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Meta-Analysis
. 2011 Sep 7;2011(9):CD005960.
doi: 10.1002/14651858.CD005960.pub2.

Patellar tendon versus hamstring tendon autograft for anterior cruciate ligament rupture in adults

Nicholas Gh Mohtadi  1 , Denise S Chan, Katie N Dainty, Daniel B Whelan
Affiliations
Meta-Analysis

Patellar tendon versus hamstring tendon autograft for anterior cruciate ligament rupture in adults

Nicholas Gh Mohtadi et al. Cochrane Database Syst Rev. .

Abstract

Background: Reconstruction of the anterior cruciate ligament (ACL) commonly involves patellar tendon (PT) or hamstring tendon(s) (HT) autografts. There is no consensus with respect to the choice between these two grafts in ACL surgery.

Objectives: This review compared the outcomes of ACL reconstruction using PT versus HT autografts in ACL deficient patients.

Search strategy: We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (April 2008), the Cochrane Central Register of Controlled Trials (2008, Issue 2), MEDLINE (1966 to April 10 2008), EMBASE (1980 to April 10 2008), conference proceedings and reference lists. No language restrictions were applied.

Selection criteria: Randomized and quasi-randomized controlled trials comparing outcomes (minimum two year follow-up) following ACL reconstruction using either PT or HT autografts in skeletally mature adults, irrespective of the number of bundles, fixation method or incision technique.

Data collection and analysis: After independent study selection, the four authors independently assessed trial quality and risk of bias, and extracted data using pre-developed forms. Trial authors were contacted for additional data and information. Risk ratios with 95% confidence intervals were calculated for dichotomous outcomes, and mean differences and 95% confidence intervals for continuous outcomes.

Main results: Nineteen trials providing outcome data for 1597 young to middle-aged adults were included. Many trials were at high risk of bias reflecting inadequate methods of randomization, lack of blinding and incomplete assessment of outcome.Pooled data for primary outcomes, reported in a minority of trials, showed no statistically significant differences between the two graft choices for functional assessment (single leg hop test), return to activity, Tegner and Lysholm scores, and subjective measures of outcome. There were also no differences found between the two interventions for re-rupture or International Knee Documentation Committee scores. There were inadequate long-term results, such as to assess the development of osteoarthritis.All tests (instrumental, Lachman, pivot shift) for static stability consistently showed that PT reconstruction resulted in a more statically stable knee compared with HT reconstruction. Conversely, patients experienced more anterior knee problems, especially with kneeling, after PT reconstruction. PT reconstructions resulted in a statistically significant loss of extension range of motion and a trend towards loss of knee extension strength. HT reconstructions demonstrated a trend towards loss of flexion range of motion and a statistically significant loss of knee flexion strength. The clinical importance of the above range of motion losses is unclear.

Authors' conclusions: There is insufficient evidence to draw conclusions on differences between the two grafts for long-term functional outcome. While PT reconstructions are more likely to result in statically stable knees, they are also associated with more anterior knee problems.

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Conflict of interest statement

None known.

