| Background:Despite the popularity of anterior cruciate ligament(ACL)reconstructions,there remains significant controversy regarding whether an autograft,allograft,or artificialgraft should be used for primary ACL reconstruction.Purpose:To assess the relative efficacy of bone–patellar tendon–bone(BPTB)autografts,four-strand hamstring tendon(4sHT)autografts,non-irradiated allografts,irradiated allografts,and artificial ligaments for ACL reconstruction.Study Design:Systematic review and meta-analysis.Method:Randomized controlled trials comparing different graft methods for ACL reconstruction were included provided they contained data for change in objective IKDC score,positive Lachman test,and positive pivot shift test.Trials were assessed using the Cochrane risk of bias tool.Network meta-analysis combining direct and indirect evidence within a Bayesian framework and relative ranking of graft options was assessed with surface under the cumulative ranking(SUCRA)probabilities.The GRADE approach was used to assess the quality of evidence of estimates derived from network meta-analysis.Results:28 randomized controlled trials(2442 patients)comparing 5 different graft options were included.Pooled results showed that BPTB and 4sHT autografts resulted in a lower rate of abnormal and severely abnormal objective IKDC scores compared to artificial ligaments.BPTB autografts,4sHT autografts,and non-irradiated allografts resulted in a lower incidence of positive Lachman test and Pivot shift test compared with artificial ligaments and irradiated allografts.Compared with other graft options,BPTB autografts were ranked best for reduction in total incidence of abnormal and severely abnormal IKDC scores(SUCRA=0.77),positive Lachman test(SUCRA=0.90),and positive Pivot shift test(SUCRA=0.92).Conclusion:For individuals with ACL reconstruction,BPTB autografts are the most effective graft for improving the functional outcome and rebuilding the stability of the knee joint. |
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