Increased incidence of osteoarthritis of knee joint after ACL reconstruction with bone–patellar tendon–bone autografts than hamstring autografts: a meta-analysis of 1,443 patients at a minimum of 5 years
- 1.1k Downloads
The objective of this study was to evaluate the effectiveness of BPTB autografts versus HT autografts at a minimum of 5 years after anterior cruciate ligament (ACL) reconstruction.
A systematical search of literature was performed in PubMed, Embase and the Cochrane library to identify published randomized controlled trials (RCT) or prospective cohort studies (PCS) relevant to ACL reconstruction comparing BPTB and HT autografts. The results of the eligible studies were analysed in terms of objective International Knee Documentation Committee (IKDC) scores, return to preinjury activity level, KT-1000, Lachman test, pivot shift test, anterior knee pain, kneeling pain, extension loss, and flexion loss, graft failure and radiographic outcomes. Study quality was assessed by using the Coleman methodology score for included studies. Two reviewers independently assessed each study for quality and extracted data. Subgroup analysis of the primary outcomes was conducted according to the type of study design (RCT or PCS).
Twelve RCTs, two PCS including 1,443 patients comparing hamstring and patellar tendon autografts were identified. The results of the meta-analysis showed that there were no significant differences between BPTB and HT in terms of objective IKDC score (P = 0.83), return to preinjury activity (P = 0.69), KT-1000 (P = 0.12), Lachman test (P = 0.76), pivot shift test (P = 0.11), extension deficit (P = 0.09), flexion deficit (P = 0.71) and graft failure (P = 0.22). However, outcomes in favour of HT autografts were found in terms of anterior knee pain (P = 0.0001) and kneeling pain (P = 0.001). Radiographic evidence of osteoarthritis (OA) showed that incidence of OA was significantly higher in BPTB groups compared with HT groups based on IKDC system. These findings were still robust during the sensitivity analysis. Results from subgroup analysis of the primary outcomes were consistent with the overall analysis.
Meta-analysis of prospective trials did not detect any significant differences in clinical results, as evidenced by the objective IKDC score, return to preinjury activity level, KT-1000, Lachman test, pivot shift test, extension loss, flexion loss and graft failure. However, the meta-analysis revealed that ACL reconstruction with BPTB autografts resulted in increased anterior knee pain and kneeling pain compared with hamstring autografts. Increased incidence of OA was found after ACL reconstruction at a minimum of 5 years in BPTB group compared with HT autografts. This result should be cautiously interpreted. More high-quality RCT with strictly specified inclusion criteria are highly required before drawing a reliable conclusion.
KeywordsACL reconstruction Patellar tendon Hamstring tendon Autograft Meta-analysis
We thank all the patients and clinical researchers, who were involved in the publications we mentioned in this article.
