Advertisement

Archives of Orthopaedic and Trauma Surgery

, Volume 132, Issue 9, pp 1287–1297 | Cite as

A systematic review of randomized controlled clinical trials comparing hamstring autografts versus bone-patellar tendon-bone autografts for the reconstruction of the anterior cruciate ligament

  • Shuzhen Li
  • Yueping Chen
  • Zonghan Lin
  • Wei Cui
  • Jingmin Zhao
  • Wei SuEmail author
Arthroscopy and Sports Medicine

Abstract

Objectives

Controversies exist over which type of graft is best for the reconstruction of the anterior cruciate ligament (ACL). The purpose of this systematic review was to evaluate the effectiveness of ACL reconstruction using either hamstring (HT) autografts or bone-patellar tendon-bone (BPTB) autografts.

Methods

We searched the Cochrane Library, MEDLINE and EMBASE for published randomized controlled trials (RCT) comparing HT autografts with BPTB autografts for ACL reconstruction. Data analyses were performed using Cochrane Collaboration RevMan 5.0.

Results

Nine RCTs (738 patients) met the inclusion criteria. The combined results of the meta-analysis indicated there was a significantly lower rate of negative Pivot test [relative risk (RR) 0.87, 95 % confidence intervals (CI) 0.79–0.96, P = 0.004], anterior knee pain (RR 0.66, 95 % CI 0.45–0.96, P = 0.03) and of kneeling pain (RR 0.49, 95 % CI 0.27–0.91, P = 0.02) in the HT group than in the BPTB group.

Conclusions

ACL reconstruction with HT autografts or BPTB autografts achieved similar postoperative effects in terms of restoring knee joint function. HT autografts were inferior to BPTB autografts for restoring knee joint stability, but were associated with fewer postoperative complications.

Keywords

Anterior cruciate ligament Reconstruction Hamstring Bone-patellar tendon-bone Systematic review 

