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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

  • Xiaobo Xie
  • Zhuo Xiao
  • Qi LiEmail author
  • Bo Zhu
  • Jingxian Chen
  • Huamu Chen
  • Fangyuan Yang
  • Yuting Chen
  • Qianwei Lai
  • Xuzhou Liu
Original Article

Abstract

Purpose

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.

Methods

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).

Results

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.

Conclusion

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.

Keywords

ACL reconstruction Patellar tendon Hamstring tendon Autograft Meta-analysis 

Notes

Acknowledgments

We thank all the patients and clinical researchers, who were involved in the publications we mentioned in this article.

Conflict of interest

None.

References

  1. 1.
    Magnussen RA, Carey JL, Spindler KP (2011) Does autograft choice determine intermediate-term outcome of ACL reconstruction? Knee Surg Sports Traumatol Arthrosc 19:462–472PubMedCentralPubMedCrossRefGoogle Scholar
  2. 2.
    Kartus J, Movin T, Karlsson J (2001) Donor-site morbidity and anterior knee problems after anterior cruciate ligament reconstruction using autografts. Arthroscopy J Arthrosc Relat Surg 17(9):971–980CrossRefGoogle Scholar
  3. 3.
    Pinczewski LA, Deehan DJ, Salmon LJ, Russell VJ, Clingeleffer A (2002) A five-year comparison of patellar tendon versus four-strand hamstring tendon autograft for arthroscopic reconstruction of the anterior cruciate ligament. Am J Sports Med 30:523–536PubMedGoogle Scholar
  4. 4.
    Brandsson S, Faxén E, Kartus J, Jerre R, Eriksson BI, Karlsson J (2001) A prospective four-to-seven-year follow-up after arthroscopic anterior cruciate ligament reconstruction. Scand J Med Sci Sports 11:23–27PubMedCrossRefGoogle Scholar
  5. 5.
    Kraeutler MJ, Bravman JT, McCarty EC (2013) Bone–patellar tendon–bone autograft versus allograft in outcomes of anterior cruciate ligament reconstruction: a meta-analysis of 5182 patients. Am J Sports Med 41(10):2439–2448PubMedCrossRefGoogle Scholar
  6. 6.
    Xu M, Gao S, Zeng C, Han R, Sun J, Li H et al (2013) Outcomes of anterior cruciate ligament reconstruction using single-bundle versus double-bundle technique: meta-analysis of 19 randomized controlled trials. Arthroscopy 29(2):357–365PubMedCrossRefGoogle Scholar
  7. 7.
    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. Scand J Med Sci Sports 10:2–11PubMedCrossRefGoogle Scholar
  8. 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. 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
  10. 10.
    Claes S, Hermie L, Verdonk R, Bellemans J, Verdonk P (2013) Is osteoarthritis an inevitable consequence of anterior cruciate ligament reconstruction? A meta-analysis. Knee Surg Sports Traumatol Arthrosc 21(9):1967–1976PubMedCrossRefGoogle Scholar
  11. 11.
    Gifstad T, Sole A, Strand T, Uppheim G, Grøntvedt T, Drogset JO (2013) Long-term follow-up of patellar tendon grafts or hamstring tendon grafts in endoscopic ACL reconstructions. Knee Surg Sports Traumatol Arthrosc 21(3):576–583PubMedCrossRefGoogle Scholar
  12. 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
  13. 13.
    Sajovic M, Vengust V, Komadina R, Tavcar R, Skaza K (2006) A prospective, randomized comparison of semitendinosus and gracilis tendon versus patellar tendon autografts for anterior cruciate ligament reconstruction: five-year follow-up. Am J Sports Med 34(12):1933–1940PubMedCrossRefGoogle Scholar
  14. 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. 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. 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
  17. 17.
    Zaffagnini S, Marcacci M, Presti ML, Giordano G, Iacono F, Neri MP (2006) Prospective and randomized evaluation of ACL reconstruction with three techniques: a clinical and radiographic evaluation at 5 years follow-up. Knee Surg Sports Traumatol Arthrosc 14(11):1060–1069PubMedCrossRefGoogle Scholar
  18. 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
  19. 19.
    Matsumoto A, Yoshiya S, Muratsu H, Yagi M, Iwasaki Y, Kurosaka M 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(2):213–219PubMedCrossRefGoogle Scholar
  20. 20.
    Ibrahim SA, Al-Kussary IM, Al-Misfer AR, Al-Mutairi HQ, Ghafar SA, El Noor TA (2005) Clinical evaluation of arthroscopically assisted anterior cruciate ligament reconstruction: patellar tendon versus gracilis and semitendinosus autograft. Arthroscopy 21(4):412–417PubMedCrossRefGoogle Scholar
