A Systematic Review of Randomized Controlled Trials in Anterior Cruciate Ligament Reconstruction: Standard Techniques Are Comparable (299 Trials With 25,816 Patients)

Abstract

To provide an overview of all published randomized controlled trials (RCTs) in anterior cruciate ligament reconstruction (ACLR) summarizing the available evidence. Methods: Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we searched the Cochrane FIGCentral Register of Controlled Trials, Ovid MEDLINE, and Embase for RCTs of ACLR from their inception to August 26, 2020. Outcome measure was whether RCTs reported statistically significant findings. RCTs were then classified according to their intervention groups in a narrative synthesis of the evidence. Results: In total, 299 RCTs met the inclusion criteria and were included with a total number of 25,186 patients. Only 30 RCTs (10%) reported significant differences between the intervention and the control groups. These included 101 RCTs on grafts, 20 RCTs on tunnel placements, 48 RCTs on graft fixation, 42 RCTs on singlebundle compared with double-bundle reconstructions, 11 RCTs on additional procedures, 11 RCTs on graft tensioning, 5 RCTs on timing of surgery, 25 RCTs on technical variations from standard techniques, 6 RCTs on ACL repair, 5 RCTs on navigation, 16 RCTs on perioperative management, and 9 RCTs on other aspects of ACLR. Only 14 RCTs (4.7%) reported outcomes beyond 10 years with greater allograft failures compared with autografts, high incidence of osteoarthritic changes in reconstructed knees (22%-100%), with no significant differences in outcomes between bioabsorbable or metal screws for graft fixation, patellar versus hamstrings or single-versus double-bundle reconstructions. Conclusions: The evidence indicates that a standard arthroscopic single-or double-bundle ACLR with hamstrings/patella autografts, transportal technique, and fixation techniques familiar to the surgeon leads to comparable results. This evidence offers surgeons the flexibility to use standard and cost-effective techniques and achieve comparable outcomes. Level of Evidence: Level II; systematic review of Level I-II randomized controlled trials.

Three orthopaedic operations, over 1,000 randomized controlled trials, in over 100,000 patients

“…This evidence has shown that for the vast majority of patients, using standard arthroscopic techniques, a single- or double-bundle ACLR with hamstrings, or bone-patella tendon-bone autografts, implanted using a transportal technique and graft fixation methods familiar to the surgeon, achieve satisfactory and comparable clinical outcomes as reported by the included RCTs. 14 …”

“… 12 , 13 Recently, we systematically reviewed all published RCTs of TKA, THA, and ACLR. 14 - 16 Here, we present an overview of our findings and the lessons learnt from 1,014 RCTs in 107,511 patients.…”

Chronic pain and functional impairment after arthroscopic surgery for a knee injury

“…парциальных артроскопических менискэктомий и около 200 тыс. реконструкций ПКС [4,5]. К сожалению, в доступной литературе не представлены статистические данные о ежегодном количестве таких операций в России.…”

An Interrupted Time Series Analysis Measuring the Impact of Research and Education on Clinical Practice

“…Graft selection is an important component, impacting long-term outcomes, including graft failure and revision. Many studies have shown that allograft utilization is associated with worse outcomes following ACLR compared with autograft 6-9 . Our own previous study found a 3 times higher revision risk with allograft compared with bone-patellar tendon-bone (BPTB) autograft 10 .…”