Table 2.

Summary of Grafts RCTs With Significant Findings

RCT	Level of Evidence	Subgroup	Interventions	Outcome Measures	Results
Tian et al., 201719	I	Allograft	Irradiated vs nonirradiated hamstrings allograft double bundle at 5.7 years’ FU (n = 83/112)	Lachman test, pivot shift test, KT-2000 arthrometer, IKDC, functional, subjective evaluations, activity level testing, and radiologic assessment.	Significant increase in laxity and arthritic progression found in irradiated grafts; KT-2000: 86.4% Non-ir-Allo vs 35.9% Ir-Allo had a side-to-side difference of <3 mm (P < .05). Arthritic progression: 30.8% Ir-Allo group vs 11.4% Non-ir-Allo group (P < .05). No significant differences in activity level or functional scores.
Niu et al., 201620	II	Allograft	Double-layer BPTB allografts vs 4-strand hamstrings allograft at 3 years’ FU (n = 101)	Graft failure, KT-1000 arthrometer, Lachman tests, pivot-shift tests, IKDC, and Lysholm scores.	Graft failure: 2 (4%) BPTB vs 9 (17.6%) 4-SH (P = .028). Significantly better Lachman test, IKDC knee score, and Lysholm score in favor of BPTB (P < .05) although below the threshold for clinical significance.
Bottoni et al., 201521	I	Allograft	Hamstring autograft vs tibialis posterior allograft at minimum 10 years’ FU (n = 96/99)	Graft failure, subjective knee stability, and functional status SANE, Tegner, and IKDC scores.	4 (8.3%) autograft vs 13 (26.5%) allograft failures that required revision reconstruction. In the remaining patients whose graft was intact, there was no difference in functional scores.
Zhao et al., 200722	II	Hamstrings	4- vs 8-strands hamstrings double bundle at minimum 2 years’ FU (n = 68/76)	KT-1000 arthrometer, IKCD, and Lysholm scores.	8-SHG had significantly better results with: mean side-to-side difference in anterior knee laxity: 1.3 vs 2.8 mm (P = .0003). IKDC subjective: 96.3 vs 86.4 (P = .0007) Lysholm score: 96.5 vs 89.6 (P = .0006)
Ferretti et al., 200823	I	Hamstrings	Hamstrings/preserved insertion vs standard harvesting at 25 months’ FU (n = 35)	Clinical examination, isokinetic tests, and MRI	Better internal rotation with modified technique: Isokinetic tests: internal rotation strength deficit at 60° 84.60% vs 97.37% MRI: greater percentage of regenerated semitendinosus.
Mohtadi et al., 201924	I	Patella vs hamstrings	Patellar tendon, single-bundle 4-stranded hamstrings, or double-bundle hamstrings reconstruction at 5 years’ FU (n = 315/330).	ACL-QoL, IKDC, kneeling pain, Tegner activity scale, Cincinnati Occupational Rating Scale, re-ruptures, partial traumatic tears, total traumatic reinjuries, and atraumatic graft failures.	No difference in primary outcome ACL-QOL scores between groups (P = .548). No differences in IKDC, ROM, Cincinnati or Tegner scores. Kneeling pain: 10% vs 4% vs 2% (P = .029). Significantly more patients in the hamstring and double-bundle groups experienced traumatic graft reinjury compared with the patellar tendon group. Combined traumatic reinjuries: 4 vs 16 vs 17 (P = .01)
Zaffagnini et al., 200625	II	Patella vs hamstrings	BPTB, 4-strand hamstrings or single hamstrings with extra-articular plasty at 5 years’ FU (n = 75)	IKDC, IKDC subjective, Tegner, muscle circumference, anterior knee pain, kneeling pain	Anterior knee pain: 36% vs 12% vs 8% (P = .03) Kneeling pain: 72% vs 44% vs 12% (P = .0001) IKDC subjective: 82 vs 76 vs 89 (P = .04) No significant differences in functional scores.
Dahlstedt et al., 199026	II	Synthetic graft	Gore-Tex prosthetic ligament vs Kennedy ligament augmentation device at 3 years’ FU (n = 41)	Lysholm scores, activity scores, and arthrometry	Better outcomes with augmentation device and more complication with Gore-Tex group.

ACL-QoL, anterior cruciate ligament quality of life; BPTB, bone–patella tendon–bone; FU, follow-up; IKDC, International Knee Documentation Committee; MRI, magnetic resonance imaging; RCT, randomized controlled trial; ROM, range of motion.