| Objective: To evaluate the efficacy and safety of hamstring(HT)autografts versus bone-patellar tendon-bone(BPTB)autografts for the reconstruction of anterior cruciate ligament (ACL).Methods: A computerized search of articles published between 1980 and September 2008 was performed using MEDLINE,EMBASE and Chinese Biomedicine Database(CBM). Additionally, a search from the Cochrane Library (Issue 3, 2008) was performed to identify studies comparing the results of HT autografts and BPTB autografts for the reconstruction of ACL. The quality of included studies was critically assessed and data analyses were performed with Cochrane Collaboration's RevMan 5.0.Results: Eight literatures of 6 studies were included, all of which are randomized controlled trials (RCT). We divided into two sub-groups according to the number of HT strands, one is the sub-group with HT=2 and the other is the sub-group with HT>2. Meta-analyses showed that, compared with BPTB,for 2-strand hamstring, IKDC [RR=0.81, 95%CI(0.67,0.98),P=0.03] was lower, and there was no difference of Pivot-test [RR=0.82, 95%CI(0.58, 1.14, P=0.24], for over 2-strand hamstring sub-group, there was no difference in IKDC score [RR=1.03,95%CI(0.91, 1.17),P=0.59], KT-1000[MD=0.39, 95%CI (-0.11,0.88), P=0.13], Lachman-test[RR=0.97,95%CI(0.77, 1.11)P=0.39], Pivot- test [RR=0.92, 95%CI(0.79, 1.08), P=0.30], anterior knee pain [RR=0.85, 95%CI (0.39, 1.42), P=0.53] and infection rate[RR=0.66,95%CI(0.66, 2.55), P= 0.45], but the kneeling pain [RR=0.42,95%CI(0.26,0.67),P=0.0003] was appa- rently lower.Conclusions: Compared with BPTB, for reconstruction of ACL, over 2-strand HT can achieve the same effect on resuming knee function, stability and the incidence of anterior knee pain and infection after operation, and postoperative kneeling pain is obviously reduced, but the influence of the loss of flexion and extension and graft failure needs further study. |
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