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Comparing Outcomes after Anterior Cruciate Ligament Reconstruction with either Hamstring or Patellar Tendon Grafts : A Systematic Review

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Comparing Outcomes after Anterior Cruciate Ligament Reconstruction with either Hamstring or Patellar Tendon Grafts : A Systematic Review

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Samenvatting

Background:The use of the bone-patellar tendon-bone (BPTB) graft has been considered the standard for anterior cruciate ligament (ACL) reconstruction for years, however there exists no sufficient evidence to support the use of this graft type over the semitendinosus (ST) or semitendinosus/gracilis (STG) tendon graft. For this reason we conducted this review to investigate if there could be found a significant difference between the two techniques using a range of outcomes that are considered valid for this purpose. Hypothesis: There is no significant difference between the two methods of reconstruction Study design:Systematic review of randomized clinical trials Methods:We searched for articles in Medline and through Google Scholar with our selected keywords and criteria. Outcome measures used when comparing the two graft types were the International Knee Documentation Scale (IKDC), Lysholm scale, Tegner scale and the Cincinatti knee scoring system. Additional outcomes investigated were patellafemoral symptoms and amount of saggital tibial translation using the KT-1000 arthrometer. Results: No clinically significant differences where found in any of the 7 reviewed studies concerning outcomes from IKDC, Lysholm, Tegner and Cincinnati knee scoring systems. Conclusion: There exists no significant evidence to support the BPTB graft as the golden standard. Both techniques improves from pre-operatively to postoperatively. BPTB grafts is associated with higher incindence of anterior knee pain and kneeling pain. Keywords: ACL reconstruction, patellar, hamstring, Clinical Trial, IKDC, Lysholm and Cincinnatti Recommendations/suggestion for further research/projects It is important to note that ,although our findings suggest no significant differences in either of the functional scoring sheets used, there may still exist significant differences using BPTB and ST grafts which may be revealed if conducting a systematic review using other outcome measures. Comparing differences in fixaton and rehabilitation methods in relation to the two techniques is also of interest in order to get a more complete picture. However it would be close to impossible to carry out this review with the criteria we have, using identical fixation methods and post-operative rehabilitation in all studies There is not yet published enough high quality trials that uses identical methodology throughout Perhaps using larger populations and longer follow up periods in RCT’s will show different results. We have to realise, however, that such studies are difficult to arrange and follow through, further investigation of possible differences between BPTB and ST/STG grafts is nevertheless necessary to determine if there actually exists significant differences. If any significant differences does indeed exist, this knowledge might be of great benefit to specific patient groups or individual patients.

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OrganisatieHogeschool van Amsterdam
InstituutGezondheid
Gepubliceerd in
Jaar2007
TypeBachelorscriptie
TaalEngels

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