Reconstruction of the Anterior Cruciate Ligament: Meta-analysis of Patellar Tendon Versus Hamstring Tendon Autograft

摘要: Purpose: No graft tissue has consistently shown superiority over others for reconstruction of the anterior cruciate ligament (ACL). Bone–patellar tendon-bone (BPTB) and doubled hamstring tendon (semitendinosus gracilis) (HT) are most commonly used autologous grafts. We performed a meta-analysis to compare effectiveness ACL using either BPTB or HT Type Study: Systematic review meta-analysis. Methods: searched MEDLINE database (1966 April 2003) English-language randomized prospective studies comparing 3- 4-strand grafts reconstruction. For inclusion, were required follow identical rehabilitation protocols within each study, provide subjective objective outcome data after minimum average 2-year follow-up. Comparison between identified measure combined random-effects model Results: Eleven reports fulfilled criteria inclusion. Outcomes favoring found in following measures: normal Lachman examination (relative risk [RR], 0.91; 95% confidence interval [CI], 0.83–0.99; P = .025), pivot-shift (RR, 0.94; CI, 0.88–1.0; .067), KT-1000 manual-maximum side-to-side difference ≤3 mm 0.75; 0.55–1.01; .057), fewer reconstructions resulting flexion loss >5° 1.41; 1.01–1.96; .04). Intermediate level laxity was more common with graft, as by higher rates abnormal >0 1.22; 0.99–1.5; .06), 1.3; 0.96–1.75; .09), differences >3 1.64; 1.13–2.39; .01). Outcome measures that favored absence patellofemoral crepitance 1.08; 1.01–1.15; .03), results extension 0.56; 0.3–1.03; kneeling pain. The incidence instability, defined grade 2, >5 mm, not significantly different 2 All other different. Conclusions: presented this show instability is However, likely result Lachman, pivot-shift, Level Evidence: I.