Outcomes of Anterior Cruciate Ligament Reconstruction in Females using Hamstring versus Patellar-Tendon-Bone Grafts: A Systematic Review and Meta-Analysis
ESSKA Academy. Tan S. May 12, 2018; 218117; FP43-1175
Si Heng Sharon Tan
Si Heng Sharon Tan
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Objectives: Some studies reported inferior outcomes with increased anterior-posterior laxity, increased re-ruptures rates and decreased return to sports in female anterior cruciate ligament reconstruction (ACL) with hamstring grafts as compared to patellar-tendon-bone grafts. However, these results are controversial, and there exist other studies that have reported no differences with either graft.

The purpose of the review is to investigate the outcomes of female ACL reconstructions after hamstring versus patellar-tendon-bone grafts.

Methods: The review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. All original randomised controlled trials and prospective cohort studies that compared clinical outcomes after ACL reconstruction in female patients using hamstring versus patellar-tendon-bone grafts were included.

Results: Thirteen publications were included. No significant differences were noted between hamstring and patellar-tendon-bone grafts for all outcomes.

The relative risk (RR) and standardized mean difference (SMD) were insignificant for all outcomes pooled. These include Lachman's test (RR 1.42; 95% CI: 0.63 - 3.20), pivot shift test (RR 1.39; 95% CI: 0.85 - 2.27), instrumented laxity (SMD 0.22; 95% CI: -0.17 - 0.62), International Knee Documentation Committee (IKDC) objective knee score (RR 1.14; 95% CI: 0.87 - 1.47), extension deficits (RR 0.64; 95% CI: 0.30 - 1.35), graft rupture or failure (RR 1.22; 95% CI: 0.53 - 2.81), revision surgeries (RR 1.06; 95% CI: 0.83 - 1.36), Lysholm score (SMD -0.35; 95% CI: -1.32 - 0.62) and anterior knee pain (RR 0.89; 95% CI: 0.63 - 1.26).

The other outcomes unable to be pooled were also insignificant in most studies. These include anterior drawer test, flexion deficit, quadriceps and hamstring strength, single leg hop test, IKDC subjective knee score, Noyes score, Single Assessment Numeric Evaluation (SANE) score, Tegner score, Cincinnati sports activity scale and return to sports.

Conclusions: This represents the first conclusive study that investigated the outcomes of ACL reconstructions in females following hamstring versus patellar-tendon-bone grafts. Females showed comparable results in all outcomes regardless of graft used. These included anterior-posterior laxity parameters, objective knee scores, neuromuscular testing, graft rupture or revision rates, subjective knee scores, sports and activity level, and anterior knee pain. Collectively, these suggest that either hamstring or patellar-tendon-bone grafts could be used for ACL reconstruction in females.

Anterior cruciate ligament reconstruction; female; hamstring; patellar-tendon-bone; graft
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