Purpose
The primary aim was to summarize and assess current evidence from randomized controlled
trials (RCTs) on anterior cruciate ligament injuries, with special reference to graft
type and surgical technique. The secondary aims were to identify the relative strengths
and weaknesses of the selected studies, to resolve contradictions in the literature,
and to evaluate the need for further studies.
Methods
A PubMed database search using the key words “anterior cruciate ligament” was performed.
The search was limited to RCTs published in English between January 1995 and March
2009. Articles on the subject of graft type and surgical technique were identified.
After initial screening and a subsequent quality appraisal based on the CONSORT (Consolidated
Standards of Reporting Trials) Statement, a total of 39 articles were included in
this review.
Results
There are no differences between the bone–patellar tendon–bone (BPTB) graft and the
hamstring tendon (HT) graft in terms of laxity, clinical outcome, time to return to
sports, patellofemoral crepitations, 1-leg hop test, range of motion, thigh muscle
circumference, or anterior knee sensory deficit. The BPTB graft produces more anterior
knee pain and kneeling pain than the HT graft, but the difference disappears with
time. The harvest site affects muscle strength initially but not over time. There
is a possible correlation between the development of osteoarthritis and the BPTB graft.
The HT graft produces more tunnel widening than the BPTB graft, but there is no correlation
between tunnel widening and clinical outcome or laxity. The semitendinosus and gracilis
graft is associated with inferior knee flexion at higher angles, as compared with
the semitendinosus graft. There are probably no differences between the BPTB graft
and the bone-HT-bone graft in terms of laxity and clinical outcome. Semitendinosus
and gracilis tendon harvesting probably reduces hamstring muscle strength for approximately
1 year. Double-bundle reconstruction produces less rotatory laxity than single-bundle
reconstruction. Double-bundle reconstruction by use of an 8-strand HT graft probably
produces less laxity than single-bundle reconstruction. There are no differences in
clinical outcome when single-bundle and double-bundle anterior cruciate ligament reconstructions
are compared.
Conclusions
In the quality assessment several weaknesses in the study design of the RCTs were
found. This emphasizes the need for further high-quality studies, especially with
long-term follow-up.
Level of Evidence
Level II, systematic review of randomized controlled trials.
Key Words
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Article info
Footnotes
The authors report no conflict of interest.
Identification
Copyright
© 2009 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
