Lower donor site morbidity with hamstring and quadriceps tendon autograft compared with bone-patellar tendon-bone autograft after anterior cruciate ligament reconstruction: a systematic review and network meta-analysis of randomized controlled trials

Kunze, Kyle N.; Moran, Jay; Polce, Evan M.; Pareek, Ayoosh; Strickland, Sabrina M.; Williams, Riley J.

doi:10.1007/s00167-023-07402-2

Cited by 23 publications

(8 citation statements)

References 48 publications

(92 reference statements)

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“…Hamstring tendon autograft was the most frequent autograft choice in our cohort (91%), followed by patellar tendon graft in 8.6%. The high use of hamstring tendon autograft is consistent with the findings from other European registries, such as the Scandanavian registries [24][25][26][27][33][34][35]. However, BTB is a more popular autograft choice in studies from the United States [36,37].…”

Section: Vte Risk Groupssupporting

confidence: 83%

Satisfactory 5‐year functional outcomes following primary ACL reconstructions from the UK National Ligament Registry

Gabr,

Mancino,

Robinson

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeThe aim of this study was to describe the 10‐year findings from the UK National Ligament Registry (NLR).MethodsA retrospective review was performed for prospectively collected data on the NLR between January 2013 and December 2022. All patients who underwent primary ACL reconstruction (ACLR) on the registry were included. Surgical characteristics were analysed, including surgeon grade and case volume, concomitant knee procedures, venous thromboembolic prophylaxis, graft characteristics, femoral and tibial tunnel drilling, and fixation methods. Clinical outcomes were collected preoperatively and at 6 months, 1 year, 2 years and 5 years following the index procedure.ResultsDuring the study period, 17,492 unilateral ACLR procedures were recorded. Autograft was used in 98%, most commonly a combined semitendinosus and gracilis graft (77%) or patella tendon graft (31%). Allograft was used in only 1% of the patients. In 52% of cases, ACLR was associated with an additional procedure, with isolated medial meniscal surgery being the most common (21%). Femoral tunnel drilling was mostly performed through an anteromedial portal (73%) and tibial tunnel drilling using an outside–in technique (92%). The most common method of femoral graft fixation was with an Endobutton fixed loop suspensory device (77%), while interference screws predominated for tibial tunnel fixation (86%). Patients who underwent ACLR surgery showed significant improvement in their functional outcome scores at six months, 1 year, 2 years and 5 years postoperatively.ConclusionData from the NLR shows a detailed description of the current trends and evolution of ACLR in the United Kingdom over the last 10 years. Satisfactory functional outcomes were observed 5 years postoperatively. This study provides useful information on the prevalence of ACL‐associated injuries and current surgical techniques with the aim of improving the quality of clinical care and patients' outcomes. Moreover, it provides surgeons with a benchmark against which to compare current practices and functional outcomes following ACLR across the United Kingdom.Level of EvidenceLevel III.

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Section: Vte Risk Groupssupporting

confidence: 83%

Satisfactory 5‐year functional outcomes following primary ACL reconstructions from the UK National Ligament Registry

Gabr,

Mancino,

Robinson

et al. 2024

Knee surg. sports traumatol. arthrosc.

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“…52 When compared to other graft options, the QT graft has benefits such as lower morbidity at the donor site (defined as anterior knee pain, difficulty or inability to kneel or both) when compared to the patellar tendon autograft. 53 In a cohort study, ACL reconstruction using a QT graft showed a lower rate of rerupture when compared to autologous flexor graft. 54 In a recent study with 6,652 ACL reconstructions, cases using QT graft had a lower rate of septic arthritis when compared to cases using flexor grafts, patellar tendon grafts or allografts.…”

Section: Autologous Quadricipital Tendon Graftmentioning

confidence: 99%

Novas técnicas de enxertia para reconstrucão do LCA: Artigo de atualização

Lara,

Novaretti,

Nunes

et al. 2024

Rev Bras Ortop (Sao Paulo)

