Comparison 1.
Patella tendon versus hamstring tendon autografts for ACL reconstruction
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
|---|---|---|---|---|
| 1 Functional assessment ‐ single hop test: participants with < 90% of opposite side | 5 | 534 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.17 [0.84, 1.63] |
| 2 Return to activity: participants returning to light or sedentary activity only | 4 | 304 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.23 [0.81, 1.85] |
| 3 Tegner activity level (0: to 10: top activity) | 7 | Mean Difference (IV, Fixed, 95% CI) | Subtotals only | |
| 3.1 Studies with full data | 4 | 323 | Mean Difference (IV, Fixed, 95% CI) | 0.23 [‐0.12, 0.59] |
| 3.2 Exploratory analysis: including studies with imputed SDs | 7 | 537 | Mean Difference (IV, Fixed, 95% CI) | 0.10 [‐0.18, 0.38] |
| 3.3 Randomized studies | 3 | 273 | Mean Difference (IV, Fixed, 95% CI) | 0.13 [‐0.27, 0.52] |
| 4 Lysholm Score: mean score | 7 | Mean Difference (IV, Fixed, 95% CI) | Subtotals only | |
| 4.1 Studies with full data | 5 | 482 | Mean Difference (IV, Fixed, 95% CI) | 0.00 [‐1.72, 1.72] |
| 4.2 Exploratory analysis: including studies with imputed SDs | 7 | 637 | Mean Difference (IV, Fixed, 95% CI) | ‐0.20 [‐1.76, 1.36] |
| 4.3 Randomized studies | 4 | 428 | Mean Difference (IV, Fixed, 95% CI) | 0.00 [‐1.87, 1.87] |
| 5 Cincinnati Score: mean score | 2 | 118 | Mean Difference (IV, Fixed, 95% CI) | ‐1.30 [‐4.95, 2.35] |
| 6 Re‐rupture rate | 13 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 6.1 All studies | 13 | 1156 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.78 [0.41, 1.50] |
| 6.2 Quasi‐randomized studies | 7 | 560 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.83 [0.33, 2.06] |
| 6.3 Randomized studies | 6 | 596 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.79 [0.31, 2.01] |
| 6.4 HT Femoral fixation with endobutton | 4 | 351 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.83 [0.24, 2.80] |
| 6.5 HT Femoral fixation with screw | 6 | 509 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.82 [0.31, 2.19] |
| 6.6 HT Graft with < 4 strands | 2 | 208 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.30 [0.34, 15.58] |
| 6.7 HT Graft with 4 strands | 11 | 919 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.67 [0.32, 1.38] |
| 7 KT arthrometer: patients with > 5 mm side to side difference at 134 Newtons/30 lbs | 4 | 311 | Risk Ratio (M‐H, Random, 95% CI) | 0.40 [0.07, 2.33] |
| 8 KT arthrometer: patients with > 5 mm side to side difference at Maximum Manual Force | 6 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 8.1 All studies | 6 | 524 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.53 [0.25, 1.09] |
| 8.2 Quasi‐randomized studies | 5 | 431 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.49 [0.22, 1.09] |
| 8.3 Randomized studies | 1 | 93 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.74 [0.13, 4.24] |
| 8.4 HT Femoral fixation with endobutton | 2 | 135 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.36 [0.10, 1.25] |
| 8.5 HT Femoral fixation with screw | 2 | 139 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.83 [0.27, 2.59] |
| 8.6 HT Graft with < 4 strands | 1 | 130 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.44 [0.09, 2.11] |
| 8.7 HT Graft with 4 strands | 5 | 394 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.55 [0.24, 1.25] |
| 9 KT arthrometer: Mean side to side difference (mm) at 134 Newtons/30 lbs | 7 | Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| 9.1 Studies with full data | 3 | 195 | Mean Difference (IV, Random, 95% CI) | ‐0.65 [‐1.35, 0.04] |
| 9.2 All studies: including those with imputed SDs | 7 | 465 | Mean Difference (IV, Random, 95% CI) | ‐0.94 [‐1.66, ‐0.22] |
