2017 ISAKOS Biennial Congress ePoster #1064
Quadriceps Tendon-Bone is Superior to Bone- Patella Tendon- Bone Autograft when Reconstructing the Anterior Cruciate Ligament: A Meta-Analysis
Osman Riaz, MBChB, MRCS, Huddersfield, West Yorkshire UNITED KINGDOM
Adeel Aqil, MB ChB, MRCS, Huddersfield UNITED KINGDOM
Fahad Siddique Hossain, FRCS (Tr & Orth), Walsall, West Midlands UNITED KINGDOM
Gautam Chakrabarty, MBBS, D Orth, MS Orth, MCh Orth, FRCS Ed, FRCS, Huddersfield UNITED KINGDOM
Graham Radcliffe, MB ChB, FRCS, Bradford UNITED KINGDOM
Calderdale and Huddersfield NHS Foundation Trust, Bradford Teaching Hospitals NHS Foundation Trust, Huddersfield/Bradford, West Yorkshire, UNITED KINGDOM
FDA Status Not Applicable
Summary
Meta-analysis comparing quadriceps tendon grafts versus bone patella tendon bone graft for ACL reconstruction
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Abstract
Background
Bone-patella tendon-bone (BPTB) is a popular graft for reconstruction of the anterior cruciate ligament (ACL). However the quadriceps tendon–bone (QTB) has been advocated as an alternative graft, in order to avoid potential problems associated with BPTB harvest sites. We aimed to quantitatively assess the outcomes of published studies, which compared the use of BPTB and QTB autografts when reconstructing the ACL.
Method
MEDLINE, Embase, and CINAHL databases were searched for relevant articles published between January 1980 to January 2015 for the purpose of identifying studies comparing BPTB and QTB autografts for ACL reconstruction. A double extraction technique was used and Included studies were assessed regarding their methodological quality prior to analysis. Outcomes analysed included graft failure rates, objective and subjective stability assessments, as well as the presence and severity of donor site morbidity.
Results
Five studies contributed to the quantitative analysis of 806 patients with 452 patients included in the BPTB group and 354 patients in the QTB group. Graft failure rates were similar between the two groups (OR=0.61; CI= 0.17-2.15; z=0.78, p=0.44). There were no significant differences between the two groups when testing antero-posterior stability using an arthrometer (SMD=0.07; CI= -0.12, 0.25; z=0.70, p=0.48). At one year post-operatively there was no difference in the percentage of patients with a positive pivot shift tests between the two groups (OR=1.0; CI= 0.85, 1.18; z=0.01, p=0.99). However significantly less patients had graft site pain 1 year following surgery in the QTB group (OR=0.10; CI= 0.02, 0.43; z= 3.12, p= 0.002). Also, significantly fewer numbers of patients reported moderate to severe pain whilst kneeling in the QTB group (OR=0.16; CI=0.07, 0.37; z=4.26, p<0.001).
Conclusion
This study demonstrates good and comparable graft survival rates and stability of operated knees when either BPTB or QTB auto grafts are used. However there are significantly less adverse donor site symptoms with the use of QTB compared to BPTB grafts. The current evidence favours the use of the QTB over the BPTB autograft for primary ACL reconstructions.