Bone-patellar tendon-bone versus four strands hamstring grafts for anterior cruciate ligament reconstruction

Introduction. The goal of the present meta-analysis was to compare bone-patellar tendon-bone (BPTB) versus four-strands hamstring tendon (4SHT) autografts for primary anterior cruciate ligament (ACL) reconstruction. Methods. The present meta-analysis was conducted according to the PRISMA guidelines. The literature search was performed in July 2019. All the randomized clinical trials comparing BPTB versus 4SHT autografts for primary ACL reconstruction were considered for inclusion. The statistical analysis was performed through the Review Manager Software. Results. The BPTB detected lower values of pivot-shift test ≥ 3 mm (p = 0.0009), Lachman test ≥ 5 mm (p = 0.03), arthrometer displacement ≥ 3 mm (p = 0.001), mean arthrometer displacement (p = 0.50), higher rate of kneeling pain (p = 0.01), anterior knee pain (p <0.0001) and graft failures (p = 0.03). Concerning the clinical scores (IKCD and Lysholm score), any statistically significant results were detected. Conclusions. Providing more stability, we hypothesize that young and demanding patients may gain more benefits from BPTB graft. In the case of treating patients with reduced performanc-es, it may be more reasonable to use a 4SHT because of the lower incidence of graft rupture, kneeling, and anterior knee pain.