A Meta-Analysis of Stability After Anterior Cruciate Ligament Reconstruction as a Function of Hamstring versus Patellar-Tendon Graft, and Fixation Type
By
Chadwick C. Prodromos, M.D., Brian T. Joyce, B.A., Kelvin Shi, M.S., Brett L. Keller, B.S, B.A.
Published in:
Arthroscopy: The Journal of Arthroscopic and Related Surgery
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ABSTRACT
PURPOSE: Four-strand Hamstring graft (4HS) is stronger than 10mm-Bone-Patellar-Tendon-Bone graft (BTB) and has equal tunnel pullout strength, but has been felt by some to produce lower rates of stability after Anterior Cruciate Ligament Reconstruction (ACLR). Our purpose was to test the hypothesis that 4HS ACLR with modern fixation would produce equal or greater stability than BTB ACLR.
TYPE OF STUDY: Meta-Analysis
METHODS: A computerized search was used to find all ACLR series using HS and/or BTB published since 1990. Inclusion criteria were minimum 24-month follow-up; stratified presentation of arthrometric stability data; and at least 30 lb arthrometric testing force. 24 4HS, 8 two-strand hamstring (2HS), and 32 BTB series met these criteria and were subdivided into groups according to fixation type. We used The International- Knee-Documentation-Committee classification of a side-to-side instrumented Lachman test difference of < 2mm as normal stability, and > 5mm difference as abnormal stability. Series with at least 80% normal and at most 3% abnormal stability were designated high stability. Meta-analytic methods were used to determine group level differences.
RESULTS: Total-4HS had a higher normal stability rate than Total-BTB: 77% vs. 66% p<0.001; and lower abnormal stability: 4.4% vs. 5.9% p=0.029. 4HS ACLR using endobutton and second-generation tibial fixation (EB2-4HS) had higher normal stability (80%) and lower abnormal stability (1.7%) than all other subgroups, including BTB with 2 interference-screws (70% normal, 5.0% abnormal) p<0.001. 84% of the series in the EB2-4HS group were high stability series. No more than 33% of the series from any other group were high stability
CONCLUSIONS: The recent literature would suggest that 4HS ACLR produces higher stability rates than BTB; that 4HS stability rates are fixation dependent; that aperture fixation offers no stability advantage; and that endobutton with second-generation tibial fixation produces high stability rates more consistently than other graft/fixation combinations.
LEVEL OF EVIDENCE: Level IV
KEY WORDS: Anterior Cruciate Ligament; Hamstring; Patellar Tendon; Meta-Analysis; Reconstruction; Stability
This article was published in Arthroscopy: The Journal of Arthroscopic and Related Surgery,
Volume 21, by C.C. Prodromos, et al.
A Meta-Analysis of Stability After Anterior Cruciate Ligament Reconstruction as a Function of Hamstring Versus Patellar Tendon Graft and Fixation Type,
pages 1201.e1-1202.e9, Copyright 2005, and is posted with permission from the Arthroscopy Association of North America