A Meta-Analysis of Stability After Anterior Cruciate Ligament Reconstruction as a Function of Hamstring Versus Patellar Tendon Graft and Fixation Type

Prodromos, Chadwick C.; Joyce, Brian T.; Shi, Kelvin; Keller, Brett L.

doi:10.1016/j.arthro.2005.08.036

Cited by 114 publications

(94 citation statements)

References 58 publications

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“…Furthermore, we hypothesized a priori that modern state-ofthe-art hamstring graft fixation technique would have similar effects on stability as bone-patellar tendon-bone autografts, thus, questioning the poor evidence that patellar tendon autografts offer better stability. The rationale for choosing this subgroup was adapted from previous studies claiming superior femoral fixation with endobuttons and subsequent superior stability (Prodromos et al 2005). Thus, our hypothesis was set a priori.…”

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confidence: 99%

Hamstring tendon autograft better than bone patellartendon bone autograft in ACL reconstruction A cumulative meta-analysis and clinically relevant sensitivity analysis applied to a previously published analysis

2007

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Background Current debate on treatment options for anterior cruciate ligament (ACL) reconstruction complicate the choice between hamstring and bone patellartendon bone autografts. We hypothesized a priori that cumulative meta-analysis (a form of sensitivity analysis) might show that the evidence for reduction of morbidity by hamstring grafts could have been reached at an earlier time. Furthermore, we hypothesized a priori that modern state-of-the-art hamstring graft fixation technique would give similar results regarding stability as bone-patellar tendon-bone autografts.Methods We performed a cumulative meta-analysis and sensitivity analysis based on femoral graft fixation techniques to compare hamstring autograft and bonepatellar tendon-bone autografts in ACL reconstruction derived from a previously published meta-analysis.Results Cumulatively, that hamstring autograft reduces anterior knee pain had already reached statistical significance in 2001 (relative risk 0.49 (95%CI: 0.32-0.76; p = 0.001, I2 = 0%)). The modern endobutton hamstring graft fixation technique (2 studies) yielded similar stability in the Lachman test as bone-patellar tendon-bone grafts, with a relative risk of 1.1 (95%CI: 0.82-1.5; p = 0.6, I2 = 0%). Exclusion of the endobutton group explains the increased laxity in the hamstring graft group.Interpretation Cumulative meta-analysis strengthens the evidence for reduced morbidity using hamstring tendon autograft for anterior cruciate ligament reconstruction. Sensitivity analysis focusing on state-of-the-

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confidence: 99%

Hamstring tendon autograft better than bone patellartendon bone autograft in ACL reconstruction A cumulative meta-analysis and clinically relevant sensitivity analysis applied to a previously published analysis

2007

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“…Evolution of these cases made the results similar. In another meta-analysis, Podromos et al (21) confirmed that the superiority of the patellar tendon was due to failure of flexor tendon fixation, and that using suspended fixation led to the best results.…”

Section: Discussionmentioning

confidence: 75%

Estudo comparativo da reconstrução do LCA com o posicionamento anatômico dos túneis entre o tendão patelar e os tendões flexores

Pádua¹,

Maldonado²,

Vilela³

et al. 2012

Rev. bras. ortop.

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The authors declare that there was no conflict of interest in conducting this work ABSTRACTObjective: To compare ACL reconstruction with anatomical positioning of the tunnels using the hamstring or patellar tendons. Methods: We prospectively evaluated 52 patients who underwent ACL reconstruction using the Chambat's technique, with anatomical positioning of the tunnels drilled outside in. They were divided into group A, with 27 patients, using the patellar tendon as a graft, and group B, with 25 patients, using the hamstring. Results: In group A 26 patients were very satisfied or satisfied and 1 unhappy, in group B. 25 patients were very satisfied or satisfied with the procedure (p = 0.990). According to the Lysholm scale, group A had a mean score of 96.11 and group B, 95.32 (p=0.594). In relation to preoperative IKDC, 100% of the patients in group A and 92% of those in group B were IKDC C or D (p = 0.221); in the assessment with a minimum of two-year follow-up, 96% of group A and 92% of group B were IKDC A or B (p = 0.256). The Lachman test, pivot shift, return to sports activities, and the comparative difference in anterior translation (Rolimeter TM ) also showed no statistically significant difference. In group A, 5 patients (18.5%) were unable to kneel on a hard surface, whereas no patient in group B had this complaint. Conclusion: The anterior cruciate ligament reconstruction presents similar results using the hamstring or patellar tendon with anatomical positioning of the tunnels. Drilling the femoral tunnel outside in is a reproducible and accurate option in the correct placement the femoral tunnel.

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“…[29][30][31][32][33] Se decidió entonces que la fijación distal fuera en la cortical y, para ello, se emplearon sucesivamente dos dispositivos que permiten suspender injertos ST-RI cuádruples de un estribo. También simultáneamente se resolvían las dificultades para observar la posición final del tornillo tibial, en el fondo de un túnel largo, para lo cual había que introducir la óptica a fin de ver su ubicación en profundidad y, a veces, realizar controles radiográficos que permitieran ver si el tornillo no traspasaba la cortical posterior (en un caso con injerto HTH la mitad de su longitud sobrepasaba la cortical tibial posterior, sin complicaciones vasculonerviosas).…”

Section: Discussionunclassified

Ruptura del ligamento cruzado posterior. Fijacion cortical retrógrada. [Rupture of posterior cruciate ligament. Retrograde cortical tibial fixation]

Alonso¹

2015

Rev. Asoc. Arg. Ort. y Traumatol

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IntroducciónPresentamos las dificultades propias de cada una de las técnicas empleadas en la reconstrucción del Ligamento Cruzado Posterior (LCP), el objetivo es analizar retrospectivamente si hemos mejorado el resultado final con la técnica actual de fijación cortical tibial retrógrada.Material y MétodoSobre 106 pacientes operados con distintas técnicas de fijación artroscópica en rupturas del LCP, tipo II y III se incluyen 96 reconstrucciones en las cuales evaluamos retrospectivamente el cajón posterior (CP) radiográfico al alta. Se excluyeron 8 pacientes que no están de alta o se perdieron durante el tratamiento y dos pacientes operados con injerto de tendón cuadricipital, que por el escaso número no tienen relevancia estadística y cuyo CP al alta fue similar a nuestras primeras cirugías.ResultadosEl CP radiográfico al alta tuvo diferencias estadísticamente significativas entre la técnica actual y las otras realizadas anteriormente.ConclusiónLa reconstrucción del LCP con esta técnica, objetivamente ha mejorado el CP final radiográfico.

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A Meta-Analysis of Stability After Anterior Cruciate Ligament Reconstruction as a Function of Hamstring Versus Patellar Tendon Graft and Fixation Type

Cited by 114 publications

References 58 publications

Hamstring tendon autograft better than bone patellartendon bone autograft in ACL reconstruction A cumulative meta-analysis and clinically relevant sensitivity analysis applied to a previously published analysis

Hamstring tendon autograft better than bone patellartendon bone autograft in ACL reconstruction A cumulative meta-analysis and clinically relevant sensitivity analysis applied to a previously published analysis

Estudo comparativo da reconstrução do LCA com o posicionamento anatômico dos túneis entre o tendão patelar e os tendões flexores

Ruptura del ligamento cruzado posterior. Fijacion cortical retrógrada. [Rupture of posterior cruciate ligament. Retrograde cortical tibial fixation]

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