  21. 21.
    Leys T, Salmon L, Waller A, Linklater J, Pinczewski L (2012) Clinical results and risk factors for reinjury 15 years after anterior cruciate ligament reconstruction: a prospective study of hamstring and patellar tendon grafts. Am J Sports Med 40(3):595–605PubMedCrossRefGoogle Scholar
  22. 22.
    Bourke HE, Salmon LJ, Waller A, Patterson V, Pinczewski LA (2012) Survival of the anterior cruciate ligament graft and the contralateral ACL at a minimum of 15 years. Am J Sports Med 40(9):1985–1992PubMedCrossRefGoogle Scholar
  23. 23.
    Salmon L, Bourke H, Patterson V, Waller A, Pinczewski L (2012) A 15-year survival analysis of the anterior cruciate ligament graft and the contralateral ACL following reconstruction. J Sci Med Sport 15:S355CrossRefGoogle Scholar
  24. 24.
    Pinczewski LA, Lyman J, Salmon LJ, Russell VJ, Roe J, Linklater J (2007) A 10-year comparison of anterior cruciate ligament reconstructions with hamstring tendon and patellar tendon autograft: a controlled, prospective trial. Am J Sports Med 35(4):564–574PubMedCrossRefGoogle Scholar
  25. 25.
    Roe J, Pinczewski LA, Russell VJ, Salmon LJ, Kawamata T, Chew M (2005) A 7-year follow-up of patellar tendon and hamstring tendon grafts for arthroscopic anterior cruciate ligament reconstruction: differences and similarities. Am J Sports Med 33(9):1337–1345PubMedCrossRefGoogle Scholar
  26. 26.
    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(5):653–665PubMedCrossRefGoogle Scholar
  27. 27.
    O’Neill DB (2001) Arthroscopically assisted reconstruction of the anterior cruciate ligament. A follow-up report. J Bone Joint Surg Am 83-A(9):1329–1332PubMedGoogle Scholar
  28. 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. 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. 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. 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. 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
  33. 33.
    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(5):740–748PubMedCrossRefGoogle Scholar
  34. 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
  35. 35.
    Victor J, Bellemans J, Witvrouw E, Govaers K, Fabry G (1997) Graft selection in anterior cruciate ligament reconstruction–prospective analysis of patellar tendon autografts compared with allografts. Int Orthop 21(2):93–97PubMedCentralPubMedCrossRefGoogle Scholar
  36. 36.
    Li S, Su W, Zhao J, Xu Y, Bo Z, Ding X, Wei Q (2011) A meta-analysis of hamstring autografts versus bone–patellar tendon–bone autografts for reconstruction of the anterior cruciate ligament. Knee 18(5):287–293PubMedCrossRefGoogle Scholar
  37. 37.
    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
  38. 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. 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
  40. 40.
    Noyes FR, Butler DL, Grood ES, Zernicke RF, Hefzy MS (1984) Biomechanical analysis of human ligament grafts used in knee-ligament repair and reconstructions. J Bone Joint Surg Am 66:344–352PubMedGoogle Scholar
  41. 41.
    Yagi M, Wong EK, Kanamori A, Debski RE, Fu FH, Woo SL (2002) Biomechanical analysis of an anatomic anterior cruciate ligament reconstruction. Am J Sports Med 30(5):660–666PubMedGoogle Scholar
  42. 42.
    Keays SL, Newcombe PA, Bullock-Saxton JE, Bullock MI, Keays AC (2010) Factors involved in the development of osteoarthritis after anterior cruciate ligament surgery. Am J Sports Med 38(3):455–463PubMedCrossRefGoogle Scholar
  43. 43.
    Li RT, Lorenz S, Xu Y, Harner CD, Fu FH, Irrgang JJ (2011) Predictors of radiographic knee osteoarthritis after anterior cruciate ligament reconstruction. Am J Sports Med 39(12):2595–2603PubMedCrossRefGoogle Scholar
  44. 44.
    Funk FJ Jr (1983) Osteoarthritis of the knee following ligamentous injury. Clin Orthop Relat Res 172:154–157PubMedGoogle Scholar

Copyright information

© Springer-Verlag France 2014

Authors and Affiliations

  • Xiaobo Xie
    • 1
    • 2
  • Zhuo Xiao
    • 3
  • Qi Li
    • 1
    Email author
  • Bo Zhu
    • 1
  • Jingxian Chen
    • 1
  • Huamu Chen
    • 1
  • Fangyuan Yang
    • 1
  • Yuting Chen
    • 1
  • Qianwei Lai
    • 1
  • Xuzhou Liu
    • 1
  1. 1.Department of Orthopedics, Zhujiang HospitalSouthern Medical UniversityGuangzhouChina
  2. 2.Department of OrthopedicsMeizhou People’s HospitalMeizhouChina
  3. 3.Department of Emergency Surgery, Zhujiang HospitalSouthern Medical UniversityGuangzhouChina

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