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ResumoA reconstrução do ligamento cruzado anterior (LCA) é um procedimento comum para lesões desse ligamento, especialmente em atletas. Existem diferentes tipos de enxertos utilizados, e a escolha depende de vários fatores. Os enxertos autólogos, do próprio paciente, são a opção mais comum, com rápida incorporação e menor taxa de falha. Enxertos aloenxertos, de doadores, têm seu papel em casos específicos. Os enxertos sintéticos, usados na década de 80, têm vantagens como ausência de morbidade no local doador, mas estudos mostraram complicações a longo prazo. Os enxertos híbridos, combinando enxertos autólogos e aloenxertos, têm ganhado interesse, permitindo um diâmetro maior e reduzindo a morbidade. O enxerto autólogo do tendão do músculo fibular longo tem recebido atenção, com resultados positivos, boa função do joelho e menor hipotrofia da coxa no local doador. O enxerto autólogo do tendão quadricipital tem ganhado popularidade, com resultados comparáveis aos enxertos de tendão patelar e de flexores, menor morbidade no local doador e menor taxa de re-ruptura. A escolha do enxerto evoluiu, com os enxertos autólogos de flexores sendo preferidos para pacientes menos ativos e o enxerto patelar com fragmento ósseo para atletas de alta performance. Enxertos aloenxertos, sintéticos e híbridos têm seu papel em circunstâncias específicas. A escolha deve ser baseada em evidências científicas, considerando vantagens e desvantagens. A reconstrução do LCA é um procedimento complexo que requer considerações individuais para selecionar o enxerto mais adequado.

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“…The median number of studies included was 15 (IQR = 8.6-21.4) and the median number of total patients included was 1398 (IQR = 771.5-2024.5). Studies were published in 21 different journals, with the most common journals of publication being: The Journal of Arthroscopic and Related Surgery (nine studies; 18%) [4,5,10,11,13,25,32,54,60], The American Journal of Sports Medicine (seven studies; 14%) [6,16,22,23,48,67,69] and Knee Surgery, Sports Traumatology, Arthroscopy (six studies; 12%) [26,35,40,41,49,72]. The most commonly investigated comparison of autografts in included studies was HT versus BPTB (35/50, 70%), followed by QT versus HT versus BPTB (9/50, 18%), QT versus HT (3/ 50, 6%) and QT versus BPTB (1/50, 2%).…”

Section: Study Characteristicsmentioning

confidence: 99%

Evaluating the quality of systematic reviews of comparative studies in autograft‐based anterior cruciate ligament reconstruction using the AMSTAR‐2 tool: A systematic umbrella review

Sritharan,

Milantoni,

Abdel Khalik

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeThere remains a lack of consensus around autograft selection in anterior cruciate ligament reconstruction (ACLR), though there is a large body of overlapping systematic reviews and meta‐analyses. Systematic reviews and their methodological quality were aimed to be further assessed, using a validated tool known as assessing the methodological quality of systematic reviews (AMSTAR‐2).MethodsMEDLINE, Embase and CENTRAL were searched from inception to 23 April 2023 for systematic reviews (with/without meta‐analysis) comparing primary ACLR autografts. A final quality rating from AMSTAR‐2 was provided for each study (‘critically low’, ‘low’, ‘moderate’ or ‘high’ quality). Correlational analyses were conducted for ratings in relation to study characteristics.ResultsTwo thousand five hundred and ninety‐eight studies were screened, and 50 studies were ultimately included. Twenty‐four studies (48%) were rated as ‘critically low’, 17 (34%) as ‘low’, seven (14%) as ‘moderate’ and two (4%) as ‘high’ quality. The least followed domains were reporting on sources of funding (1/50 studies), the impact of risk of bias on results of meta‐analyses (11/36 studies) and publication bias (17/36 studies). There was a significant increase in the frequency of studies graded as ‘moderate’ compared to ‘low’ or ‘critically low’ quality over time (p = 0.020).ConclusionThe methodological quality of systematic reviews comparing autografts in ACLR is low, with many studies being rated lower due to commonly absent aspects of systematic review methodology such as investigating sources of funding and publication bias. More recent studies were generally more likely to be of higher quality. Authors are advised to consult AMSTAR‐2 prior to conducting systematic reviews in ACLR.Level of Evidence: Level IV.

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Lower donor site morbidity with hamstring and quadriceps tendon autograft compared with bone-patellar tendon-bone autograft after anterior cruciate ligament reconstruction: a systematic review and network meta-analysis of randomized controlled trials

Cited by 23 publications

References 48 publications

Satisfactory 5‐year functional outcomes following primary ACL reconstructions from the UK National Ligament Registry

Satisfactory 5‐year functional outcomes following primary ACL reconstructions from the UK National Ligament Registry

Novas técnicas de enxertia para reconstrucão do LCA: Artigo de atualização

Evaluating the quality of systematic reviews of comparative studies in autograft‐based anterior cruciate ligament reconstruction using the AMSTAR‐2 tool: A systematic umbrella review

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