Figures

Figure 1
Figure 1
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Analysis 1.1
Analysis 1.1
Comparison 1 Patella tendon versus hamstring tendon autografts for ACL reconstruction, Outcome 1 Functional assessment ‐ single hop test: participants with < 90% of opposite side.
Analysis 1.2
Analysis 1.2
Comparison 1 Patella tendon versus hamstring tendon autografts for ACL reconstruction, Outcome 2 Return to activity: participants returning to light or sedentary activity only.
Analysis 1.3
Analysis 1.3
Comparison 1 Patella tendon versus hamstring tendon autografts for ACL reconstruction, Outcome 3 Tegner activity level (0: to 10: top activity).
Analysis 1.4
Analysis 1.4
Comparison 1 Patella tendon versus hamstring tendon autografts for ACL reconstruction, Outcome 4 Lysholm Score: mean score.
Analysis 1.5
Analysis 1.5
Comparison 1 Patella tendon versus hamstring tendon autografts for ACL reconstruction, Outcome 5 Cincinnati Score: mean score.
Analysis 1.6
Analysis 1.6
Comparison 1 Patella tendon versus hamstring tendon autografts for ACL reconstruction, Outcome 6 Re‐rupture rate.
Analysis 1.7
Analysis 1.7
Comparison 1 Patella tendon versus hamstring tendon autografts for ACL reconstruction, Outcome 7 KT arthrometer: patients with > 5 mm side to side difference at 134 Newtons/30 lbs.
Analysis 1.8
Analysis 1.8
Comparison 1 Patella tendon versus hamstring tendon autografts for ACL reconstruction, Outcome 8 KT arthrometer: patients with > 5 mm side to side difference at Maximum Manual Force.
Analysis 1.9
Analysis 1.9
Comparison 1 Patella tendon versus hamstring tendon autografts for ACL reconstruction, Outcome 9 KT arthrometer: Mean side to side difference (mm) at 134 Newtons/30 lbs.
Analysis 1.10
Analysis 1.10
Comparison 1 Patella tendon versus hamstring tendon autografts for ACL reconstruction, Outcome 10 KT arthrometer: Mean side to side difference (mm) at Maximum Manual Force.
Analysis 1.11
Analysis 1.11
Comparison 1 Patella tendon versus hamstring tendon autografts for ACL reconstruction, Outcome 11 Lachman Test: patients with > 2 mm or positive test.
Analysis 1.12
Analysis 1.12
Comparison 1 Patella tendon versus hamstring tendon autografts for ACL reconstruction, Outcome 12 Pivot Shift: patients with a positive test.
Analysis 1.13
Analysis 1.13
Comparison 1 Patella tendon versus hamstring tendon autografts for ACL reconstruction, Outcome 13 IKDC: patients with Normal and Nearly Normal scores.
Analysis 1.14
Analysis 1.14
Comparison 1 Patella tendon versus hamstring tendon autografts for ACL reconstruction, Outcome 14 IKDC Subjective score (1995 version): patients with Normal and Nearly Normal scores.
Analysis 1.15
Analysis 1.15
Comparison 1 Patella tendon versus hamstring tendon autografts for ACL reconstruction, Outcome 15 IKDC Subjective score (2000 version): Mean score.
Analysis 1.16
Analysis 1.16
Comparison 1 Patella tendon versus hamstring tendon autografts for ACL reconstruction, Outcome 16 Range of motion: Heel height difference (mm).
Analysis 1.17
Analysis 1.17
Comparison 1 Patella tendon versus hamstring tendon autografts for ACL reconstruction, Outcome 17 Range of motion: Extension deficit > 3 degrees.
Analysis 1.18
Analysis 1.18
Comparison 1 Patella tendon versus hamstring tendon autografts for ACL reconstruction, Outcome 18 Range of motion: Flexion deficit > 5 degrees.
Analysis 1.19
Analysis 1.19
Comparison 1 Patella tendon versus hamstring tendon autografts for ACL reconstruction, Outcome 19 Strength testing: Mean flexion at 60 deg/s (as % torque of opposite knee).
Analysis 1.20
Analysis 1.20
Comparison 1 Patella tendon versus hamstring tendon autografts for ACL reconstruction, Outcome 20 Strength testing: Mean flexion at 180 deg/s (as % torque of opposite knee).
Analysis 1.21
Analysis 1.21
Comparison 1 Patella tendon versus hamstring tendon autografts for ACL reconstruction, Outcome 21 Strength testing: Mean extension at 60 deg/s (as % torque of opposite knee).
Analysis 1.22
Analysis 1.22
Comparison 1 Patella tendon versus hamstring tendon autografts for ACL reconstruction, Outcome 22 Strength testing: Mean extension at 180 deg/s (as % torque of opposite knee).
Analysis 1.23
Analysis 1.23
Comparison 1 Patella tendon versus hamstring tendon autografts for ACL reconstruction, Outcome 23 Anterior knee symptomatology: Incidence (general).
Analysis 1.24
Analysis 1.24
Comparison 1 Patella tendon versus hamstring tendon autografts for ACL reconstruction, Outcome 24 Anterior knee symptomatology: Kneeling discomfort.
Analysis 1.25
Analysis 1.25
Comparison 1 Patella tendon versus hamstring tendon autografts for ACL reconstruction, Outcome 25 Numbers of participants in analyses / Numbers entered in each trial.
Analysis 1.26
Analysis 1.26
Comparison 1 Patella tendon versus hamstring tendon autografts for ACL reconstruction, Outcome 26 Numbers with acute reconstructions at baseline.
Analysis 1.27
Analysis 1.27
Comparison 1 Patella tendon versus hamstring tendon autografts for ACL reconstruction, Outcome 27 Numbers of males at baseline.
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Update of

