Evidence-Based ACL Reconstruction

There is controversy in the literature regarding a number of topics related to anterior cruciate ligament (ACL)reconstruction. The purpose of this article is to answer the following questions: ۱) Bone patellar tendon bone (BPTB) reconstruction or hamstring reconstruction (HR); ۲) Double bundle or single bundle; ۳) Allograft or authograft; ۴) Early or late reconstruction; ۵) Rate of return to sports after ACL reconstruction; ۶) Rate of osteoarthritis after ACL reconstruction. A Cochrane Library and PubMed (MEDLINE) search of systematic reviews and meta-analysis related to ACL reconstruction was performed. The key words were: ACL reconstruction, systematic reviews and meta-analysis. The main criteria for selection were that the articles were systematic reviews and meta-analysesfocused on the aforementioned questions. Sixty-nine articles were found, but only ۲۶ were selected and reviewed because they had a high grade (I-II) of evidence. BPTB-R was associated with better postoperative knee stability but with a higher rate of morbidity. However, the results of both procedures in terms of functional outcome in the long-term were similar. The double-bundle ACL reconstruction technique showed better outcomes in rotational laxity, although functional recovery was similar between single-bundle and double-bundle. Autograft yielded better results than allograft. There was no difference between early and delayed reconstruction. ۸۲% of patients were able to return to some kind of sport participation. ۲۸% of patients presented radiological signs of osteoarthritis with a follow-up of minimum ۱۰ years.

کلیدواژه ها:

ACL ، BPTB ، Hamstring ، Reconstruction