Credibility and quality of meta-analyses addressing graft choice in anterior cruciate ligament reconstruction: a systematic review

Kurz, Adrian Z.; Evaniew, Nathan; Yeung, Marco; Samuelsson, Kristian; Peterson, Devin; Ayeni, Olufemi R.

doi:10.1007/s00167-016-4282-z

Cited by 14 publications

(15 citation statements)

References 65 publications

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“…8,25,32,39,40 However, it has been reported that the credibility and quality of published meta-analyses have been limited. 25 As a result, it is recommended that decisions regarding graft choice be made on an individual basis, taking into account patient factors and preferences, surgeon experience, and the best available evidence. 25 Recently, several authors have reported a multitude of advantages of combined ACL and anterolateral ligament (ALL) grafts.…”

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confidence: 99%

“…25 As a result, it is recommended that decisions regarding graft choice be made on an individual basis, taking into account patient factors and preferences, surgeon experience, and the best available evidence. 25 Recently, several authors have reported a multitude of advantages of combined ACL and anterolateral ligament (ALL) grafts. These advantages have been attributed to load sharing with the ACL graft and improved knee kinematics.…”

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confidence: 99%

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Combined ACL and Anterolateral Reconstruction Is Not Associated With a Higher Risk of Adverse Outcomes: Preliminary Results From the SANTI Randomized Controlled Trial

Sonnery‐Cottet

Pioger

Vieira

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: The widespread historical abandonment of lateral extra-articular procedures in anterior cruciate ligament (ACL) injuries occurred as a result of concerns about high rates of adverse events. Recently, the popularity of lateral extra-articular procedures has resurged, warranting an urgent evaluation of their safety profile. Purpose/Hypothesis: The aim of this study was to perform an interim analysis of the ongoing SANTI randomized controlled trial to determine whether combined ACL and anterolateral ligament reconstruction (ACL + ALLR) is associated with an increased rate of adverse outcomes when compared with isolated ACL reconstruction (ACLR). The hypothesis was that there would be no significant difference between groups at a minimum follow-up of 1 year. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: Recruitment commenced in November 2016. Patients scheduled for ACLR were randomized to either isolated ACLR (with bone–patellar tendon–bone [BPTB] autograft) or combined ACL + ALLR (with hamstring tendon autograft). All patients with a minimum follow-up of 1 year by March 2019 were included. The evaluated parameters included complications and reoperations, knee laxity parameters, range of motion, and scores on the Tegner, Lysholm, International Knee Documentation Committee (IKDC), and Knee injury and Osteoarthritis Outcome Score (KOOS) instruments. Results: A total of 224 patients (112 in each group) with a mean ± SD follow-up of 12.3 ± 1.9 months (range, 12-19 months) formed the study population. A significantly higher rate of reoperation for cyclops syndrome was noted in the isolated ACLR group compared with the combined ACL + ALLR group (8.9% vs 0%, respectively; P = .0012). No significant differences were found in frequency of graft rupture (ACLR, 5.4%; ACL + ALLR, 0.9%; P = .1191), range of motion deficits, pain, or reoperation for meniscectomy between groups. No cases of postoperative infection, venous thromboembolism, or arthrofibrosis were seen. Subjective IKDC (81.2 vs 86.8; P = .0048), Lysholm (88 vs 92; P = .0131), and some components of the KOOS were significantly better in the combined ACL + ALLR group. Conclusion: This study demonstrates no evidence of an increased risk of short-term adverse events after combined ACL + ALLR compared with isolated ACLR with BPTB graft. Registration: NCT03740022 ( ClinicalTrials.gov Identifier)

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Combined ACL and Anterolateral Reconstruction Is Not Associated With a Higher Risk of Adverse Outcomes: Preliminary Results From the SANTI Randomized Controlled Trial

Sonnery‐Cottet

Pioger

Vieira

et al. 2020

Orthopaedic Journal of Sports Medicine

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“…A review analyzing these 17 meta-analyses have been published and concluded there to be insufficient evidence to recommend for or against either graft. 33 However, these meta-analyses have been performed on both female and male patients, and no single systematic review or metaanalysis has focused on female patients alone. Three other reviews have looked into the influence of gender on the outcomes of ACL reconstructions.…”

