Hamstring tendon autograft better than bone patellartendon bone autograft in ACL reconstruction A cumulative meta-analysis and clinically relevant sensitivity analysis applied to a previously published analysis

Abstract

Background Current debate on treatment options for anterior cruciate ligament (ACL) reconstruction complicate the choice between hamstring and bone patellartendon bone autografts. We hypothesized a priori that cumulative meta-analysis (a form of sensitivity analysis) might show that the evidence for reduction of morbidity by hamstring grafts could have been reached at an earlier time. Furthermore, we hypothesized a priori that modern state-of-the-art hamstring graft fixation technique would give similar results regarding stability as bone-patellar tendon-bone autografts.Methods We performed a cumulative meta-analysis and sensitivity analysis based on femoral graft fixation techniques to compare hamstring autograft and bonepatellar tendon-bone autografts in ACL reconstruction derived from a previously published meta-analysis.Results Cumulatively, that hamstring autograft reduces anterior knee pain had already reached statistical significance in 2001 (relative risk 0.49 (95%CI: 0.32-0.76; p = 0.001, I2 = 0%)). The modern endobutton hamstring graft fixation technique (2 studies) yielded similar stability in the Lachman test as bone-patellar tendon-bone grafts, with a relative risk of 1.1 (95%CI: 0.82-1.5; p = 0.6, I2 = 0%). Exclusion of the endobutton group explains the increased laxity in the hamstring graft group.Interpretation Cumulative meta-analysis strengthens the evidence for reduced morbidity using hamstring tendon autograft for anterior cruciate ligament reconstruction. Sensitivity analysis focusing on state-of-the-

A prospective study of functional outcome of ACL reconstruction with quadrupled semitendinosus tendon autograft using Endobutton and bioabsorbable interference screw

“…Thus laxity tests performed at 02 year follow-up was statistically significant suggesting improvement in the stability of knee between pre-operative and post-operative status of patients in our study. These results are comparable to the results achieved by various other authors Beynnon et al [17] Saccomanno et al [33] and Poolman et al [34] Functional Outcome H. E. Bourke et al [35] reported the outcome of 'isolated' anterior cruciate ligament (ACL) ruptures treated with anatomical endoscopic reconstruction using hamstring tendon autograft at a mean of 15 years. A total of 152 patients underwent subjective assessment at 15 years.…”

Artroskopik ön çapraz bağ onarımı için hamstring tendon otogreftine kıyasla kuadriseps tendon kullanımı: Klinik sonuçların karşılaştırmalı analizi

“…[7] Poolman et al [8] reported that newer hamstring graft fixation methods yielded similar stability as bone-patellar tendon-bone grafts. None of our patients had any clinical problem requiring revision surgery due to failure of fixation.…”

Functional outcome of anterior cruciate ligament reconstruction with quadruple hamstring tendon graft using EndoButton and bioabsorbable interference screw: minimum 2-year follow-up

“…These results are comparable to the results achieved by various other authors world-wide. 4,9,20,21 In this study, we had one case of graft re-rupture, but it was not related to the surgical technique. One patient was diagnosed to have cyclops lesion on MRI resulting in painful restriction of terminal extension.…”