A comparison of outcomes of bone-patellar tendon-bone grafts versus other grafts following anterior cruciate ligament surgery

Abstract

Anterior cruciate ligament ruptures are a very common musculoskeletal injury that can be treated surgically using several different grafts, such as the bone-patellar tendon-bone, hamstring tendon and quadriceps tendon graft. The aim of this PICO study was to determine if the BPTB graft was the best alternative, with the research question being, “do Bone Patellar Tendon Grafts in patients who have undergone ACL surgery offer a higher risk of failure compared to other grafts?” Population – Patients that underwent ACL reconstruction, Intervention – Bone-Patellar Tendon-Bone graft, Comparison – other graft types, Outcome – risk of graft failure. The inclusion criteria consisted of adult males and females up to 65 years of age, athletes, and general population, BPTB used as a comparison, systematic reviews, meta-analyses, RCTs and cohort studies. Studies were excluded if they were of low-quality, if patients were under 18 or over 65, or if they had other knee injuries. The search was carried out using four different databases, PubMed, MEDLINE (PROQUEST), Taylor and Francis Online and CINAHL Complete (EBSCO). From the 328 studies obtained, eight were chosen as the key studies. The Critical Appraisal Skills Programme Checklist was used to assess the reliability, validity, and applicability of the key studies. Most studies found that in terms of failure rates and knee stability, the BPTB graft offers the best results. In terms of kneeling and anterior knee pain, BPTB grafts were more prone to this complication, but show favourable strength results following ACLR. In conclusion, there is no one graft which performs the best in all the outcomes investigated, and there were some conflicting results. The results of this study show that there is trend towards better outcomes with the BPTB for most of the outcomes however, more research is needed, especially locally. Younger, more active patients, such as the majority of ACL patients in Malta, would benefit from BPTB grafts.