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Poehling-Monaghan KL, Salem H, Ross KE, et al. Long-Term Outcomes in Anterior Cruciate Ligament Reconstruction: A Systematic Review of Patellar Tendon Versus Hamstring Autografts. Orthop J Sports Med. 2017;5(6):2325967117709735doi: 10.1177/2325967117709735.
Poehling-Monaghan, K. L., Salem, H., Ross, K. E., Secrist, E., Ciccotti, M. C., Tjoumakaris, F., Ciccotti, M. G., & Freedman, K. B. (2017). Long-Term Outcomes in Anterior Cruciate Ligament Reconstruction: A Systematic Review of Patellar Tendon Versus Hamstring Autografts. Orthopaedic journal of sports medicine, 5(6), 2325967117709735. https://doi.org/10.1177/2325967117709735
Poehling-Monaghan, Kirsten L, et al. "Long-Term Outcomes in Anterior Cruciate Ligament Reconstruction: A Systematic Review of Patellar Tendon Versus Hamstring Autografts." Orthopaedic journal of sports medicine vol. 5,6 (2017): 2325967117709735. doi: https://doi.org/10.1177/2325967117709735
Poehling-Monaghan KL, Salem H, Ross KE, Secrist E, Ciccotti MC, Tjoumakaris F, Ciccotti MG, Freedman KB. Long-Term Outcomes in Anterior Cruciate Ligament Reconstruction: A Systematic Review of Patellar Tendon Versus Hamstring Autografts. Orthop J Sports Med. 2017 Jun 14;5(6):2325967117709735. doi: 10.1177/2325967117709735. eCollection 2017 Jun. PMID: 28660230; PMCID: PMC5476329.
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Orthop J Sports Med. 2017 Jun 14;5(6):2325967117709735. doi: 10.1177/2325967117709735. eCollection 2017 Jun.

Long-Term Outcomes in Anterior Cruciate Ligament Reconstruction: A Systematic Review of Patellar Tendon Versus Hamstring Autografts.

Orthopaedic journal of sports medicine

Kirsten L Poehling-Monaghan, Hytham Salem, Kirsten E Ross, Eric Secrist, Michael C Ciccotti, Fotios Tjoumakaris, Michael G Ciccotti, Kevin B Freedman

Affiliations

  1. Rothman Institute, Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
  2. Jefferson Medical College, Philadelphia, Pennsylvania, USA.

PMID: 28660230 PMCID: PMC5476329 DOI: 10.1177/2325967117709735

Abstract

BACKGROUND: Much controversy still exists surrounding graft choice in anterior cruciate ligament (ACL) reconstruction. Over the past decade, an increase in comparative studies with longer follow-up has enhanced our understanding of current graft options and outcomes.

PURPOSE: To describe the long-term comparative outcomes of ACL reconstruction with autograft bone-patellar tendon-bone (BPTB) versus autograft hamstring (HS) ACL reconstruction with regard to clinical and radiographic outcomes.

STUDY DESIGN: Systematic review; Level of evidence, 2.

METHODS: A search of the PubMed, MEDLINE, Cochrane, and Scopus databases was performed to identify studies in the English language with outcome data comparing ACL reconstruction utilizing autograft BPTB and autograft HS; only studies with a minimum 5-year follow-up were included. Outcome data included failure and complications, manual and instrumented laxity, patient-reported outcomes, and radiographic risk of osteoarthritis.

RESULTS: Twelve studies with a total of 953 patients met the inclusion criteria. Of these studies, 8 were level 1 evidence and 2 were level 2. Mean follow-up was 8.96 years (range, 5-15.3 years). No differences in graft failure or manual or instrumented laxity were seen in any studies. Lower clinical outcomes scores and greater motion loss were seen in BPTB patients in 1 and 2 studies, respectively. Two of 4 studies reporting on anterior knee pain, and 3 of 7 that recorded kneeling pain found it more frequently among BPTB patients. One study found significantly increased reoperation rates in HS patients, while another found a similar result in BPTB, and 1 study reported a significant increase in contralateral ACL tears in BPTB patients. Three of 5 studies reporting on radiographic evidence of osteoarthritis noted significantly increased rates in BPTB patients.

CONCLUSION: This systematic review comparing long-term outcomes after ACL reconstruction with either autograft BPTB or autograft HS suggests no significant differences in manual/instrumented laxity and graft failures between graft types. An increase in long-term anterior knee pain, kneeling pain, and higher rates of osteoarthritis were noted with BPTB graft use.

Keywords: ACL reconstruction; autograft; long-term; osteoarthritis; review

Conflict of interest statement

The authors declared that they have no conflicts of interest in the authorship and publication of this contribution.

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