPB and/or 2SHT, and/or 4SHT were accessed. Grafts other than BTPB and/or 4SHT and/or 2SHT were not considered. Articles reporting outcomes of allografts or synthetic grafts were not eligible, nor were those concerning revision settings. Articles reporting ACL reconstruction in patients with multi-ligament damage were also not eligible. Data from 95,575 procedures were retrieved. The median length of follow-up was 36 months. The median age of the patients was 27.5 years. With regard to joint laxity, similarity was found in terms of Lachman and Pivot shift tests between all three autografts. The BPTB demonstrated the greatest stability in terms of instrumental laxity. BPTB demonstrated the greatest PROMs. BPTB demonstrated the greatest rate of AKP, while AKP in 2SHT and 4SHT was similar. Concerning failure, statistically significant inconsistency was found (P = 0.008). The 4SHT demonstrated the quickest return to sport, followed by BPTB, and 2SHT. There was evidence of a negative association between the time span between injury to surgery, Lysholm score (P = 0.04), and Tegner scale (P = 0.04). Furthermore, there was evidence of a weak positive association between the time span between injury to surgery and return to sport (P = 0.01). BPTB may result in lower joint laxity, greater PROMs, and greater peak flexion torque compared to 2SHT and 4SHT autografts. On the other hand, BPTB reported the lowest peak extension torque and the greatest rate of AKP. Finally, a longer time span between injury and surgery negatively influences outcome.

Factors Associated With Sports Function and Psychological Readiness to Return to Sports at 12 Months After Anterior Cruciate Ligament Reconstruction: A Cross-sectional Study

“…A vast majority of the ACLR procedures in the current study were performed using a hamstring tendon graft. A recent network meta-analysis reported differences in joint stability, PROM scores, and RTS rates between different graft types (hamstring and patella), 40 and, thus, we cannot generalize the results to those who have undergone reconstruction using a different graft. Along the same lines, we only included patients who had undergone ACLR with a time of 1 year after surgery, and we cannot generalize our findings to those with an ACL-deficient knee or other time interval since ACLR.…”

Anterior cruciate ligament reconstruction in skeletally immature patients is effective: A systematic review

“…Graft choice is crucial in ACL reconstruction in children [98,99], but between studies, heterogeneities in graft choice were evident. A bone-patellar tendonbone autograft has the advantage of high initial strength compared with other tissues [100,101]. Its tendon-bone interface also allows bone-to-bone healing [102].…”

Tendon cross‐sectional area on magnetic resonance imaging and anthropometric characteristics can be used to predict insufficient four‐strand hamstring autograft diameter in anterior cruciate ligament reconstruction: A systematic review

“…The four-strand hamstring autograft is a common graft source for anterior cruciate ligament reconstruction (ACLR) [12]. Hamstring autografts provide certain advantages to alternative options, including reduced injury to the extensor mechanism and decreased rates of anterior knee pain [38]. Recent literature has outlined the influence of graft diameter on failure rates in ACLR when using this graft option [17].…”