2017 ISAKOS Biennial Congress ePoster #1167

 

Outcome Of Patellar Tendon Versus 4-Strand Hamstring Tendon Autografts For Anterior Cruciate Ligament Reconstruction: A Meta-Analysis Of Prospective Randomised Trials

Y.K. Michael Chee, M.B.B.S. (Singapore), Singapore SINGAPORE
Yongsheng Chen, MBBS MRSCI MMED(Orth), Singapore SINGAPORE
Christopher Jon Pearce, MBChB MRCS FRCS (Tr&Orth), Singapore SINGAPORE
Diarmuid P Murphy, MB, BCh, BaO, (NUI), FRCSI, FRCS (Trauma & Orth), Singapore SINGAPORE
Lingaraj Krishna, MBBS, MMed(Orth), FRCSEd(Orth), Singapore SINGAPORE
James Hui, MBBS, FRCS, FAMS, M.D. (Orthopaedic Surgery), Singapore SINGAPORE
Wilson Wang, Singapore SINGAPORE
Bee Choo Tai, BA MSc PhD, Singapore SINGAPORE
Abhijeet A Salunke, MBBS MS(Orth), Singapore SINGAPORE
Satku K Satkunanantham, MD SINGAPORE

National University Hospital Sports Centre, National University Health System, Singapore, SINGAPORE

FDA Status Not Applicable

Summary

A systematic review and meta-analysis of Level I studies which found that primary ACL reconstruction with 4-strand hamstring tendon technique achieves clinical results which are comparable to the patella tendon technique with significantly less post-operative complications.

Abstract

Purpose

The purpose of this study was to compare clinical outcomes of anterior cruciate ligament reconstruction using patellar tendon versus hamstring tendon.

Methods

We performed a comprehensive systematic review and meta-analysis of the English literature on Pubmed, Scopus, Web of Science and the Cochrane register for papers which compared clinical outcomes of patellar tendon (PT) versus hamstring tendon (PT) for anterior cruciate ligament reconstruction. Outcome measures analysed included re-rupture rate, KT-1000, International Knee Documentation Committee grade, Lachman, Pivot Shift, Lysholm score, Tegner activity scale, anterior knee discomfort and kneeling discomfort.

Results

We included 44 studies from an initial 1168 abstracts for the systematic review, and eventually, 19 studies were included in the meta-analysis. The study population consisted of a total of 1784 patients. The average follow up duration was 58.8 months.

Results

We found significant differences in favour of the HT technique in the domains of anterior knee pain, kneeling pain and restriction in the range of active extension( “extension deficit”). We found no differences between the PT and HT technique in terms of re-rupture rate. There were no clinically significant differences for the outcomes of Lysholm score and Tegner activity scale as well as the KT-1000 side to side at maximum manual force.

Conclusions

Contemporary 4-strand HT ACL reconstruction is comparable to the PT technique in terms of clinical stability and post-operative functional status across most parameters studied. The HT technique carries lower risk of post-operative complications such as anterior knee pain, kneeling discomfort and extension deficit. Primary ACL reconstruction using the 4-strand HT technique achieves clinical results which are comparable to the PT technique with significantly less post-operative complications.