  • doi: 10.1002/14651858.CD005960

References

References to studies included in this review

    1. Aglietti P, Buzzi R, Zaccherotti G, Biase P. Patellar tendon versus doubled semitendinosus and gracilis tendons for anterior cruciate ligament reconstruction. American Journal of Sports Medicine 1994;22(2):211‐7; discussion 217‐8. - PubMed
    2. Aglietti P, Zaccherotti G, Buzzi R, Biase P. A comparison between patellar tendon and double semitendinosus/gracilis tendon for anterior cruciate ligament reconstruction. A minimum five‐year followup. Journal of Sports Traumatology & Related Research 1997;19(2):58‐68.
    1. Aglietti P, Giron F, Buzzi R, Biddau F, Sasso F. Anterior cruciate ligament reconstruction: bone‐patellar tendon‐bone compared with double semitendinosus and gracilis tendon grafts. A prospective, randomized clinical trial. Journal of Bone and Joint Surgery ‐ American Volume 2004;86(10):2143‐55. - PubMed
    1. Anderson A. Personal communication (email) August 10 2007.
    2. Anderson AF, Snyder RB, Lipscomb AB, Jr. Anterior cruciate ligament reconstruction. A prospective randomized study of three surgical methods. American Journal of Sports Medicine 2001;29(3):272‐9. - PubMed
    1. Aune AK. Personal communication (email) April 3 2008.
    2. Aune AK, Holm I, Risberg MA, Jensen HK, Steen H. Four‐strand hamstring tendon autograft compared with patellar tendon‐bone autograft for anterior cruciate ligament reconstruction. A randomized study with two‐year follow‐up. American Journal of Sports Medicine 2001;29(6):722‐8. - PubMed
    1. Beynnon BD, Johnson RJ, Fleming BC, Kannus P, Kaplan M, Samani J, et al. Anterior cruciate ligament replacement: comparison of bone‐patellar tendon‐bone grafts with two‐strand hamstring grafts. A prospective, randomized study. Journal of Bone and Joint Surgery ‐ American Volume 2002;84(9):1503‐13. - PubMed

References to studies excluded from this review

    1. Bach T, Hoher J, Schutz C, Tiling T. Frontal cruciate ligament replacement with semitendinosus 4‐ply transplant versus patellar transplant [Vordere Kreuzbandersatzplastik mit Semitendinosus 4‐fach Transplantat versus Patellarsehnentransplantat]. Hefte zur Zeitschrift "Der Unfallchirurg". 2000; Vol. 275:245.
    1. Beard DJ, Anderson JL, Davies S, Price AJ, Dodd CA. Hamstrings vs. patella tendon for anterior cruciate ligament reconstruction: a randomised controlled trial. Knee 2001;8(1):45‐50. - PubMed
    1. Callaway GH, Nicholas SJ, Cavanaugh JT, Cavo C, Pavlov H, Wickiewicz TL, et al. Hamstring augmentation versus patella tendon reconstruction of acute anterior cruciate ligament disruption: A randomized, prospective study (Abstract). Orthopaedic Transactions 1994;18:1017.
    1. Carter TR, Edinger S. Isokinetic evaluation of anterior cruciate ligament reconstruction: hamstring versus patellar tendon. Arthroscopy 1999;15(2):169‐72. - PubMed
    1. Hantes, M Zibis A, Zachos B, Basdekis G, Malikos K. Donor site morbidity in the first year after ACL reconstruction: A comparative study between patellar tendon and hamstrings (Abstract 241). 11th ESSKA 2000 Congress. 2004.

References to ongoing studies

    1. Taylor D, DeBerardino T, Nelson B, Tenuta J, Mountcastle S. A comparison of patellar tendon and hamstring tendons for ACL reconstruction using similar femoral and tibial fixation methods: A randomized study. 12th ESSKA 2000 Congress Conference Proceedings. May 24‐27, 2006.

Additional references

    1. Aglietti P, Zaccherotti G, Buzzi R, Biase P. A comparison between patellar tendon and double semitendinosus/gracilis tendon for anterior cruciate ligament reconstruction. A minimum five‐year followup. Journal of Sports Traumatology & Related Research 1997;19(2):58‐68.
    1. Ahlden M, Kartus J, Ejerhed L, Karlsson J, Sernert N. Knee laxity measurements after anterior cruciate ligament reconstruction, using either bone‐patellar‐tendon‐bone or hamstring tendon autografts, with special emphasis on comparison over time. Knee Surgery, Sports Traumatology, Arthroscopy 2009;17(9):1117‐24. - PubMed
    1. Barrack RL, Bruckner JD, Kneisl J, Inman WS, Alexander AH. The outcome of nonoperatively treated tears of the anterior cruciate ligament in active young adults. Clinical Orthopaedics and Related Research 1990;(259):192‐9. - PubMed
    1. Bhandari M, Richards RR, Sprague S, Schemitsch EH. The quality of reporting of randomized trials in the Journal of Bone and Joint Surgery from 1988 through 2000. Journal of Bone and Joint Surgery ‐ American Volume 2002;84:388‐96. - PubMed
    1. Biau DJ, Tournoux C, Katsahian S, Shranz PJ, Nizard RS. Bone‐patellar tendon‐bone autografts versus hamstring autografts for reconstruction of anterior cruciate ligament: meta‐analysis. BMJ 2006;332(7548):995‐1001. - PMC - PubMed

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