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Credibility and quality of meta-analyses addressing graft choice in anterior cruciate ligament reconstruction: a systematic review

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

This systematic review examined the methodological credibility and quality of reporting of all meta-analyses which have compared bone-patellar tendon-bone (BPTB) versus hamstring tendon (HT) for anterior cruciate ligament (ACL) reconstruction (ACLR).

Methods

EMBASE, MEDLINE, and The Cochrane Library were systematically searched, and two reviewers independently assessed eligibility, credibility according to the Users’ Guide to medical literature, and completeness of reporting according to the preferred reporting items for systematic review and meta-analyses (PRISMA) checklist. Inter-rater agreement was quantified using Kappa, and we used Pearson’s correlation coefficient to evaluate potential associations.

Results

Seventeen meta-analyses were identified comparing BPTB versus HT for ACLR. The majority of meta-analyses were published in 2011 (5; 29 %), and North America was the most common continent of publication (6; 35 %). The three most commonly reported outcomes were stability (82 %), complications (76 %), and function (return to sport, IKDC score) (71 %). The median number of satisfactorily reported items in the Users’ Guide was three out of seven (IQR 2–4). The median number of satisfactorily reported items in PRISMA for the meta-analyses was 20 out of 27 (IQR 19–22).

Conclusion

The credibility of the meta-analyses comparing BPTB versus HT autograft for ACLR although limited is improving with time. Earlier studies had limited methodological rigour; however, the more recent studies have shown promise in improved methodology. The study findings suggest that decisions should be made on a case-to-case basis with coordination of patient factors and preferences as well as surgeon experience on the background of the best available evidence.

Level of evidence

IV.

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Abbreviations

BPTB:

Bone-patellar tendon-bone

HT:

Hamstring tendon

ACL:

Anterior cruciate ligament

ACLR:

Anterior cruciate ligament reconstruction

QT:

Quadriceps tendon

RCT:

Randomized controlled trials

IKDC:

International Knee Documentation Committee score

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

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Acknowledgments

We would like to acknowledge Nicole Simunovic for her expert help with statistical analysis and proof reading the manuscript. No funding was received for this study.

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Authors and Affiliations

  1. Division of Orthopaedics, Department of Surgery, McMaster University, 293 Wellington St. N, Hamilton, ON, L8L 8E7, Canada

    Adrian Kurz, Nathan Evaniew & Marco Yeung

  2. Division of Orthopaedics, Department of Surgery, McMaster University, 1200 Main St West, 4E15, Hamilton, ON, L8N 3Z5, Canada

    Devin Peterson & Olufemi R. Ayeni

  3. Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden

    Kristian Samuelsson

  4. Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden

    Kristian Samuelsson

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  1. Adrian Kurz
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Correspondence to Olufemi R. Ayeni.

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Table 5 Electronic search strategy for MEDLINE
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Kurz, A., Evaniew, N., Yeung, M. et al. Credibility and quality of meta-analyses addressing graft choice in anterior cruciate ligament reconstruction: a systematic review. Knee Surg Sports Traumatol Arthrosc 25, 538–551 (2017). https://doi.org/10.1007/s00167-016-4282-z

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