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DOI: 10.1055/s-0038-1669916
Outcomes of Anterior Cruciate Ligament Reconstruction in Females Using Patellar–Tendon–Bone versus Hamstring Autografts: A Systematic Review and Meta-Analysis
Publication History
03 June 2018
23 July 2018
Publication Date:
13 September 2018 (online)
![](https://www.thieme-connect.de/media/jks/201908/lookinside/thumbnails/10-1055-s-0038-1669916_180164oa-1.jpg)
Abstract
The current review aims to compare the outcomes of anterior cruciate ligament (ACL) reconstruction in the female population after patellar–tendon–bone and hamstring grafts. The review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. All original randomized controlled trials and prospective cohort studies that compared clinical outcomes after female ACL reconstruction using hamstring versus patellar–tendon–bone grafts were included. All clinical outcomes reported by three or more studies were included. Fifteen publications, with 948 female patients, were included. Most outcomes were reported to have no significant graft differences by all studies that reported the outcome. These included all the outcomes for objective knee scores (International Knee Documentation Committee [IKDC] objective knee score), neuromuscular testing (quadriceps strength, hamstring strength, and single hop test), graft rupture or failure, and subjective knee scores (Lysholm score and IKDC subjective knee score). The pivot shift test, flexion deficit, and presence of crepitus were also reported to have no significant graft differences by all studies. Some studies reported a significant difference in anteroposterior laxity (Lachman's test and instrumented laxity), range of motion deficits (extension deficit), and sports and activity level (Tegner score). However, these statistically significant differences were noted to be clinically insignificant due to the normal population variation or standard error of measurement of these tools of evaluation. Patients reconstructed with patellar-tendon–bone grafts have a higher risk of kneeling pain. There was no significant difference in the incidence of crepitus. Most of the outcomes following female ACL reconstructions showed no clinically and statistically significant difference when either patellar–tendon–bone or hamstring autograft was used. These included outcomes for anteroposterior laxity, objective knee scores, neuromuscular testing, graft rupture or failure, subjective knee scores, sports and activity level, and crepitus. This a level II study.
Keywords
anterior cruciate ligament reconstruction - female - gender - sex - hamstring - patellar–tendon–bone - graft-
References
- 1 Lind M, Menhert F, Pedersen AB. Incidence and outcome after revision anterior cruciate ligament reconstruction: results from the Danish registry for knee ligament reconstructions. Am J Sports Med 2012; 40 (07) 1551-1557
- 2 Mall NA, Chalmers PN, Moric M. , et al. Incidence and trends of anterior cruciate ligament reconstruction in the United States. Am J Sports Med 2014; 42 (10) 2363-2370
- 3 Tan SH, Lau BP, Khin LW, Lingaraj K. The importance of patient sex in the outcomes of anterior cruciate ligament reconstructions: a systematic review and meta-analysis. Am J Sports Med 2016; 44 (01) 242-254
- 4 Tan SHS, Kripesh A, Chan CX, Krishna L. Gender Differences in Intra-articular and Extra-articular Injuries Associated with Acute Anterior Cruciate Ligament Ruptures. J Knee Surg 2018; DOI: 10.1055/s-0038-1666828.
- 5 Prodromos CC, Han Y, Rogowski J, Joyce B, Shi K. A meta-analysis of the incidence of anterior cruciate ligament tears as a function of gender, sport, and a knee injury-reduction regimen. Arthroscopy 2007; 23 (12) 1320-1325
- 6 Sutton KM, Bullock JM. Anterior cruciate ligament rupture: differences between males and females. J Am Acad Orthop Surg 2013; 21 (01) 41-50
- 7 Myer GD, Ford KR, Paterno MV, Nick TG, Hewett TE. The effects of generalized joint laxity on risk of anterior cruciate ligament injury in young female athletes. Am J Sports Med 2008; 36 (06) 1073-1080
- 8 Bizzini M, Gorelick M, Munzinger U, Drobny T. Joint laxity and isokinetic thigh muscle strength characteristics after anterior cruciate ligament reconstruction: bone patellar tendon bone versus quadrupled hamstring autografts. Clin J Sport Med 2006; 16 (01) 4-9
- 9 Barrett GR, Noojin FK, Hartzog CW, Nash CR. Reconstruction of the anterior cruciate ligament in females: A comparison of hamstring versus patellar tendon autograft. Arthroscopy 2002; 18 (01) 46-54
- 10 Corry IS, Webb JM, Clingeleffer AJ, Pinczewski LA. Arthroscopic reconstruction of the anterior cruciate ligament. A comparison of patellar tendon autograft and four-strand hamstring tendon autograft. Am J Sports Med 1999; 27 (04) 444-454
- 11 Mohtadi N, Chan D, Barber R, Paolucci EO. Reruptures, reinjuries, and revisions at a minimum 2-year follow-up: a randomized clinical trial comparing 3 graft types for ACL reconstruction. Clin J Sport Med 2016; 26 (02) 96-107
- 12 Engelen-van Melick N, van Cingel REH, van Tienen TG, Nijhuis-van der Sanden MWG. Functional performance 2-9 years after ACL reconstruction: cross-sectional comparison between athletes with bone-patellar tendon-bone, semitendinosus/gracilis and healthy controls. Knee Surg Sports Traumatol Arthrosc 2017; 25 (05) 1412-1423
