Bone–Patellar Tendon–Bone Autografts Versus Hamstring Autografts Using the Same Suspensory Fixations in ACL Reconstruction: A Systematic Review and Meta-analysis

Abstract

Background: Bone–patellar tendon–bone (BPB) autografts and hamstring tendon (HT) autografts are 2 popular choices for anterior cruciate ligament reconstruction (ACLR). Although existing meta-analyses have explored the clinical outcomes between BPB and HT autografts, none have based their analysis on studies with just femoral suspensory fixation methods. Purpose: To evaluate and compare clinical outcomes, particularly graft failure and knee stability, of ACLR with BPB or HT autografts with suspensory femoral fixation. Study Design: Systematic review; Level of evidence, 4. Methods: A literature search was conducted of studies reporting single-bundle ACLR with BPB autografts and HT autografts with suspensory fixation with a minimum 24-month follow-up. Graft failure rate, knee stability, and clinical outcomes were compared for BPB versus HT autografts. Knee stability was measured with the Lachman test, pivot-shift test, and KT-1000/2000 arthrometer side-to-side difference (SSD). Clinical outcomes were measured with Lysholm scores and the Tegner activity scale, as well as rate of return to preinjury sports. Donor site morbidity among included studies was reviewed. A random-effects model was used for calculations of summary estimates. Subgroup, sensitivity, and trial sequential analyses were conducted. Results: Five studies were included. Graft failure was seen more often in the HT group than the BPB group, and this was statistically significant ( P = .03). However, the trial sequential analysis outcome indicated that the included sample size was not large enough to support a solid positive finding. The analysis showed no significant difference in SSD, Lachman test, pivot-shift test, rate of return to sports, Lysholm score, or Tegner score between groups. Subgroup analyses found no significant difference between groups. Conclusion: This meta-analysis demonstrated no significant differences in knee stability and knee functional outcomes between BPB and HT autografts with suspensory fixation. More evidence is needed to prove the lower risk of failure with use of BTB autograft with suspensory fixation.