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Medline ® Abstract for Reference 122

of 'Anterior cruciate ligament injury'

Hamstring tendon autograft better than bone patellar-tendon bone autograft in ACL reconstruction: a cumulative meta-analysis and clinically relevant sensitivity analysis applied to a previously published analysis.
Poolman RW, Farrokhyar F, Bhandari M
Acta Orthop. 2007;78(3):350.
BACKGROUND: Current debate on treatment options for anterior cruciate ligament (ACL) reconstruction complicate the choice between hamstring and bone-patellar tendon-bone autografts. We hypothesized a priori that cumulative meta-analysis (a form of sensitivity analysis) might show that the evidence for reduction of morbidity by hamstring grafts could have been reached at an earlier time. Furthermore, we hypothesized a priori that modern state-of-the-art hamstring graft fixation technique would give similar results regarding stability as bone-patellar tendon-bone autografts.
METHODS: We performed a cumulative meta-analysis and sensitivity analysis based on femoral graft fixation techniques to compare hamstring autograft and bone-patellar tendon-bone autografts in ACL reconstruction derived from a previously published meta-analysis.
RESULTS: Cumulatively, that hamstring autograft reduces anterior knee pain had already reached statistical significance in 2001 (relative risk 0.49 (95%CI: 0.32-0.76; p = 0.001,I2 = 0%)). The modern endobutton hamstring graft fixation technique (2 studies) yielded similar stability in the Lachman test as bone-patellar tendon-bone grafts, with a relative risk of 1.1 (95%CI: 0.82-1.5; p = 0.6, I2 = 0%). Exclusion of the endobutton group explains the increased laxity in the hamstring graft group.
INTERPRETATION: Cumulative meta-analysis strengthens the evidence for reduced morbidity using hamstring tendon autograft for anterior cruciate ligament reconstruction. Sensitivity analysis focusing on state-of-the-art hamstring graft fixation techniques further weakens the evidence that bone-patellar tendon-bone autografts provide better stability.
Department of Orthopaedic Surgery, Onze Lieve Vrouwe Gasthuis, NL-1090 HM Amsterdam, The Netherlands. poolman@trauma.nl