Bone-Patellar Tendon-Bone versus Hamstring Tendon Autografts for Anterior Cruciate Ligament Reconstruction: A Systematic Review

Abstract

Introduction: Anterior cruciate ligament (ACL) rupture is a common sports-related injury. The two most frequently used autografts for ACL reconstruction are the bone-patellar tendon-bone (BPTB) graft and the hamstring tendon (HT) graft. This review compares the long-term outcomes of these two graft choices.

Methods: A systematic search was performed for RCTs comparing BPTB to four-strand HT autografts for primary ACL reconstruction. Primary outcomes included instrumented laxity measurements (e.g., KT-1000), rates of graft failure or re-rupture, and patient-reported functional outcomes. Donor site morbidity, such as anterior knee pain, was also assessed.

Results: The meta-analysis of numerous RCTs demonstrated that BPTB grafts resulted in a statistically significant lower rate of graft failure and better objective knee stability on laxity testing. However, the BPTB group had a significantly higher incidence of anterior knee pain and kneeling pain. There were no significant differences in overall patient-reported functional scores between the groups.

Discussion: The choice between BPTB and HT grafts involves a trade-off. BPTB offers superior stability and lower failure rates, making it a preferred choice for high-demand athletes. HT grafts avoid the morbidity of anterior knee pain, which may be more suitable for other patient populations.

Conclusion: BPTB autografts provide better knee stability and lower failure rates for ACL reconstruction, but at the cost of increased anterior knee pain.