Outcome of Patellar Tendon Versus 4-Strand Hamstring Tendon Autografts for Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis of Prospective Randomized Trials

Liang

Orthopaedic Journal of Sports Medicine

et al. 2019

Background: Bone–patellar tendon–bone (BPB) autografts and hamstring tendon (HT) autografts are 2 popular choices for anterior cruciate ligament reconstruction (ACLR). Although existing meta-analyses have explored the clinical outcomes between BPB and HT autografts, none have based their analysis on studies with just femoral suspensory fixation methods. Purpose: To evaluate and compare clinical outcomes, particularly graft failure and knee stability, of ACLR with BPB or HT autografts with suspensory femoral fixation. Study Design: Systematic review; Level of evidence, 4. Methods: A literature search was conducted of studies reporting single-bundle ACLR with BPB autografts and HT autografts with suspensory fixation with a minimum 24-month follow-up. Graft failure rate, knee stability, and clinical outcomes were compared for BPB versus HT autografts. Knee stability was measured with the Lachman test, pivot-shift test, and KT-1000/2000 arthrometer side-to-side difference (SSD). Clinical outcomes were measured with Lysholm scores and the Tegner activity scale, as well as rate of return to preinjury sports. Donor site morbidity among included studies was reviewed. A random-effects model was used for calculations of summary estimates. Subgroup, sensitivity, and trial sequential analyses were conducted. Results: Five studies were included. Graft failure was seen more often in the HT group than the BPB group, and this was statistically significant ( P = .03). However, the trial sequential analysis outcome indicated that the included sample size was not large enough to support a solid positive finding. The analysis showed no significant difference in SSD, Lachman test, pivot-shift test, rate of return to sports, Lysholm score, or Tegner score between groups. Subgroup analyses found no significant difference between groups. Conclusion: This meta-analysis demonstrated no significant differences in knee stability and knee functional outcomes between BPB and HT autografts with suspensory fixation. More evidence is needed to prove the lower risk of failure with use of BTB autograft with suspensory fixation.

Section: Discussionmentioning

confidence: 97%

Bone–Patellar Tendon–Bone Autografts Versus Hamstring Autografts Using the Same Suspensory Fixations in ACL Reconstruction: A Systematic Review and Meta-analysis

Liang

Orthopaedic Journal of Sports Medicine

et al. 2019

“…9 The hamstring tendon grafts have greater mechanical strength than a bone-patellar tendon-bone graft. 10 Patients treated with hamstring tendon grafts are less likely to suffer patella-femoral pain and extension loss. Using the hamstring tendon can cause a significant change in hamstring muscle strength.…”

Section: Discussionmentioning

confidence: 99%

Functional outcome of arthroscopic reconstruction of anterior cruciate ligament tear using peroneus longus tendon autograft

et al. 2018

Background: The objective of the study was to evaluate the functional outcome of arthroscopic reconstruction of ACL tear using triple layered PLT autograft and to study its effect on ankle stability.Methods: The study included 25 patients. The range of age was 18-42 years. Pre-op clinical tests and MRI was done to confirm tear. Reconstruction was done arthroscopically. Physiotheraphy protocol was fixed for all patients. Final outcome was assessed at 6 months using IKDC score and ankle stability was assessed by grading muscle power (MRC grading) with the normal side as control.Results: IKDC score was normal or near normal in 21 patients and only 4 patients were rated as abnormal or severely abnormal. Mean IKDC Score was 83.53. Stability of the ACL was assessed using the Lachman test: normal in 18 cases (72%), 1+ laxity in 5 cases (20%), 2+ and 3+ in 1 case (4%) each. Pivot shift was negative in 15 cases (60%), Pivot glide was seen in 9 cases (36%) and gross pivot shift was seen in 1 patient. Partial meniscectomy of the medial meniscus was performed in 5 patients. No patient experienced ankle dysfunction however 2 patients had pressure pain in the region of the graft harvest.Conclusions: PLT graft is similar to the native ACL both in terms of thickness and strength. It can be an appropriate autograft option for ACL reconstruction without compromising ankle function and avoiding potential complications of hamstring and BPTB autograft obtained from the knee region.

“…In this Technical Note, we described endoscopic autogenous hamstring harvest for ACL reconstruction using the gracilis and semitendinosus tendons. Because the hamstring autograft has a reduced incidence of patellofemoral crepitance, kneeling pain, and extension loss, 10 , 11 it is among the most common grafts for ACL reconstruction. The hamstrings can also be used in other ligament reconstruction procedures, including the elbow 12 and the ankle 13 , 14 , 15 ligaments.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Harvest of Autogenous Gracilis and Semitendinosus Tendons

Yeh

Liu

et al. 2018

Arthroscopy Techniques

The hamstring autograft is one of the most popular grafts for anterior cruciate ligament (ACL) reconstruction. Although many techniques for arthroscopic ACL reconstruction using hamstring autografts have been invented, hamstring harvest techniques have not been focused. Hamstrings are harvested using an open technique that requires a 2- to 5-cm skin incision. In this Technical Note, we describe an endoscopic harvest technique of autogenous gracilis and semitendinosus tendon. This technique needs only a 1- to 1.5-cm skin incision and provides surgeons a sufficient view to safely harvest the hamstrings.