ACL reconstruction: BPTB graft has better stability but more complications than hamstring .
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2013;1(11):286 Arch Orthop Trauma Surg. 2012 Sep;132(9):1287-97. doi: 10.1007/s00402-012-1532-5. Epub 2012 Jun 3This meta-analysis and systematic review identified 9 randomized controlled trials comparing hamstring (HT) autografts and bone-patellar tendon-bone (BPTB) autografts in patients undergoing anterior cruciate ligament (ACL) reconstruction. The analysis indicated that the HT autograft group had a significantly lower proportion of patients with a negative Pivot test than the BPTB autograft group. However, fewer patients in the HT group experienced post-operative anterior knee pain and kneeling pain compared to the BPTB group.
Were the search methods used to find evidence (original research) on the primary question or questions stated?
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Were the criteria used for deciding which studies to include in the overview reported?
Was the bias in the selection of studies avoided?
Were the criteria used for assessing the validity of the included studies reported?
Was the validity of all of the studies referred to in the text assessed with use of appropriate criteria (either in selecting the studies for inclusion or in analyzing the studies that were cited)?
Were the methods used to combine the findings of the relevant studies (to reach a conclusion) reported?
Were the findings of the relevant studies combined appropriately relative to the primary question that the overview addresses?
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Sí = 1
Incierto = 0,5
No relevante = 0
No = 0
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Introduction
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Accessing Data
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Analysing Data
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Results
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Discussion
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
El Índice de Fragilidad es una herramienta que ayuda en la interpretación de hallazgos significativos, proporcionando una medida de fuerza para un resultado. El Índice de Fragilidad representa el número de eventos consecutivos que es necesario añadir a un resultado dicotómico para que el hallazgo deje de ser significativo. Un número pequeño representa un hallazgo más débil y un número grande un hallazgo más fuerte.
¿Por qué se necesitaba ahora este estudio?
There is currently much debate regarding the optimal type of graft that for ACL reconstruction. While autografts have been considered superior to allografts, it is still uncertain as to which type of autograft is best. HT autografts have been associated with a lower risk of donor site morbidity than BPTB autografts, whereas BPTB grafts have been shown to be more stable than the HT alternative. This meta-analysis and systematic review, therefore, aimed to include only randomized controlled trials in comparing the effectiveness of HT and BPTB autografts in patients undergoing ACL reconstruction.
¿Cuál era la pregunta principal de la investigación?
Is there a difference between HT and BPTB autografts with regard to stability, function, and complications in patients undergoing ACL reconstruction?
- According to 8 studies, the two autografts did not differ with respect to post-operative knee joint function (IKDC scores) (RR 1.05, 95 % CI 0.93-1.19, p=0.41)
- The pooled data from 5 studies indicated that there was no significant difference between the two types of autografts for the proportion of patients with negative Lachman test results (RR 0.65, 95 % CI 0.18-2.34, p=0.51)
- According to 6 studies, the BPTB autograft resulted in a higher proportion of patients with a negative Pivot test than the HT autograft (RR 0.87, 95 % CI 0.79-0.96, p=0.004)
- The HT group demonstrated a lower incidence of post-operative anterior knee pain (4 studies) (RR 0.66, 95 % CI 0.45-0.96, p=0.03) and kneeling pain (6 studies) (RR 0.49, 95 % CI 0.27-0.91, p=0.02) than the BPTB group
- From 5 studies, extension loss of 5 degrees or greater was seen in 26 out of 219 HT group patients and 29 out of 178 BPTB group patients (RR 0.63, 95% CI 0.39-1.01); from 3 studies, flexion loss of 5 degrees or more was seen in 62 of 141 HT patients and 37 of 105 BPTB patients (RR 1.03, 95 % CI 0.78-1.35)
- There was no difference between the two groups for the incidence of graft failure (8 studies; RR 1.37, 95 % CI 0.67-2.81, p=0.38), infection rate (6 studies; RR 1.04, 95 % CI 0.46-2.35, p=0.93), and rate of reoperation related to the meniscus (RR 1.78, 95 % CI 0.75-4.22, p=0.19)
¿Qué es lo que más debo recordar?
The results suggested that bone-patellar tendon-bone (BPTB) autografts were superior to hamstring autografts with respect to the resulting knee joint stability after ACL reconstruction. However, the hamstring graft resulted in fewer complications (anterior knee pain, and pain when kneeling) than the BPTB graft.
¿Cómo afectará esto al cuidado de mis pacientes?
Using a BPTB autograft for ACL reconstruction results in greater rotational stability compared to using a hamstring autograft as assessed with the Pivot shift test at the expense of a higher likelihood of anterior knee pain and kneeling pain.Although patients who received the BPTB autograft tended to demonstrate better recovery of knee joint stability than those who received the hamstring graft, a greater incidence of anterior knee pain and kneeling pain was seen in the BPTB patients than the hamstring group patients.
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