2017 ISAKOS Biennial Congress ePoster #1113

 

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

Michael G. Ciccotti, MD, Philadelphia, PA UNITED STATES
Kirsten L. Poehling-Monaghan, MD, Gaithersburg, MD UNITED STATES
Kirsten E Ross, BS, Philadelphia, PA UNITED STATES
Eric Secrist, BS, Philadelphia, PA UNITED STATES
Michael G. Ciccotti, MD, Philadelphia, PA UNITED STATES
Fotios P. Tjoumakaris, MD, Egg Harbor Township, NJ UNITED STATES
Kevin Freedman, MD, Bryn Mawr, PA UNITED STATES

Rothman Insitute, Philadelphia, PA, UNITED STATES

FDA Status Not Applicable

Summary

The purpose of this study is to describe the long-term comparative outcomes of ACL reconstruction with autograft bone-patellar tendon-bone (BPTB) versus autograft hamstring (HS) ACL reconstruction with respect to clinical and radiographic outcomes.

Abstract

Background

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

Hypothesis/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 respect to clinical and radiographic outcomes.

Study Design: Systematic review (Level II)

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 with a minimum 5-year follow-up. Outcome data included failure and complications, manual and instrumented laxity, patient reported outcomes and radiographic risk of osteoarthritis.

Results

Seventeen studies with a total of 1,523 patients met inclusion criteria. Of these studies, 10 studies were Level I evidence, and 7 were Level II. Mean follow-up was 10.4 years (range: 5-15.3). No differences in manual or instrumented laxity were seen in any studies. Lower clinical outcomes scores and greater motion loss were seen in BPTB patients in 2 and 3 studies, respectively. Eight of 13 studies reporting on anterior knee/kneeling pain found it more frequently among BPTB patients. One study found significantly increased re-operation rates in HS patients, while another found a similar result in BPTB, and 2 studies reported a significant increase in contralateral ACL tears in BPTB patients. Seven of the 9 studies reporting on radiographic evidence of osteoarthritis (OA) noted significantly increased rates in BPTB patients. No significant differences were seen in graft failure in any studies.

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 anterior knee/kneeling pain and higher rates of osteoarthritis were noted with BPTB graft use.