| 9.3 Randomized studies | 3 | 185 | Mean Difference (IV, Random, 95% CI) | ‐1.68 [‐3.03, ‐0.32] |
| 9.4 HT Femoral fixation with endobutton | 1 | 48 | Mean Difference (IV, Random, 95% CI) | ‐1.03 [‐1.84, ‐0.22] |
| 9.5 HT Femoral fixation with screw | 3 | 193 | Mean Difference (IV, Random, 95% CI) | ‐0.59 [‐1.32, 0.13] |
| 9.6 HT Graft with < 4 strands | 1 | 44 | Mean Difference (IV, Random, 95% CI) | ‐3.30 [‐4.43, ‐2.17] |
| 9.7 HT Graft with 4 strands | 6 | 421 | Mean Difference (IV, Random, 95% CI) | ‐0.60 [‐0.96, ‐0.24] |
| 10 KT arthrometer: Mean side to side difference (mm) at Maximum Manual Force | 7 | Mean Difference (IV, Fixed, 95% CI) | Subtotals only | |
| 10.1 Studies with full data | 4 | 294 | Mean Difference (IV, Fixed, 95% CI) | ‐0.51 [‐0.95, ‐0.07] |
| 10.2 All studies (including those with imputed SDs) | 7 | 440 | Mean Difference (IV, Fixed, 95% CI) | ‐0.63 [‐0.99, ‐0.27] |
| 10.3 Randomized studies | 3 | 222 | Mean Difference (IV, Fixed, 95% CI) | ‐0.52 [‐1.04, 0.00] |
| 10.4 HT Femoral fixation with endobutton | 1 | 61 | Mean Difference (IV, Fixed, 95% CI) | 0.0 [‐1.08, 1.08] |
| 10.5 HT Femoral fixation with screw | 4 | 251 | Mean Difference (IV, Fixed, 95% CI) | ‐0.67 [‐1.13, ‐0.22] |
| 10.6 HT Graft with < 4 strands | 2 | 108 | Mean Difference (IV, Fixed, 95% CI) | ‐1.04 [‐1.82, ‐0.27] |
| 10.7 HT Graft with 4 strands | 5 | 332 | Mean Difference (IV, Fixed, 95% CI) | ‐0.52 [‐0.92, ‐0.11] |
| 11 Lachman Test: patients with > 2 mm or positive test | 10 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 11.1 All studies | 10 | 856 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.83 [0.71, 0.99] |
| 11.2 Quasi‐randomized studies | 4 | 261 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.63 [0.40, 0.98] |
| 11.3 Randomized studies | 5 | 470 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.89 [0.73, 1.07] |
| 11.4 HT Femoral fixation with endobutton | 3 | 289 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.83 [0.62, 1.11] |
| 11.5 HT Femoral fixation with screw | 4 | 326 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.93 [0.70, 1.22] |
| 11.6 HT Graft with < 4 strands | 3 | 246 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.87 [0.65, 1.15] |
| 11.7 HT Graft with 4 strands | 7 | 584 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.85 [0.69, 1.05] |
| 12 Pivot Shift: patients with a positive test | 14 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 12.1 All studies | 14 | 1118 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.70 [0.54, 0.89] |
| 12.2 Quasi‐randomized studies | 8 | 583 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.78 [0.55, 1.10] |
| 12.3 Randomized studies | 6 | 535 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.62 [0.44, 0.88] |
| 12.4 HT Femoral fixation with endobutton | 4 | 346 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.69 [0.46, 1.02] |
| 12.5 HT Femoral fixation with screw | 4 | 319 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.59 [0.32, 1.09] |
| 12.6 HT Graft with < 4 strands | 3 | 189 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.53 [0.29, 0.98] |
| 12.7 HT Graft with 4 strands | 12 | 968 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.71 [0.55, 0.93] |
| 13 IKDC: patients with Normal and Nearly Normal scores | 15 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 13.1 All studies (2000 version) | 2 | 192 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.94 [0.84, 1.06] |
| 13.2 All studies (1995 version) | 13 | 1150 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.01 [0.95, 1.07] |
| 13.3 Quasi‐randomized studies (1995 version) | 6 | 542 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.00 [0.93, 1.07] |
