Long-term results after anterior cruciate ligament reconstruction using patellar tendon versus hamstring tendon autograft with a minimum follow-up of 10 years—a systematic review

Abstract

Introduction A lot of research addresses superiority of the two commonly used autografts bone-patellar tendon-bone (BPTB) and hamstring tendon for anterior cruciate ligament (ACL) reconstruction, without getting to consensus. While there are numerous studies and reviews on short- to mid-term follow-up, not much literature is available on long-term follow-up. As patients suffering ACL injuries are often of young age and high athletic activity, it is crucial to have the best evidence possible for graft choice to minimize consequences, like osteoarthritis later on. Materials and methods A search of the online databases, PubMed and Embase, was carried out last on 31st March 2022 for studies comparing BPTB and hamstring tendon (HT) autografts for ACL reconstruction in human patients with a minimum follow-up of 10 years. The methodological quality of each study has been evaluated using the modified Coleman Methodology Score. Results on the three variables patient-oriented outcomes, clinical testing and measurements and radiographic outcomes were gathered and are presented in this review. Results Of 1299 records found, nine studies with a total of 1833 patients were identified and included in this systematic review. The methodological quality of the studies ranged from a Coleman Score of 63–88. Many studies reported no or only few statistically significant differences. Significant results in favour of BPTB were found for activity levels and for instrumented laxity testing with the KT-1000 arthrometer. Better outcomes for HT were found in IKDC-SKF, the KOOS, donor site morbidity, pivot shift test, radiographic osteoarthritis (IKDC C or D) and contralateral ACL rupture. No studies presented significant differences in terms of Lysholm Score or Tegner Activity Score, Lachman test, single-legged hop test, deficits in range of motion, osteoarthritis using the Kellgren and Lawrence classification or graft rupture. Conclusion We cannot recommend one graft to be superior, since both grafts show disadvantages in the long-term follow-up. Considering the limitation of our systematic review of no quantitative analysis, we cannot draw further conclusions from the many insignificant results presented by individual studies. Level of evidence: IV.

Ten-year outcomes of anterior cruciate ligament reconstruction with hamstring tendon autograft and femoral fixation with a cortico-cancellous screw suspension device

“…However, it is crucial to consider that the studies included in that review are dated to the 1990s and the current standard of practice could be more accurate in terms of tunnel preparation and femoral tunnel placement. However, these data were similar to those reported by Sollberger et al [ 21 ]. In their systematic review, they reported a rate of knee OA ≥ 2 (KL classification) in 32–55.2% of cases after 10 years of follow-up.…”

“…However, the mean follow-up period was 82 (minimum 48 and maximum 108) months. A recent systematic review and meta-analysis that compares the clinical results between HT and patellar tendon reported a failure rate of HT graft from 6.3% to 18% at minimum 10 years of follow-up [ 21 ]. Our results showed a lower rate of graft failure (5.4%) compared to existing literature [ 22 ].…”

Evaluating the quality of systematic reviews of comparative studies in autograft‐based anterior cruciate ligament reconstruction using the AMSTAR‐2 tool: A systematic umbrella review

“…Of the 2598 studies initially identified from the search strategy, a total of 50 systematic reviews (36 systematic reviews with meta‐analyses, 14 systematic reviews alone) were included in the final quality assessment (Figure 1) [1‐7, 10‐13, 16, 19, 21‐23, 25‐29, 31‐33, 35, 38‐42, 44, 46, 48, 52, 54, 58‐60, 65‐69, 71‐75, 77]. Cohen's κ Scores were 0.73, 0.75 and 0.74 at the title/abstract, full‐text screening and AMSTAR‐2 assessment stages, respectively, indicating substantial agreement at all phases of the review.…”

Periosteal wrapping of the hamstring tendon autograft improves graft healing and prevents tunnel widening after anterior cruciate ligament anatomic reconstruction

“…Hamstring tendon autografts are widely used for anterior cruciate ligament (ACL) reconstruction [ 1 ]. However, slower graft-tunnel incorporation, graft maturation, and tunnel widening remain some of the biggest concerns with hamstring autografts compared with BTB autografts [ 2 – 4 ]. Several studies have investigated different methods for enhancing graft-tunnel healing to increase osteointegration, including the use of bone morphogenic proteins, platelet-derived growth factors, transforming growth factor-b1 (TGF-b1), bone substitutes, and periosteum autografts [ 5 – 7 ].…”