References

  1. 1.
    Fu FH, Bennett CH, Ma CB, Menetrey J, Lattermann C (2000) Current trends in anterior cruciate ligament reconstruction. Part II. Operative procedures and clinical correlations. Am J Sports Med 28:124–130PubMedGoogle Scholar
  2. 2.
    Matsumoto A, Yoshiya S, Muratsu H et al (2006) A comparison of bone-patellar tendon-bone and bone-hamstring tendon-bone autografts for anterior cruciate ligament reconstruction. Am J Sports Med 34:213–219PubMedCrossRefGoogle Scholar
  3. 3.
    Gorschewsky O, Klakow A, Riechert K, Pitzl M, Becker R (2005) Clinical comparison of the tutoplast allograft and autologous patellar tendon (bone-patellar tendon-bone) for the reconstruction of the anterior cruciate ligament: 2- and 6-year results. Am J Sports Med 33:1202–1209PubMedCrossRefGoogle Scholar
  4. 4.
    Barrett G, Stokes D, White M (2005) Anterior cruciate ligament reconstruction in patients older than 40 years: allograft versus autograft patellar tendon. Am J Sports Med 33:1505–1512PubMedCrossRefGoogle Scholar
  5. 5.
    Prodromos C, Joyce B, Shi K (2007) A meta-analysis of stability of antografts compared to allografts after anterior cruciate ligament reconstruction. Knee Surg Sport Traumatol Arthrosc 15:851–856CrossRefGoogle Scholar
  6. 6.
    Harilainen A, Sandelin J (2009) A prospective comparison of 3 hamstring ACL fixation devices-rigidfix, bioScrew, and intrafix-randomized into 4 groups with 2 years of follow-up. Am J Sports Med 37:699–706PubMedCrossRefGoogle Scholar
  7. 7.
    Biau DJ, Tournoux C, Katsahian S, Schranz PJ, Nizard RS (2006) Bone-patellar tendon-bone autografts versus hamstring autografts for reconstruction of anterior cruciate ligament: meta-analysis. BMJ 332:995–1001PubMedCrossRefGoogle Scholar
  8. 8.
    Kartus J, Magnusson L, Stener S, Brandsson S, Eriksson BI, Karlsson J (1999) Complications following arthroscopic anterior cruciate ligament reconstruction: a 2-5-year follow-up of 604 patients with special emphasis on anterior knee pain. Knee Surg Sports Traumatol Arthrosc 7:2–8PubMedCrossRefGoogle Scholar
  9. 9.
    Shelbourne KD, Trumper RV (1997) Preventing anterior knee pain after anterior cruciate ligament reconstruction. Am J Sports Med 25:41–47PubMedCrossRefGoogle Scholar
  10. 10.
    Freedman KB, D’Amato MJ, Nedeff DD, Kaz A, Bach BR Jr (2003) Arthroscopic anterior cruciate ligament reconstruction: a meta-analysis comparing patellar tendon and hamstring tendon autografts. Am J Sports Med 31:2–11PubMedGoogle Scholar
  11. 11.
    Spindler KP, Kuhn JE, Freedman KB, Matthews CE, Dittus RS, Harrell FE Jr (2004) Anterior cruciate ligament reconstruction autograft choice: bone-tendon-bone versus hamstring. Am J Sports Med 32:1986–1995PubMedCrossRefGoogle Scholar
  12. 12.
    Biau DJ, Tournoux C, Katsahian S, Schranz P, Nizard R (2007) ACL reconstruction a meta-analysis of functional scores. Clin Orthop Relat Res 458:180–187PubMedGoogle Scholar
  13. 13.
    Goldblatt JP, Fitzsimmons SE, Balk E, Richmond JC (2005) Reconstruction of the anterior cruciate ligament: meta-analysis of patellar tendon versus hamstring tendon autografts. Arthroscopy 21:791–803PubMedCrossRefGoogle Scholar
  14. 14.
    Biau DJ, Katsahian S, Kartus J et al (2009) Patellar tendon versus hamstring tendon autografts for reconstructing the anterior cruciate ligament: a meta-analysis based on individual patient data. Am J Sports Med 37:2470–2478PubMedCrossRefGoogle Scholar
  15. 15.
    Lenza M, Belloti JC, Gomes Dos Santos JB, Matsumoto MH, Faloppa F (2009) Surgical interventions for treating acute fractures or non-union of the middle third of the clavicle. Cochrane Database Syst Rev 4:CD007428Google Scholar
  16. 16.
    Lefebvre C, Manheimer E, Glanville J (2008) Chapter 6: searching for studies. In: Higgins JPT, Green S (eds) Cochrane handbook for systematic reviews of interventions version 5.0.0 (updated February 2008). The Cochrane Collaboration. Available from http://www.cochrane-handbook.org
  17. 17.