| 13.4 Randomized studies (1995 version) | 6 | 548 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.00 [0.89, 1.12] |
| 13.5 HT Femoral fixation with endobutton (1995 version) | 5 | 381 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.01 [0.88, 1.15] |
| 13.6 HT Femoral fixation with screw (1995 version) | 4 | 328 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.92 [0.81, 1.04] |
| 13.7 HT Graft with < 4 strands (1995 version) | 4 | 407 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.03 [0.94, 1.12] |
| 13.8 HT Graft with 4 strands (1995 version) | 8 | 655 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.98 [0.90, 1.06] |
| 14 IKDC Subjective score (1995 version): patients with Normal and Nearly Normal scores | 6 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 14.1 All studies | 6 | 427 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.99 [0.94, 1.06] |
| 14.2 Quasi‐randomized studies | 2 | 94 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.95 [0.83, 1.09] |
| 14.3 Randomized studies | 4 | 333 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.01 [0.94, 1.07] |
| 14.4 HT Femoral fixation with endobutton | 2 | 97 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.93 [0.80, 1.07] |
| 14.5 HT Femoral fixation with screw | 3 | 262 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.99 [0.92, 1.07] |
| 14.6 HT Graft with < 4 strands | 3 | 182 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.05 [0.93, 1.18] |
| 14.7 HT Graft with 4 strands | 4 | 283 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.97 [0.91, 1.03] |
| 15 IKDC Subjective score (2000 version): Mean score | 2 | 192 | Mean Difference (IV, Fixed, 95% CI) | ‐2.78 [‐5.74, 0.18] |
| 16 Range of motion: Heel height difference (mm) | 3 | Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| 16.1 All studies | 3 | 215 | Mean Difference (IV, Random, 95% CI) | 3.72 [‐1.38, 8.82] |
| 17 Range of motion: Extension deficit > 3 degrees | 14 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 17.1 All studies | 14 | 1139 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.71 [1.25, 2.33] |
| 17.2 Quasi‐randomized studies | 9 | 691 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.49 [0.76, 2.91] |
| 17.3 Randomized studies | 5 | 448 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.79 [1.26, 2.54] |
| 17.4 HT Femoral fixation with endobutton | 4 | 337 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.58 [1.00, 2.49] |
| 17.5 HT Femoral fixation with screw | 5 | 357 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.64 [1.04, 2.58] |
| 17.6 HT Graft with < 4 strands | 3 | 267 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.67 [0.83, 3.35] |
| 17.7 HT Graft with 4 strands | 9 | 742 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.78 [1.22, 2.59] |
| 18 Range of motion: Flexion deficit > 5 degrees | 12 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 18.1 All studies | 12 | 1001 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.88 [0.70, 1.10] |
| 18.2 Quasi‐randomized studies | 7 | 553 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.08 [0.89, 4.87] |
| 18.3 Randomized studies | 5 | 448 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.77 [0.61, 0.97] |
| 18.4 HT Femoral fixation with endobutton | 3 | 252 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.68 [0.40, 1.16] |
| 18.5 HT Femoral fixation with screw | 4 | 304 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.94 [0.74, 1.19] |
| 18.6 HT Graft with < 4 strands | 3 | 267 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.08 [0.74, 1.55] |
| 18.7 HT Graft with 4 strands | 9 | 706 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.88 [0.66, 1.19] |
| 19 Strength testing: Mean flexion at 60 deg/s (as % torque of opposite knee) | 5 | Mean Difference (IV, Fixed, 95% CI) | Subtotals only | |
