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Quadriceps Tendon-Bone or Patellar Tendon-Bone Autografts When Reconstructing the Anterior Cruciate Ligament: A Meta-analysis

Riaz, Osman, MRCS*; Aqil, Adeel, MRCS; Mannan, Ashim, MRCS; Hossain, Fahad, FRCS*; Ali, Mubusher, MBChB; Chakrabarty, Gautam, FRCS*; Radcliffe, Graham, FRCS

Clinical Journal of Sport Medicine: May 2018 - Volume 28 - Issue 3 - p 316–324
doi: 10.1097/JSM.0000000000000451
Critical Review

Objective: We aimed to quantitatively assess the outcomes of studies, comparing the use of Bone-patellar tendon-bone (BPTB) and the quadriceps tendon-bone (QTB) autografts when reconstructing the anterior cruciate ligament (ACL).

Data Sources: MEDLINE, Embase, and CINAHL databases were searched for relevant articles published between January 1980 and January 2015 for the purpose of identifying studies comparing BPTB and QTB autografts for ACL reconstruction. Included studies were assessed regarding their methodological quality before analysis. Outcomes analyzed were graft failure rates, objective and subjective stability assessments, as well as the presence and severity of donor site morbidity.

Main Results: Five studies contributed to the quantitative analysis of 806 patients with 452 patients included in the BPTB group and 354 patients in the QTB group. Graft failure rates were similar between the 2 groups [odds ratio (OR) = 0.61; confidence interval (CI) = 0.17-2.15; Z = 0.78, P = 0.44]. There were no significant differences between the 2 groups when testing anteroposterior stability using an arthrometer (standardized mean difference = 0.07; CI = −0.12-0.25; Z = 0.70, P = 0.48). At 1 year postoperatively, there was no difference in the percentage of patients with a positive pivot shift test between the 2 groups (OR = 1.0; CI = 0.85-1.18; Z = 0.01, P = 0.99). However, significantly less patients had graft site pain 1 year after surgery in the QTB group (OR = 0.10; CI = 0.02-0.43; Z = 3.12, P = 0.002). Similarly, fewer patients reported moderate to severe pain while kneeling, in the QTB group (OR = 0.16; CI = 0.07-0.37; Z = 4.26, P < 0.001).

Conclusions: This study demonstrates comparable survival rates and joint stability when BPTB and QTB grafts are used. However, fewer adverse donor site symptoms are evident with QTB grafts.

Level of Evidence: III.

*Calderdale and Huddersfield NHS Foundation Trust, Lindley, United Kingdom; and

Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom.

Corresponding Author: Adeel Aqil, MRCS, Bradford Royal Infirmary, Duckworth Lane, Bradford, BD9 6RJ (a.aqil@imperial.ac.uk).

The authors report no conflicts of interest.

Ethical Review Statement: All investigations were conducted in conformity with ethical principles of research. Informed consent was not required, as this study did not involve human subjects. This work was performed at Bradford and Calderdale and Huddersfield Teaching Hospitals NHS Foundation Trust, United Kingdom. This manuscript has been seen and approved by all authors, and it is not under consideration for publication elsewhere in a similar form, in any language, except in abstract form.

Received December 04, 2016

Accepted April 03, 2017

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