Conflict of interest
- 8.Coleman BD, Khan KM, Maffulli N, Cook JL, Wark JD (2000) Studies of surgical outcome after patellar tendinopathy: clinical significance of methodological deficiencies and guidelines for future studies. Victorian Institute of Sport Tendon Study Group. Scand J Med Sci Sports 10(1):2–11PubMedCrossRefGoogle Scholar
- 9.Kartus J, Ejerhed L, Sernert N, Brandsson S, Karlsson J (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(3):328–335PubMedGoogle Scholar
- 12.Sajovic M, Strahovnik A, Dernovsek MZ, Skaza K (2011) Quality of life and clinical outcome comparison of semitendinosus and gracilis tendon versus patellar tendon autografts for anterior cruciate ligament reconstruction: an 11-year follow-up of a randomized controlled trial. Am J Sports Med 39(10):2161–2169PubMedCrossRefGoogle Scholar
- 14.Zaffagnini S, Bruni D, Marcheggiani Muccioli GM, Bonanzinga T, Lopomo N, Bignozzi S, Marcacci M (2011) Single-bundle patellar tendon versus non-anatomical double-bundle hamstrings ACL reconstruction: a prospective randomized study at 8-year minimum follow-up. Knee Surg Sports Traumatol Arthrosc 19(3):390–397PubMedCrossRefGoogle Scholar
- 15.Holm I, Oiestad BE, Risberg MA, Aune AK (2010) No difference in knee function or prevalence of osteoarthritis after reconstruction of the anterior cruciate ligament with 4-strand hamstring autograft versus patellar tendon-bone autograft: a randomized study with 10-year follow-up. Am J Sports Med 38(3):448–454PubMedCrossRefGoogle Scholar
- 16.Barenius B, Nordlander M, Ponzer S, Tidermark J, Eriksson K (2010) Quality of life and clinical outcome after anterior cruciate ligament reconstruction using patellar tendon graft or quadrupled semitendinosus graft: an 8-year follow-up of a randomized controlled trial. Am J Sports Med 38(8):1533–1541PubMedCrossRefGoogle Scholar
- 18.Harilainen A, Linko E, Sandelin J (2006) Randomized prospective study of ACL reconstruction with interference screw fixation in patellar tendon autografts versus femoral metal plate suspension and tibial post fixation in hamstring tendon autografts: 5-year clinical and radiological follow-up results. Knee Surg Sports Traumatol Arthrosc 14(6):517–528PubMedCrossRefGoogle Scholar
- 28.Keays SL, Bullock-Saxton JE, Keays AC, Newcombe PA, Bullock MI (2007) A 6-year follow-up of the effect of graft site on strength, stability, range of motion, function, and joint degeneration after anterior cruciate ligament reconstruction: patellar tendon versus semitendinosus and Gracilis tendon graft. Am J Sports Med 35(5):729–739PubMedCrossRefGoogle Scholar
- 29.Mascarenhas R, Tranovich MJ, Kropf EJ, Fu FH, Harner CD (2012) Bone–patellar tendon–bone autograft versus hamstring autograft anterior cruciate ligament reconstruction in the young athlete: a retrospective matched analysis with 2–10 year follow-up. Knee Surg Sports Traumatol Arthrosc 20(8):1520–1527PubMedCrossRefGoogle Scholar
- 30.Volpi P, Marinoni L, Bait C, Galli M, de Girolamo L (2009) Tibial fixation in anterior cruciate ligament reconstruction with bone–patellar tendon–bone and semitendinosus-gracilis autografts: a comparison between bioabsorbable screws and bioabsorbable cross-pin fixation. Am J Sports Med 37(4):808–812PubMedCrossRefGoogle Scholar
- 31.Lidén M, Sernert N, Rostgård-Christensen L, Kartus C, Ejerhed L (2008) Osteoarthritic changes after anterior cruciate ligament reconstruction using bone–patellar tendon–bone or hamstring tendon autografts: a retrospective, 7-year radiographic and clinical follow-up study. Arthroscopy 24(8):899–908PubMedCrossRefGoogle Scholar
- 32.Ahldén M, Kartus J, Ejerhed L, Karlsson J, Sernert N (2009) 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 Surg Sports Traumatol Arthrosc 17(9):1117–1124PubMedCrossRefGoogle Scholar
- 34.Marumo K, Kumagae Y, Tanaka T, Fujii K (2000) Long-term results of anterior cruciate ligament reconstruction using semitendinosus and gracilis tendons with Kennedy ligament augmentation device compared with patellar tendon autografts. J Long Term Eff Med Implants 10(4):251–265PubMedCrossRefGoogle Scholar
- 38.Li S, Chen Y, Lin Z, Cui W, Zhao J, Su W (2012) 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. Arch Orthop Trauma Surg 132(9):1287–1297PubMedCrossRefGoogle Scholar
- 39.Mohtadi NG, Chan DS, Dainty KN, Whelan DB (2011) Patellar tendon versus hamstring tendon autograft for anterior cruciate ligament rupture in adults. Cochrane Database Syst Rev 7(9):CD005960Google Scholar