Bone-patellar tendon-bone autografts versus hamstring autografts for reconstruction of anterior cruciate ligament: meta-analysis

doi:10.1136/bmj.38784.384109.2F

BMJ, doi: 10.1136/bmj.38784.384109.2F, (Published 7 April 2006)

RESEARCH

Bone-patellar tendon-bone autografts versus hamstring autografts for reconstruction of anterior cruciate ligament: meta-analysis

David J Biau ¹^*, Caroline Tournoux ², Sandrine Katsahian ², Peter J Schranz ³, Rémy S Nizard ⁴

¹ Service de chirurgie orthopédique et traumatologique, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 75679 Paris, France
² Département de biostatistique et informatique médicale, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, 75475 Paris
³ Orthopaedics and Trauma, Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Exeter EX2 5DW
⁴ Service de chirurgie orthopédique et traumatologique, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, 75010 Paris

^* Correspondence to: djmbiau{at}yahoo.fr.

Objectives To compare bone-patellar tendon-bone autografts withhamstring autografts for reconstruction of the anterior cruciateligament.

Data sources Medline, WebSPIRS, Science Citation Index,Current Contents databases, and Cochrane Central Register ofControlled Trials.

Review methods All randomised controlled trialsreporting one or more outcome related to stability (instrumentedmeasurement of knee laxity, Lachman test, or pivot shift test)and morbidity (anterior knee pain, kneeling test, loss of extension,or graft failure). Study quality was assessed by using a 5 pointscale. Random effect models were used to pool the data. Heterogeneityin the effect of treatment was tested on the basis of studyquality, randomisation status, and number of tendon strandsused.

Results 24 trials of 18 cohorts (1512 patients) met theinclusion criteria. Study quality was poor for nine studiesand fair for nine studies. The weighted mean difference of theinstrumented measurement of knee laxity was 0.36 (95% confidenceinterval 0.01 to 0.71; P=0.04). Relative risk of a positiveLachman test was 1.22 (1.01 to 1.47; P=0.04), of anterior kneepain 0.57 (0.44 to 0.74; P<0.0001), of a positive kneelingtest 0.26 (0.14 to 0.48; P<0.0001), and of loss of extension0.52 (0.34 to 0.80; P=0.003). Other results were not significant.

ConclusionMorbidity was lower for hamstring autografts than for patellartendon autografts. Evidence that patellar tendon autograftsoffer better stability was weak. The poor quality of the studiescalls into question the robustness of the analyses.

(Accepted 23 February 2006)

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