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Increased incidence of osteoarthritis of knee joint after ACL reconstruction with bone-patellar tendon-bone autografts than hamstring autografts: a meta-analysis of 1,443 patients at a minimum of 5 years.
MedLine Citation:
PMID:  24748500     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
PURPOSE: The objective of this study was to evaluate the effectiveness of BPTB autografts versus HT autografts at a minimum of 5 years after anterior cruciate ligament (ACL) reconstruction.
METHODS: A systematical search of literature was performed in PubMed, Embase and the Cochrane library to identify published randomized controlled trials (RCT) or prospective cohort studies (PCS) relevant to ACL reconstruction comparing BPTB and HT autografts. The results of the eligible studies were analysed in terms of objective International Knee Documentation Committee (IKDC) scores, return to preinjury activity level, KT-1000, Lachman test, pivot shift test, anterior knee pain, kneeling pain, extension loss, and flexion loss, graft failure and radiographic outcomes. Study quality was assessed by using the Coleman methodology score for included studies. Two reviewers independently assessed each study for quality and extracted data. Subgroup analysis of the primary outcomes was conducted according to the type of study design (RCT or PCS).
RESULTS: Twelve RCTs, two PCS including 1,443 patients comparing hamstring and patellar tendon autografts were identified. The results of the meta-analysis showed that there were no significant differences between BPTB and HT in terms of objective IKDC score (P = 0.83), return to preinjury activity (P = 0.69), KT-1000 (P = 0.12), Lachman test (P = 0.76), pivot shift test (P = 0.11), extension deficit (P = 0.09), flexion deficit (P = 0.71) and graft failure (P = 0.22). However, outcomes in favour of HT autografts were found in terms of anterior knee pain (P = 0.0001) and kneeling pain (P = 0.001). Radiographic evidence of osteoarthritis (OA) showed that incidence of OA was significantly higher in BPTB groups compared with HT groups based on IKDC system. These findings were still robust during the sensitivity analysis. Results from subgroup analysis of the primary outcomes were consistent with the overall analysis.
CONCLUSION: Meta-analysis of prospective trials did not detect any significant differences in clinical results, as evidenced by the objective IKDC score, return to preinjury activity level, KT-1000, Lachman test, pivot shift test, extension loss, flexion loss and graft failure. However, the meta-analysis revealed that ACL reconstruction with BPTB autografts resulted in increased anterior knee pain and kneeling pain compared with hamstring autografts. Increased incidence of OA was found after ACL reconstruction at a minimum of 5 years in BPTB group compared with HT autografts. This result should be cautiously interpreted. More high-quality RCT with strictly specified inclusion criteria are highly required before drawing a reliable conclusion.
Authors:
Xiaobo Xie; Zhuo Xiao; Qi Li; Bo Zhu; Jingxian Chen; Huamu Chen; Fangyuan Yang; Yuting Chen; Qianwei Lai; Xuzhou Liu
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-4-21
Journal Detail:
Title:  European journal of orthopaedic surgery & traumatology : orthopedie traumatologie     Volume:  -     ISSN:  1633-8065     ISO Abbreviation:  Eur J Orthop Surg Traumatol     Publication Date:  2014 Apr 
Date Detail:
Created Date:  2014-4-21     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9518037     Medline TA:  Eur J Orthop Surg Traumatol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
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