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confidence: 99%

Outcomes of Anterior Cruciate Ligament Reconstruction in Females Using Patellar–Tendon–Bone versus Hamstring Autografts: A Systematic Review and Meta-Analysis

2018

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The current review aims to compare the outcomes of anterior cruciate ligament (ACL) reconstruction in the female population after patellar-tendon-bone and hamstring grafts. The review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. All original randomized controlled trials and prospective cohort studies that compared clinical outcomes after female ACL reconstruction using hamstring versus patellar-tendon-bone grafts were included. All clinical outcomes reported by three or more studies were included. Fifteen publications, with 948 female patients, were included. Most outcomes were reported to have no significant graft differences by all studies that reported the outcome. These included all the outcomes for objective knee scores (International Knee Documentation Committee [IKDC] objective knee score), neuromuscular testing (quadriceps strength, hamstring strength, and single hop test), graft rupture or failure, and subjective knee scores (Lysholm score and IKDC subjective knee score). The pivot shift test, flexion deficit, and presence of crepitus were also reported to have no significant graft differences by all studies. Some studies reported a significant difference in anteroposterior laxity (Lachman's test and instrumented laxity), range of motion deficits (extension deficit), and sports and activity level (Tegner score). However, these statistically significant differences were noted to be clinically insignificant due to the normal population variation or standard error of measurement of these tools of evaluation. Patients reconstructed with patellar-tendon-bone grafts have a higher risk of kneeling pain. There was no significant difference in the incidence of crepitus. Most of the outcomes following female ACL reconstructions showed no clinically and statistically significant difference when either patellar-tendon-bone or hamstring autograft was used. These included outcomes for anteroposterior laxity, objective knee scores, neuromuscular testing, graft rupture or failure, subjective knee scores, sports and activity level, and crepitus. This a level II study.

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“…In a recent systematic review by Kurz et al. 24 reporting on the credibility and quality of meta-analyses addressing graft choice in ACLR, the investigator reported limited credibility of some of the included studies, with a trend toward earlier studies having limited methodological “rigor.” More high-quality studies are needed to evaluate graft choice in ACLRs and improve surgical techniques, coupled with biological approaches to ultimately improve the return to activities of the patients. Historically, most knee arthroscopists debated the indications and benefits of patellar tendon and hamstring autografts.…”

Section: Discussionmentioning

confidence: 99%

Biologically Augmented Quadriceps Tendon Autograft With Platelet-Rich Plasma for Anterior Cruciate Ligament Reconstruction

Chahla

Cinque

Mandelbaum

2018

Arthroscopy Techniques

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Anterior cruciate ligament (ACL) reconstruction is one of the most common procedures studied in the orthopaedic literature. In this regard, graft preparation is a key factor for successful outcomes. Although current methods to reconstruct the ACL are generally perceived to be successful, recent studies indicate that normal structure and function of the knee are fully restored in less than half of the patients. Therefore, biologically augmenting these scaffolds could provide a potential solution for improving healing times and biomechanical properties of the graft. The purpose of this Technical Note is to describe our preferred technique for an ACL graft preparation (quadriceps tendon) augmented with platelet-rich plasma.

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Credibility and quality of meta-analyses addressing graft choice in anterior cruciate ligament reconstruction: a systematic review

Abstract: IV.

Cited by 14 publications

References 65 publications

Combined ACL and Anterolateral Reconstruction Is Not Associated With a Higher Risk of Adverse Outcomes: Preliminary Results From the SANTI Randomized Controlled Trial

Combined ACL and Anterolateral Reconstruction Is Not Associated With a Higher Risk of Adverse Outcomes: Preliminary Results From the SANTI Randomized Controlled Trial

Outcomes of Anterior Cruciate Ligament Reconstruction in Females Using Patellar–Tendon–Bone versus Hamstring Autografts: A Systematic Review and Meta-Analysis

Biologically Augmented Quadriceps Tendon Autograft With Platelet-Rich Plasma for Anterior Cruciate Ligament Reconstruction

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