    Higgins JPT, Altman DG (2008) Chapter 8: assessing risk of bias in included studies. In: Higgins JPT, Green S (eds) Cochrane handbook for systematic reviews of interventions version 5.0.0 (updated February 2008). The Cochrane Collaboration. Available from http://www.cochrane-handbook.org
  18. 18.
    Anderson AF, Snyder RB, Lipscomb AB Jr (2001) Anterior cruciate ligament reconstruction. A prospective randomized study of three surgical methods. Am J Sports Med 29:272–279PubMedGoogle Scholar
  19. 19.
    Beynnon BD, Johnson RJ, Fleming BC et al (2002) Anterior cruciate ligament replacement: comparison of bone-patellar tendon-bone grafts with two-strand hamstring grafts—a prospective, randomized study. J Bone Joint Surg Am 84:1503–1513PubMedGoogle Scholar
  20. 20.
    Ejerhed L, Kartus J, Sernert N, Kohler K, Karlsson J (2003) Patellar tendon or semitendinosus tendon autografts for anterior cruciate ligament reconstruction? A prospective randomized study with a two-year follow-up. Am J Sports Med 31:19–25PubMedGoogle Scholar
  21. 21.
    Lidén M, Ejerhed L, Sernert N, Laxdal G, Kartus J (2007) Patellar tendon or semitendinosus tendon autografts for anterior cruciate ligament reconstruction: a prospective, randomized study with a 7-Year follow-up. Am J Sports Med 35:740–748PubMedCrossRefGoogle Scholar
  22. 22.
    Webster KE, Feller JA, Hameister KA (2001) Bone tunnel enlargement following anterior cruciate ligament reconstruction: a randomised comparison of hamstring and patellar tendon grafts with 2-year follow-up. Knee Surg Sports Traumatol Arthrosc 9:86–91PubMedCrossRefGoogle Scholar
  23. 23.
    Feller JA, Webster KE (2003) A randomized comparison of patellar tendon and hamstring tendon anterior cruciate ligament reconstruction. Am J Sports Med 31:564–573PubMedGoogle Scholar
  24. 24.
    Laxdal G, Kartus J, Hansson L, Heidvall M, Ejerhed L, Karlsson J (2005) A prospective randomized comparison of bone-patellar tendon-bone and hamstring grafts for anterior cruciate ligament reconstruction. Arthroscopy 21:34–42PubMedCrossRefGoogle Scholar
  25. 25.
    Maletis GB, Cameron SL, Tengan JJ, Burchette RJ (2007) A prospective randomized study of anterior cruciate ligament reconstruction: a comparison of patellar tendon and quadruple-strand semitendinosus/gracilis tendons fixed with bioabsorbable interference screws. Am J Sports Med 35:384–394PubMedCrossRefGoogle Scholar
  26. 26.
    Taylor DC, DeBerardino TM, Nelson BJ, Duffey M, Tenuta J, Stoneman PD, Sturdivant RX, Mountcastle S (2009) Patellar tendon versus hamstring tendon autografts for anterior cruciate ligament reconstruction: a randomized controlled trial using similar femoral and tibial fixation methods. Am J Sports Med 37:1946–1957PubMedCrossRefGoogle Scholar
  27. 27.
    Drogset JO, Strand T, Uppheim G, Odegård B, Bøe A, Grøntvedt T (2010) Autologous patellar tendon and quadrupled hamstring grafts in anterior cruciate ligament reconstruction: a prospective randomized multicenter review of different fixation methods. Knee Surg Sports Traumatol Arthrosc 18:1085–1093PubMedCrossRefGoogle Scholar
  28. 28.
    Wipfler B, Donner S, Zechmann CM, Springer J, Siebold R, Paessler HH (2011) Anterior cruciate ligament reconstruction using patellar tendon versus hamstring tendon: a prospective comparative study with 9-year follow-up. Arthroscopy 27:653–665PubMedCrossRefGoogle Scholar
  29. 29.
    Hefti F, Mueller W, Jacob RP et al (1993) Evaluation of knee ligament injuries with the IKDC form. Knee Surg Sports Traumatol Arthrosc 1:226–234PubMedCrossRefGoogle Scholar
  30. 30.
    Irrgang JJ, Ho H, Harner CD, Fu FF (1998) Use of the international knee documentation committee guidelines to assess outcome following anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 6:107–114PubMedCrossRefGoogle Scholar
  31. 31.
    Irrgang JJ, Anderson AF, Boland AL, Harner CD, Kurosaka M, Neyret P, Richmond JC, Shelborne KD (2001) Development and validation of the international knee documentation committee subjective knee form. Am J Sports Med 29:600–613PubMedGoogle Scholar
