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Hamstring Tendon Versus Bone-Patellar Tendon-Bone Autograft for ACL Reconstruction with Concurrent Lateral
Kwangho Chung1,2, Joo Hyung Han3, Se-Han Jung1,4
1Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
The Journal of Bone and Joint Surgery. American Volume
|September 15, 2025
Summary
Anterior cruciate ligament reconstruction (ACLR) with a hamstring tendon autograft and lateral extra-articular procedure (LEP) significantly reduces graft rupture and failure rates compared to isolated ACLR. Both hamstring tendon and bone-patellar tendon-bone grafts are viable options when combined with LEP.
Area of Science:
- Orthopedic Surgery
- Sports Medicine
- Biomedical Engineering
Background:
- Clinical outcomes of different anterior cruciate ligament (ACL) autografts combined with lateral extra-articular procedures (LEP) remain unevaluated.
- Randomized controlled trials (RCTs) and network meta-analysis (NMA) are needed to compare graft options for ACL reconstruction (ACLR) with concurrent LEP.
Purpose of the Study:
- To systematically review RCTs and conduct an NMA comparing graft options for ACLR with concurrent LEP.
- To evaluate clinical outcomes, including ACLR failure, knee instability, patient-reported outcomes, and complications.
Main Methods:
- Systematic search of PubMed, Embase, Cochrane Library, and Google Scholar for RCTs on primary ACLR plus LEP.
- Network meta-analysis (NMA) to compare graft options, analyzing data on ACLR failure, residual knee instability, patient-reported outcome measures, and complications.
- Therapeutic Level I evidence.
Main Results:
- ACLR with hamstring tendon (HT) autograft plus LEP showed significantly lower odds of graft rupture (OR: 0.28), graft failure (OR: 0.27), clinical failure (OR: 0.48), and residual pivot shift (OR: 0.43) compared to isolated ACLR.
- Bone-patellar tendon-bone (BPTB) autograft plus LEP significantly reduced clinical failure (OR: 0.30) compared to isolated ACLR.
- Both HT and BPTB autografts plus LEP resulted in higher Lysholm scores compared to isolated ACLR, with no significant difference between graft types when combined with LEP.
Conclusions:
- ACLR with HT autograft plus LEP demonstrated a 72% lower odds of graft rupture, 73% lower odds of graft failure, and 52% lower odds of clinical failure compared to isolated ACLR.
- ACLR with BPTB autograft plus LEP significantly lowered clinical failure odds by approximately 70%.
- Both HT and BPTB autografts are viable for ACLR plus LEP, though the benefits of LEP warrant further validation.
