Comparison Of Clinical Efficacy Of Anterior Cruciate Ligament Reconstruction By Arthroscopy Between Autologous Hamstring Tendon And Lars Artificial Ligament: A Meta-analysis

Objective:Collect the literature on the comparison of LARS artificial ligament and hamstring tendon under the arthroscopic anterior cruciate ligament reconstruction.Meta-analysis and systematic review of the subjective scores(Lysholm score,Tegner score,IKDC score)、joint stability and The complication rate were performed to compare the effects of the two grafts at different stages.Methods:Two researchers searched the international databases independently up to July 24th,2020,including English language databases(Pub Med database,Web of Science database,The Cochrane Library and EMBASE database)and Chinese databases(CNKI,Wanfang Database,VIP Database and CBM Database).The articles comparing the clinical effects of anterior cruciate ligament reconstruction with LARS artificial ligament and hamstring tendon were included.The collected literature was screened according to the inclusion and exclusion criteria,and the NEWCASTLE-OTTAWA QUALITY ASSESSMENT SCALE(NOS)was used for quality assessment.According to the research theme and the characteristics of the original documents,a document information extraction table is developed to extract information from the included documents.For the subjective score scale(Tegner,Lysholm,IKDC),the change from baseline was calculated based on the preoperative data(baseline value)and postoperative data(endpoint value).We used Review Manager 5.3 software for Meta-analysis.Stata 16software is used for Begg test to assess the publication bias.Mean difference(MD)with corresponding 95%CI was calculated for continuous outcomes while Odds ratio(OR)or relative risk(RR)with 95%confidence interval(CI)was calculated for dichotomous.Statistical heterogeneity was assessed by The P-value of the Q statistic test and I~2value.Perform sensitivity analysis on all results to check the stability of the Meta-analysis.Funnel plots were used to test publication bias.Result:Through systematic retrieval of foreign language databases and Chinese databases,a total of 391 documents were obtained.After checking for duplicate,primary screening and re-screening,13 articles were included.The time span is 2007-2019.The total sample size was 839 cases(373 cases in the LARS artificial ligament group;466 cases in the autologous hamstring tendon group).Among them,3 were prospective cohort studies,and 10 were retrospective cohort studies.The quality of study was assessed using the NEWCASTLE-OTTAWA QUALITY ASSESSMENT SCALE(NOS),Among these13 cohorts,12article was of high quality with scores≥6 according to NOS.The Meta-analysis results showed that the Subjective score(Tegner,Lysholm,IKDC)of LARS artificial ligament was higher than the autologous hamstring tendon in short term follow-up(Within 12 months),and the difference was statistically significant:Tegner score at 3 months follow-up:MD=2.02,95%CI:[1.68;2.36],P<0.00001;Lysholm score at 3 months follow-up:MD=20.14,95%CI:[19.80;20.49],P<0.00001;IKDC score at 3 months follow-up:MD=17.75,95%CI:[15.58;19.93],P<0.00001;Tegner score at6 months follow-up:MD=1.38,95%CI:[1.12;1.64],P<0.00001;Lysholm score at 6months follow-up:MD=12.01,95%CI:[8.74;15.28],P<0.00001;IKDC score at 6 months follow-up:MD=10.94,95%CI:[8.94;12.94],P<0.00001;Tegner score at 12 months follow-up:MD=0.69,95%CI:[0.07;1.31],P=0.03;Lysholm score at 12 months follow-up:MD=3.95,95%CI:[1.05;6.85],P=0.008;IKDC score at 12 months follow-up:MD=6.51,95%CI:[1.47;11.56],P=0.01.For mid-term(within 2-4 years)and long-term(more than5 years)follow-up,the Subjective score of LARS artificial ligament are similar to the autologous hamstring tendon,and the difference was not statistically significant:Tegner score within 2-4 years follow-up:MD=-0.11,95%CI:[-0.25;0.03],P=0.12;Lysholm score within 2-4 years follow-up:MD=0.15,95%CI:[-0.71;1.02],P=0.73;IKDC score within 2-4 years follow-up:MD=0.27,95%CI:[-0.28;0.82],P=0.33;Tegner score within more than 5 years follow-up:MD=0.02,95%CI:[-0.14;0.19],P=0.78;Lysholm score within more than 5 years follow-up:MD=MD=0.65,95%CI:[-0.61;1.92],P=0.31;IKDC score within more than 5 years follow-up:MD=0.18,95%CI:[-0.69;1.05],P=0.69.KT-1000 was used to measure the stability of knee joint,and the Side-to-side difference of knee joint after ACLR with LARS artificial ligament was smaller than that with autologous hamstring tendon:the difference was statistically significant:MD=-1.18,95%CI:[-1.38;-0.98],P=<0.00001;the difference of the Side-to-side difference measured by KT-2000 was not statistically significant:MD=-0.22,95%CI:[-0.60;0.15],P=0.24.The ratio of bilateral knee laxity difference<3mm and>5mm after ACLR with LARS artificial ligament is close to that of autologous hamstring tendon,and the difference is not statistically significant:OR=1.69,95%CI:[0.79;3.63],P=0.18;OR=1.69,95%CI:[0.79;3.63],P=0.18.There was no significant difference in postoperative complications between the two grafts:OR=1.44,95%CI:[0.58;3.55],P=0.43.The results of the Meta-analysis were found to be relatively stable after sensitivity analysis of the results by different methods.No publication bias was found after the Begg’s Test.Conclusion:Meta-analysis found that in terms of subjective knee scores(Lysholm score,Tegner score,IKDC score),the patient with LARS artificial ligament performed better than the patient with Hamstring Tendons in the short-term(within 12 months).As the follow-up time increases,the difference keeps shrinking.The results of the mid-term and long-term follow-up show that the performance of the two grafts is approximate(2-4 years;more than 5 years).In terms of knee stability and complications after ACLR,there is no significant difference between LARS artificial ligament and Hamstring Tendons.In general,the LARS artificial ligament is better than the Hamstring Tendons in the early stage after ACLR,but there is no significant difference in the long-term efficacy.