  32. 32.
    Poolman RW, Farrokhyar F, Bhandari M (2007) Hamstring tendon autograft better than bone patellar-tendon bone autograft in ACL reconstruction: a cumulative meta-analysis and clinically relevant sensitivity analysis applied to a previously published analysis. Acta Orthop 78:350–354PubMedCrossRefGoogle Scholar
  33. 33.
    Maher CG, Sherrington C, Herbert RD, Moseley AM, Elkins M (2003) Reliability of the PEDro scale for rating quality of randomized controlled trials. Phys Ther 83:713–721PubMedGoogle Scholar
  34. 34.
    Jing L, Jialiang W (2001) The methods and evaluation principles of systematic review. Natl Med J China 81:53–55Google Scholar
  35. 35.
    Moher D, Cook D, Eastwood S et al (1999) Improving the quality of reports of randomized controlled trials: the QUORUM statement. Lancet 354(9193):1896–1900PubMedCrossRefGoogle Scholar
  36. 36.
    Verhagen AP, de Vet HCW, de Bie RA et al (2001) The art of quality assessment of RCTs included in systematic reviews. J Clin Epidemiol 54:651–654PubMedCrossRefGoogle Scholar
  37. 37.
    Moher D, Pham B, Jones A (1998) Does quality of reports of randomised trials affect estimates of intervention efficacy reported in meta-analyses? Lancet 352:609–613PubMedCrossRefGoogle Scholar
  38. 38.
    Girgis FG, Marshall JL, Monajem A (1975) The cruciate ligaments of the knee joint. Anatomical, functional and experimental analysis. Clin Orthop Relat Res 106:216–231PubMedCrossRefGoogle Scholar
  39. 39.
    Nagano M, Yoshiya S, Kuroda R, Kurosaka M, Mizuno K (1997) Remodeling and healing process of bone-patellar tendon-bone graft in a bone tunnel: a histological study in dogs. Trans Orthop Res Soc 22:78Google Scholar
  40. 40.
    Hamner DL, Brown CH Jr, Steiner ME, Hecker AT, Hayes WC (1999) Hamstrings tendon grafts for reconstruction of the anterior cruciate ligament: biomechanical evaluation of multiple strands and tensioning techniques. J Bone Joint Surg Am 81:549–557PubMedGoogle Scholar
  41. 41.
    Rodeo SA, Arnoczky SP, Torzilli PA, Hidaka C, Warren RF (1993) Tendon-healing in a bone tunnel. A biomechanical and histological study in the dog. J Bone Joint Surg Am 75:1795–1803PubMedGoogle Scholar
  42. 42.
    Papageorgiou CD, Ma CB, Abramowitch SD, Clineff TD, Woo SL-Y (2001) A multidisciplinary study of the healing of an intraarticular anterior cruciate ligament graft in a goat model. Am J Sports Med 29:620–626PubMedGoogle Scholar
  43. 43.
    Weiler A, Hoffman RFG, Bail HJ, Rehm O, Sudkamp NP (2002) Tendon healing in a bone tunnel: part II: histologic analysis after biodegradable interference fit fixation in a model of anterior cruciate ligament reconstruction in sheep. Arthroscopy 18:124–135PubMedCrossRefGoogle Scholar
  44. 44.
    Victor J, Bellemans J, Witvrouw E et al (1997) Graft selection in anterior cruciate ligament reconstruction—prospective analysis of patellar tendon autografts compared with allografts. Int Orthop 21:93–97PubMedCrossRefGoogle Scholar
  45. 45.
    Fu FH, Bennett CH, Ma CB, Menetrey J, Lattermann C (2000) Current trends in anterior cruciate ligament reconstruction. Part II. Operative procedures and clinical correlations. Am J Sports Med 28:124–130PubMedGoogle Scholar
  46. 46.
    Kartus J, Ejerhed L, Sernert N et al (2000) Comparison of traditional and subcutaneous patellar tendon harvest. A prospective study of donor site-related problems after anterior cruciate ligament reconstruction using different graft harvesting techniques. Am J Sports Med 28:328–335PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Shuzhen Li
    • 1
  • Yueping Chen
    • 1
  • Zonghan Lin
    • 1
  • Wei Cui
    • 1
  • Jingmin Zhao
    • 2
  • Wei Su
    • 2
    Email author
  1. 1.Department of Orthopedic SurgeryThe Affiliated Ruikang Hospital of Guangxi Traditional Chinese Medical CollegeNanningChina
  2. 2.Department of Orthopaedics Trauma and Hand SurgeryThe First Affiliated Hospital of Guangxi Medical UniversityNanningChina

Personalised recommendations