Outcomes Following Anterior Cruciate Ligament Reconstruction with Patellar Tendon vs Hamstring Autografts: A Systematic Review of Randomized Controlled Trials with a Mean Follow-up of ۱۵ Years

Background: The two most common surgical treatment modalities for anterior cruciate ligament reconstruction (ACL), patellar tendon (PT) and hamstring tendon (HS) autografts, have been shown to have outcomes that are both similar and favorable; however, many of these are short or intermediate-term. The objective of this systematic review is to evaluate randomized controlled trials (RCTs) with a minimum ۱۰-year follow-up data to compare the long-term outcomes of ACL reconstructions performed using PT and HS autografts.Methods: This systematic review followed the PRISMA (Preferred Reporting Items for Systematic Reviews and MetaAnalyses) guidelines. A search of three databases (PubMed, Cochrane and EMBASE) was performed to identify RCTs with a minimum of ۱۰-year follow-up that compared clinical and/or functional outcomes between PT and HS autografts. Results: Four RCTs with a total of ۲۹۹ patients were included in the study. The mean follow-up ranged from ۱۰.۲ to ۱۷ years (mean, ۱۴.۷۹ years). No significant differences in knee laxity or clinical outcome scores were demonstrated in any of the studies. One study found that PT autografts were significantly more likely to have osteoarthritis identified by radiographic findings. Two studies found that patients with PT autografts reported increase kneeling pain, while none of the four studies reported a difference in anterior knee pain. There were no significant differences in graft failure rates.Conclusion: This review demonstrates no long-term difference in clinical or functional outcomes between PT and HS autografts. However, radiographic and subjective outcomes indicate that patients with PT autografts may experience greater kneeling pain and osteoarthritis. Therefore, orthopaedic surgeons should consider patient-centric factors when discussing graft options with patients.Level of evidence: II

کلیدواژه ها:

anterior cruciate ligament ، Autografts ، Hamstring Tendon Autograft ، Patellar Tendon Autograft