• Hong-De Wang, Hao Zhang, Tian-Rui Wang, Wei-Fei Zhang, Fu-Shun Wang, and Ying-Ze Zhang.
• Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Qiaoxi District, Shijiazhuang, Hebei, 050051, PR China; Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, 050051, PR China. Electronic address: wanghongde2015@163.com.
• Int J Surg. 2018 Aug 1; 56: 174-183.

BackgroundHamstring tendon autografts and soft-tissue allograft are commonly used for anterior cruciate ligament (ACL) reconstruction. However, the clinical outcomes between these two grafts are controversial. This meta-analysis was performed to compare clinical outcomes of primary ACL reconstruction with hamstring tendon autografts versus soft-tissue allografts.Materials And MethodsPubMed, Embase, and the Cochrane Library were searched through 8 September 2017 to identify randomized controlled studies that compared hamstring tendon autografts with soft-tissue allografts for primary ACL reconstruction. Two authors independently graded the methodological quality of each eligible study using the Cochrane Collaboration tool and extracted relevant data. Statistical heterogeneity among the trials was evaluated with chi-square and I-square tests. A sensitivity analysis was conducted to explore sources of heterogeneity. Subgroup analysis was performed to identify potential differences according to type of reconstruction technique (single-bundle or double-bundle).ResultsEight studies with 785 combined patients (396 hamstring tendon autografts and 389 soft-tissue allografts) were included. Two studies had a high risk of bias. The other six studies had unclear risk of bias. There were significant differences between the groups in subjective International Knee Documentation Committee (IKDC) score (mean difference [MD], 2.43; 95%CI, 0.69-4.18; p = 0.006), Tegner score (MD, 0.24; 95%CI, 0.03-0.45; p = 0.03), and side-to-side difference (MD, -1.37; 95%CI, -2.44 to -0.30; p = 0.01). There was no significant difference between the groups in Lysholm score, complications, pivot shift test, anterior drawer test, Lachman test, overall IKDC score, or range of motion. Subgroup analysis demonstrated that for primary ACL reconstruction using the single-bundle technique, soft-tissue allografts were inferior to hamstring tendon autografts in subjective IKDC score, anterior drawer test, and side-to-side difference.ConclusionSoft-tissue allografts are inferior to hamstring tendon autografts with respect to subjective patient evaluation and knee stability but superior in the complication of hypoesthesia for patients undergoing primary ACL reconstruction.Copyright © 2018 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

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