Patellar versus hamstring tendons in anterior cruciate ligament reconstruction: A meta-analysis

Purpose: To compare the outcome of ACL reconstuction using patellar tendon (PAT) to that when using hamstring tendons. Type of Study: Meta-analysis of controlled trials of patellar tendon versus hamstring tendons for ACL reco nstruction. Methods: Meta-analysis is a systematic method for statistical a nalyses that allows compilation of combined data from various independent s tudies. This allows one to assess the potential benefits of various treatme nts when conclusions based on individual studies are difficult to assess. W e conducted a meta-analyses (M-A) using controlled trials (CTs) to determin e if there are differences between the 2 methods, Although both surgical te chniques have potential for good results, we hypothesized that there are di fferences in outcomes between these techniques. We included CTs that used s tandard evaluation techniques with a minimum 2-year follow-up. Outcomes eva luated included: return to preinjury level of activity, KT testing, Lachman scores, pivot shift scores, range of motion (ROM) loss in flexion and exte nsion, complications, and failures. Relative risks for each outcome were ca lculated for each study and pooled across studies using a fixed effects met hod. Results: Four studies fulfilled our inclusion criteria. Relative risks with 95% confidence intervals and P values were obtained for each of the o utcomes listed above. The results show significant differences between PAT and semitendinosus and gracilis tendon (ST&G) reconstructions. PAT patients have a greater chance of attaining a statically stable knee (as measured b y KT) and nearly a 20% greater chance of returning to preinjury activity le vels. Conclusions: Although both techniques, as performed in the late 1980s and early 1990s, yielded good results, PAT reconstuction led to higher pos toperative activity levels and greater static stability than hamstring reco nstruction. This is statistically significant based on this meta-analysis.