- 13 Gobbi A, Domzalski M, Pascual J. Comparison of anterior cruciate ligament reconstruction in male and female athletes using the patellar tendon and hamstring autografts. Knee Surg Sports Traumatol Arthrosc 2004; 12 (06) 534-539
- 14 Heijne A, Hagströmer M, Werner S. A two- and five-year follow-up of clinical outcome after ACL reconstruction using BPTB or hamstring tendon grafts: a prospective intervention outcome study. Knee Surg Sports Traumatol Arthrosc 2015; 23 (03) 799-807
- 15 Kautzner J, Kos P, Hanus M, Trc T, Havlas V. A comparison of ACL reconstruction using patellar tendon versus hamstring autograft in female patients: a prospective randomised study. Int Orthop 2015; 39 (01) 125-130
- 16 Muneta T, Sekiya I, Ogiuchi T, Yagishita K, Yamamoto H, Shinomiya K. Effects of aggressive early rehabilitation on the outcome of anterior cruciate ligament reconstruction with multi-strand semitendinosus tendon. Int Orthop 1998; 22 (06) 352-356
- 17 Papalia R, Franceschi F, Tecame A, D'Adamio S, Maffulli N, Denaro V. Anterior cruciate ligament reconstruction and return to sport activity: postural control as the key to success. Int Orthop 2015; 39 (03) 527-534
- 18 Pinczewski LA, Lyman J, Salmon LJ, Russell VJ, Roe J, Linklater J. A 10-year comparison of anterior cruciate ligament reconstructions with hamstring tendon and patellar tendon autograft: a controlled, prospective trial. Am J Sports Med 2007; 35 (04) 564-574
- 19 Siebold R, Webster KE, Feller JA, Sutherland AG, Elliott J. Anterior cruciate ligament reconstruction in females: a comparison of hamstring tendon and patellar tendon autografts. Knee Surg Sports Traumatol Arthrosc 2006; 14 (11) 1070-1076
- 20 Svensson M, Sernert N, Ejerhed L, Karlsson J, Kartus JT. A prospective comparison of bone-patellar tendon-bone and hamstring grafts for anterior cruciate ligament reconstruction in female patients. Knee Surg Sports Traumatol Arthrosc 2006; 14 (03) 278-286
- 21 Thompson SM, Salmon LJ, Waller A, Linklater J, Roe JP, Pinczewski LA. Twenty-year outcome of a longitudinal prospective evaluation of isolated endoscopic anterior cruciate ligament reconstruction with patellar tendon or hamstring autograft. Am J Sports Med 2016; 44 (12) 3083-3094
- 22 Tsuda E, Ishibashi Y, Fukuda A, Tsukada H, Toh S. Comparable results between lateralized single- and double-bundle ACL reconstructions. Clin Orthop Relat Res 2009; 467 (04) 1042-1055
- 23 Higgins JPT, Sterne JAC, Savović J. , et al. A revised tool for assessing risk of bias in randomized trials. Cochrane Database Syst Rev 2016; 10 (Suppl. 01) 29-31 . Doi: dx.doi.org/10.1002/14651858.CD201601
- 24 Sterne JAC, Hernán MA, Reeves BC. , et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ 2016; 355: i4919
- 25 Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J. Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg 2003; 73 (09) 712-716
- 26 Deeks JJ, Altman DG, Bradburn MJ. Statistical methods for examining heterogeneity and combining results from several studies in meta-analysis. In: Egger M, Smith GD, Altman DG. , eds. Systematic Reviews in Health Care: Meta-analysis in Context. John Wiley & Sons; 2001: 285-321
- 27 Fleiss JL. The statistical basis of meta-analysis. Stat Methods Med Res 1993; 2 (02) 121-145
- 28 Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ 2003; 327 (7414): 557-560
- 29 Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med 2002; 21 (11) 1539-1558
- 30 Whitehead A. Meta-Analysis of Controlled Clinical Trials. West Sussex: John Wiley; 2002
- 31 Gifstad T, Foss OA, Engebretsen L. , et al. Lower risk of revision with patellar tendon autografts compared with hamstring autografts: a registry study based on 45,998 primary ACL reconstructions in Scandinavia. Am J Sports Med 2014; 42 (10) 2319-2328
- 32 Daniel DM, Stone ML, Sachs R, Malcom L. Instrumented measurement of anterior knee laxity in patients with acute anterior cruciate ligament disruption. Am J Sports Med 1985; 13 (06) 401-407
- 33 Kurz A, Evaniew N, Yeung M, Samuelsson K, Peterson D, Ayeni OR. Credibility and quality of meta-analyses addressing graft choice in anterior cruciate ligament reconstruction: a systematic review. Knee Surg Sports Traumatol Arthrosc 2017; 25 (02) 538-551
- 34 Paterno MV, Weed AM, Hewett TE. A between sex comparison of anterior-posterior knee laxity after anterior cruciate ligament reconstruction with patellar tendon or hamstrings autograft: a systematic review. Sports Med 2012; 42 (02) 135-152
- 35 Ryan J, Magnussen RA, Cox CL, Hurbanek JG, Flanigan DC, Kaeding CC. ACL reconstruction: do outcomes differ by sex? A systematic review. J Bone Joint Surg Am 2014; 96 (06) 507-512
- 36 Milanese S, Gordon S, Buettner P. , et al. Reliability and concurrent validity of knee angle measurement: smart phone app versus universal goniometer used by experienced and novice clinicians. Man Ther 2014; 19 (06) 569-574
- 37 Briggs KK, Steadman JR, Hay CJ, Hines SL. Lysholm score and Tegner activity level in individuals with normal knees. Am J Sports Med 2009; 37 (05) 898-901
- 38 Briggs KK, Lysholm J, Tegner Y, Rodkey WG, Kocher MS, Steadman JR. The reliability, validity, and responsiveness of the Lysholm score and Tegner activity scale for anterior cruciate ligament injuries of the knee: 25 years later. Am J Sports Med 2009; 37 (05) 890-897