Incidence of Osteoarthritis Between ACL Reconstruction With Different Graft Types and Between ACL Reconstruction and Repair: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Background: Variation in stiffness, fixation methods, and donor-site morbidity after anterior cruciate ligament reconstruction(ACLR) with different graft types and with anterior cruciate ligament suture repair (ACLSR) can lead to differences in dynamicknee laxity and consequent differences in posttraumatic osteoarthritis (PTOA) development.

Purpose: To compare the incidence of PTOA between different graft types used for primary ACLR and between primary ACLRand ACLSR. It was hypothesized that the incidence of PTOA would vary between ACLR with different autografts and allograftsand between ACLR and ACLSR.

Study Design: Systematic review; Level of evidence, 1.

Methods: A search of the literature was performed to identify all randomized controlled trials (RCTs) comparing radiographic evidence of PTOA after ACLR between different graft types—hamstring tendon (HT) autograft, bone-patellar tendon-bone (BPTB)autograft, quadriceps tendon autograft, and allograft—and between ACLR and ACLSR. The minimum follow-up was 2 years.Study quality was assessed using the modified Coleman Methodology Score. A meta-analysis was performed to determinewhether there was a difference in the incidence of PTOA between the different graft types and between ACLR and ACLSR.

Results: Eleven randomized controlled trials were included in the meta-analysis—HT: 440 patients (mean follow-up, 9.7 years); BPTB:307 patients (mean follow-up, 11.8 years); allograft: 246 patients (mean follow-up, 5 years); ACLSR, 22 patients (5 years). No studyreporting the incidence after ACLR with quadriceps tendon was included. The study quality ranged from 70 to 88. The meta-analysisindicated no significant difference in the incidence of PTOA between graft types used for ACLR and between ACLR and ACLSR (riskratios: HT vs BPTB, 1.05; HT vs allograft, 0.81; BPTB vs allograft, 0.82; HT vs ACLSR, not estimable [P . .05 for all]). The combinednumber of patients with PTOA in all studies per graft type showed that patients who underwent ACLR with a BPTB autograft had thehighest percentage of PTOA (HT, 23.4%; BPTB, 29.6%; allograft, 8.1%; ACLSR, 0%). However, excluding studies with a follow-up\5years resulted in similar outcomes for patients with an HT autograft and a BPTB autograft.

Conclusion: This meta-analysis reported no difference in the incidence of PTOA between graft types used for ACLR and betweenACLR and ACLSR. More research is necessary to make a reliable conclusion about which technique is associated with the lowestincidence of PTOA after ACL surgery.