| 19.1 Studies with full data | 2 | 144 | Mean Difference (IV, Fixed, 95% CI) | 11.62 [6.44, 16.80] |
| 19.2 All studies (including those with imputed SDs) | 5 | 317 | Mean Difference (IV, Fixed, 95% CI) | 6.63 [3.12, 10.13] |
| 19.3 Randomized studies (all with imputed SDs) | 3 | 173 | Mean Difference (IV, Fixed, 95% CI) | 2.39 [‐2.38, 7.16] |
| 19.4 HT Femoral fixation with endobutton | 1 | 61 | Mean Difference (IV, Fixed, 95% CI) | 4.0 [‐4.07, 12.07] |
| 19.5 HT Femoral fixation with screw | 1 | 72 | Mean Difference (IV, Fixed, 95% CI) | 14.40 [7.51, 21.29] |
| 19.6 HT Graft with < 4 strands | 2 | 112 | Mean Difference (IV, Fixed, 95% CI) | 1.53 [‐4.38, 7.44] |
| 19.7 HT Graft with 4 strands | 3 | 205 | Mean Difference (IV, Fixed, 95% CI) | 9.39 [5.04, 13.75] |
| 20 Strength testing: Mean flexion at 180 deg/s (as % torque of opposite knee) | 3 | Mean Difference (IV, Fixed, 95% CI) | Subtotals only | |
| 20.1 All studies (including those with imputed SDs) | 3 | 184 | Mean Difference (IV, Fixed, 95% CI) | 5.58 [1.52, 9.65] |
| 21 Strength testing: Mean extension at 60 deg/s (as % torque of opposite knee) | 5 | Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| 21.1 Studies with full data | 2 | 144 | Mean Difference (IV, Random, 95% CI) | ‐4.60 [‐10.19, 0.98] |
| 21.2 All studies (including those with imputed SDs) | 5 | 317 | Mean Difference (IV, Random, 95% CI) | ‐2.97 [‐8.10, 2.16] |
| 21.3 Randomized studies (all with imputed SDs) | 3 | 173 | Mean Difference (IV, Random, 95% CI) | ‐1.49 [‐10.91, 7.93] |
| 21.4 HT Femoral fixation with endobutton | 1 | 61 | Mean Difference (IV, Random, 95% CI) | 0.0 [‐8.61, 8.61] |
| 21.5 HT Femoral fixation with screw | 1 | 72 | Mean Difference (IV, Random, 95% CI) | ‐5.90 [‐13.42, 1.62] |
| 21.6 HT Graft with < 4 strands | 2 | 112 | Mean Difference (IV, Random, 95% CI) | ‐1.98 [‐18.24, 14.27] |
| 21.7 HT Graft with 4 strands | 3 | 205 | Mean Difference (IV, Random, 95% CI) | ‐3.24 [‐7.92, 1.45] |
| 22 Strength testing: Mean extension at 180 deg/s (as % torque of opposite knee) | 3 | Mean Difference (IV, Fixed, 95% CI) | Subtotals only | |
| 22.1 All studies (including those with imputed SDs) | 3 | 184 | Mean Difference (IV, Fixed, 95% CI) | ‐1.48 [‐6.45, 3.48] |
| 23 Anterior knee symptomatology: Incidence (general) | 8 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 23.1 All studies | 8 | 459 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.45 [1.05, 2.01] |
| 23.2 Quasi‐randomized studies | 4 | 232 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.73 [1.08, 2.79] |
| 23.3 Randomized studies | 4 | 227 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.22 [0.78, 1.92] |
| 23.4 HT Femoral fixation with endobutton | 3 | 158 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.58 [0.93, 2.69] |
| 23.5 HT Femoral fixation with screw | 3 | 185 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.26 [0.73, 2.15] |
| 23.6 HT Graft with < 4 strands | 2 | 84 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.88 [0.89, 3.96] |
| 23.7 HT Graft with 4 strands | 4 | 256 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.62 [1.07, 2.47] |
| 24 Anterior knee symptomatology: Kneeling discomfort | 4 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 24.1 All studies | 4 | 355 | Risk Ratio (M‐H, Fixed, 95% CI) | 4.46 [2.97, 6.69] |
| 25 Numbers of participants in analyses / Numbers entered in each trial | 17 | 1456 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.99 [0.96, 1.03] |
| 26 Numbers with acute reconstructions at baseline | 7 | 610 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.07 [0.87, 1.33] |
| 27 Numbers of males at baseline | 17 | 1423 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.98 [0.91, 1.05] |