Evidence-Based ACL Reconstruction

Document Type: CURRENT CONCEPTS REVIEW

Author

Department of Orthopaedic Surgery, La Paz University Hospital, Madrid, Spain

Abstract

There is controversy in the literature regarding a number of topics related to anterior cruciate ligament (ACL)reconstruction. The purpose of this article is to answer the following questions: 1) Bone patellar tendon bone (BPTB) reconstruction or hamstring reconstruction (HR); 2) Double bundle or single bundle; 3) Allograft or authograft; 4) Early or late reconstruction; 5) Rate of return to sports after ACL reconstruction; 6) Rate of osteoarthritis after ACL reconstruction. A Cochrane Library and PubMed (MEDLINE) search of systematic reviews and meta-analysis related to ACL reconstruction was performed. The key words were: ACL reconstruction, systematic reviews and meta-analysis. The main criteria for selection were that the articles were systematic reviews and meta-analysesfocused on the aforementioned questions. Sixty-nine articles were found, but only 26 were selected and reviewed because they had a high grade (I-II) of evidence. BPTB-R was associated with better postoperative knee stability but with a higher rate of morbidity. However, the results of both procedures in terms of functional outcome in the long-term were similar. The double-bundle ACL reconstruction technique showed better outcomes in rotational laxity, although functional recovery was similar between single-bundle and double-bundle. Autograft yielded better results than allograft. There was no difference between early and delayed reconstruction. 82% of patients were able to return to some kind of sport participation. 28% of patients presented radiological signs of osteoarthritis with a follow-up of minimum 10 years.

