Lower donor site morbidity with hamstring and quadriceps tendon autograft compared with bone-patellar tendon-bone autograft after anterior cruciate ligament reconstruction: a systematic review and network meta-analysis of randomized controlled trials

Abstract

PurposeTo perform a meta‐analysis of RCTs evaluating donor site morbidity after bone–patellar tendon–bone (BTB), hamstring tendon (HT) and quadriceps tendon (QT) autograft harvest for anterior cruciate ligament reconstruction (ACLR). MethodsPubMed, OVID/Medline and Cochrane databases were queried in July 2022. All level one articles reporting the frequency of specific donor‐site morbidity were included. Frequentist model network meta‐analyses with P‐scores were conducted to compare the prevalence of donor‐site morbidity, complications, all‐cause reoperations and revision ACLR among the three treatment groups. ResultsTwenty‐one RCTs comprising the outcomes of 1726 patients were included. The overall pooled rate of donor‐site morbidity (defined as anterior knee pain, difficulty/impossibility kneeling, or combination) was 47.3% (range, 3.8–86.7%). A 69% (95% confidence interval [95% CI]: 0.18–0.56) and 88% (95% CI: 0.04–0.33) lower odds of incurring donor‐site morbidity was observed with HT and QT autografts, respectively (p < 0.0001, both), when compared to BTB autograft. QT autograft was associated with a non‐statistically significant reduction in donor‐site morbidity compared with HT autograft (OR: 0.37, 95% CI: 0.14–1.03, n.s.). Treatment rankings (ordered from best‐to‐worst autograft choice with respect to donor‐site morbidity) were as follows: (1) QT (P‐score = 0.99), (2) HT (P‐score = 0.51) and (3) BTB (P‐score = 0.00). No statistically significant associations were observed between autograft and complications (n.s.), reoperations (n.s.) or revision ACLR (n.s.). ConclusionACLR using HT and QT autograft tissue was associated with a significant reduction in donor‐site morbidity compared to BTB autograft. Autograft selection was not associated with complications, all‐cause reoperations, or revision ACLR. Based on the current data, there is sufficient evidence to recommend that autograft selection should be personalized through considering differential rates of donor‐site morbidity in the context of patient expectations and activity level without concern for a clinically important change in the rate of adverse events. Level of evidenceLevel I.

Satisfactory 5‐year functional outcomes following primary ACL reconstructions from the UK National Ligament Registry

“…Hamstring tendon autograft was the most frequent autograft choice in our cohort (91%), followed by patellar tendon graft in 8.6%. The high use of hamstring tendon autograft is consistent with the findings from other European registries, such as the Scandanavian registries [24][25][26][27][33][34][35]. However, BTB is a more popular autograft choice in studies from the United States [36,37].…”

Novas técnicas de enxertia para reconstrucão do LCA: Artigo de atualização

“…52 When compared to other graft options, the QT graft has benefits such as lower morbidity at the donor site (defined as anterior knee pain, difficulty or inability to kneel or both) when compared to the patellar tendon autograft. 53 In a cohort study, ACL reconstruction using a QT graft showed a lower rate of rerupture when compared to autologous flexor graft. 54 In a recent study with 6,652 ACL reconstructions, cases using QT graft had a lower rate of septic arthritis when compared to cases using flexor grafts, patellar tendon grafts or allografts.…”

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

“…The median number of studies included was 15 (IQR = 8.6-21.4) and the median number of total patients included was 1398 (IQR = 771.5-2024.5). Studies were published in 21 different journals, with the most common journals of publication being: The Journal of Arthroscopic and Related Surgery (nine studies; 18%) [4,5,10,11,13,25,32,54,60], The American Journal of Sports Medicine (seven studies; 14%) [6,16,22,23,48,67,69] and Knee Surgery, Sports Traumatology, Arthroscopy (six studies; 12%) [26,35,40,41,49,72]. The most commonly investigated comparison of autografts in included studies was HT versus BPTB (35/50, 70%), followed by QT versus HT versus BPTB (9/50, 18%), QT versus HT (3/ 50, 6%) and QT versus BPTB (1/50, 2%).…”