Purpose

To conduct a systematic review and meta-analysis on graft size for the hamstrings tendon- (HT), patellar tendon- (PT) and quadriceps tendon (QT) autograft and evaluate odds for graft failure.

Methods

Medline, PubMed, Cochrane Library, Embase, Amed, and Web of Science were searched at three separate time points. Eligible studies had included patients who had undergone primary ACLR with (graft failures) or without (survivals) graft failure and had specified graft size for primary ACLR. Standardized mean differences were calculated for continuous variables, and odds ratios expressed with 95% confidence interval for the dichotomous variables of graft size for survivals versus graft failures. Risk of bias was assessed with RoBANS 2. Certainty of evidence was assessed with GRADE.

Results

A total of 45,572patients of which 43,261 HT, 2,311 PT were covered in the included 31 articles. An HT autograft size of ≥7 mm had 45% lower odds for a graft failure compared to <7 mm (p = 0.01), ≥8 mm HT autograft size had 26% lower odds for a graft failure compared to <8 mm (p=0.0002), ≥9 mm HT autograft size had 23% lower odds for a graft failure compared to <9 mm (p=0.0008) and, ≥10 mm HT autograft size had 31% lower odds for a graft failure compared to <10 mm (p=0.03). No significant odds for a graft failure were observed for patients with >10 mm compared to ≤10 mm or for patients with PT autograft.

Conclusion

With a low certainty of evidence, patients with greater HT autograft size have lower odds for graft failure compared with smaller HT autograft size. No significant difference in odds for graft failure was found for different PT autograft sizes.