ACL Reconstruction: A Meta-analysis of Functional Scores

From individual randomized studies, it is unclear whether patellar tendon grafts or hamstring tendon grafts yield the best functional results after ACL reconstruction. Therefore, we performed a meta-analysis to provide quantitative data to compare patellar with hamstring grafts after ACL reconstruction with regard to knee function. We searched computerized databases for randomized controlled trials reporting one of the following outcomes related to function: final overall International Knee Documentation Committee score and return to preinjury level of activity. Studies were abstracted independently by two reviewers. Random effect models were used to pool the data. Fourteen trials (1263 patients) met the inclusion criteria. We found no difference in final overall International Knee Documentation Committee score or in the number of patients returning to full activity after patellar and hamstring graft reconstruction. Relative risk was 0.90 for final overall International Knee Documentation Committee Class A and 0.94 for return to preinjury level of activity in favor of patellar grafts. Quantitative interaction tests on the effect of treatment based on study quality, randomization status, number of strands used, and length of followup were non significant. At last followup, only 41% and 33% of patients, respectively, had patellar and hamstring grafts reconstructed reported as normal based on the final overall International Knee Documentation Committee score.Level of Evidence: Level I, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.