Keywords


  1. Yunes M, Richmond JC, Engels EA, Pinczewski LA. Patellar versus hamstring tendons in anterior cruciate ligament reconstruction: A meta-analysis. Arthroscopy. 2001; 17:248-57.
  2. Goldblatt JP, Fitzsimmons SE, Balk E, Richmond JC. Reconstruction of the anterior cruciate ligament: meta-analysis of patellar tendon versus hamstring tendon autograft. Arthroscopy. 2005; 21:791-803.
  3. Biau DJ, Tournoux C, Katsahian S, Schranz P, Nizard R. ACL reconstruction: a meta-analysis of functional scores. Clin Orthop Relat Res. 2007;458:180-7.
  4. Poolman RW, Farrokhyar F, Bhandari M. Hamstring tendon autograft better than bone patellar-tendon bone autograft in ACLreconstruction: a cumulative meta-analysis and clinically relevant sensitivity analysis applied to a previously published analysis. Acta Orthop. 2007;78:350-4.
  5. Biau DJ, Katsahian S, Kartus J, Harilainen A, Feller JA, Sajovic M, et al. Patellar tendon versus hamstring tendon autografts for reconstructing the anterior cruciate ligament: a meta-analysis based on individual patient data. Am J Sports Med. 2009;37:2470-8.
  6. Mohtadi NG, Chan DS, Dainty KN, Whelan DB. Patellar tendon versus hamstring tendon autograft for anterior cruciate ligament rupture in adults. Cochrane Database Syst Rev. 2011 Sep 7;(9):CD005960.
  7. Magnussen RA, Carey JL, Spindler KP. Does autograft choice determine intermediate-term outcome of ACL reconstruction? Knee Surg Sports Traumatol Arthrosc. 2011;19:462-72.
  8. Li S, Su W, Zhao J, Xu Y, Bo Z, Ding X, et al. A meta-analysis of hamstring autografts versus bone-patellar tendon-bone autografts forreconstruction of the anterior cruciate ligament. Knee. 2011;18:287-93.
  9. Li S, Chen Y, Lin Z, Cui W, Zhao J, Su W. A systematic review of randomized controlled clinical trials comparing hamstring autografts versus bone-patellar tendon-bone autografts for the reconstruction of the anterior cruciate ligament. Arch Orthop Trauma Surg. 2012;132:1287-97.
  10. Chen M, Dong QR, Xu W, Ma WM, Zhou HB, Zheng ZG. Clinical outcome of single-bundle versus anatomic double-bundle reconstruction of the anterior cruciate ligament: a meta-analysis (Article in Chinese). Zhonghua Wai Ke Za Zhi. 2010;48:1332-6.
  11. Gadikota HR, Seon JK, Chen CH, Wu JL, Gill TJ, Li G. In vitro and intraoperative laxities after single-bundle and double-bundle anterior cruciate ligament reconstructions. Arthroscopy. 2011;27:849-60.
  12. Meredick RB, Vance KJ, Appleby D, Lubowitz JH. Outcome of single-bundle versus double-bundle reconstruction of the anterior cruciate ligament: a meta-analysis. Am J Sports Med. 2008;36:1414-21.
  13. Yasuda K, Tanabe Y, Kondo E, Kitamura N, Tohyama H. Anatomic double-bundle anterior cruciate ligament reconstruction. Arthroscopy. 2010; 26:21-34.
  14. Desai N, Björnsson H, Musahl V, Bhandari M, Petzold M, Fu FH, et al. Anatomic single- versus double-bundle ACL reconstruction: a meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2014; 22(5):1009-23.
  15. Li X, Xu CP, Song JQ, Jiang N, Yu B. Single-bundle versus double-bundle anterior cruciate ligament reconstruction: an up-to-date meta-analysis. Int Orthop. 2013;37:213-26.
  16. Tiamklang T, Sumanont S, Foocharoen T, Laopaiboon M. Double-bundle versus single-bundle reconstruction for anterior cruciate ligament rupture in adults. Cochrane Database Syst Rev. 2012; 11:CD008413.
  17. Zhu Y, Tang RK, Zhao P, Zhu SS, Li YG, Li JB. Double-bundle reconstruction results in superior clinical outcome than single-bundle reconstruction. Knee Surg Sports Traumatol Arthrosc. 2013;21:1085-96.
  18. Li YL, Ning GZ, Wu Q, Wu QL, Li Y, Hao Y, et al. Single-bundle or double-bundle for anterior cruciate ligament reconstruction: a meta-analysis. Knee. 2014;21:28-37.
  19. Krych AJ, Jackson JD, Hoskin TL, Dahm DL. A meta-analysis of patellar tendon autograft versus patellar tendon allograft in anterior cruciate ligament reconstruction. Arthroscopy. 2008;24:292-8.
  20. Hu J, Qu J, Xu D, Zhou J, Lu H. Allograft versus autograft for anterior cruciate ligament reconstruction: an up-to-date meta-analysis of prospective studies. Int Orthop. 2013;37:311-20.
  21. Kraeutler MJ, Bravman JT, McCarty EC. Bone-patellar tendon-bone autograft versus allograft in outcomes of anterior cruciate ligament reconstruction: a meta-analysis of 5182 patients. Am J Sports Med. 2013;41:2439-48.
  22. Smith TO, Davies L, Hing CB. Early versus delayed surgery for anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2010;18:304-11.
  23. Grant JA, Tannenbaum E, Miller BS, Bedi A. Treatment of combined complete tears of the anterior cruciate and medial collateral ligaments. Arthroscopy. 2012;28:110-22.
  24. Kwok CS, Harrison T, Servant C. The optimal timing for anterior cruciate ligament reconstruction with respect to the risk of postoperative stiffness. Arthroscopy. 2013;29:556-65.
  25. Ardern CL, Webster KE, Taylor NF, Feller JA. Return to sport following anterior cruciate ligament reconstruction surgery: a systematic review and meta-analysis of the state of play. Br J Sports Med. 2011;45:596-606.
  26. Claes S, Hermie L, Verdonk R, Bellemans J, Verdonk P. Is osteoarthritis an inevitable consequence of anterior cruciate ligament reconstruction? A meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2013;21:1967-76.