Outcomes Following Anterior Cruciate Ligament Reconstruction with Patellar Tendon vs Hamstring Autografts: A Systematic Review of Randomized Controlled Trials with a Mean Follow-up of 15 Years

BACKGROUND: The two most common surgical treatment modalities for anterior cruciate ligament reconstruction (ACL), patellar tendon (PT) and hamstring tendon (HS) autografts, have been shown to have outcomes that are both similar and favorable; however, many of these are short or intermediate-term. The objective of this systematic review is to evaluate randomized controlled trials (RCTs) with a minimum 10-year follow-up data to compare the long-term outcomes of ACL reconstructions performed using PT and HS autografts. METHODS: This systematic review followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A search of three databases (PubMed, Cochrane and EMBASE) was performed to identify RCTs with a minimum of 10-year follow-up that compared clinical and/or functional outcomes between PT and HS autografts. RESULTS: Four RCTs with a total of 299 patients were included in the study. The mean follow-up ranged from 10.2 to 17 years (mean, 14.79 years). No significant differences in knee laxity or clinical outcome scores were demonstrated in any of the studies. One study found that PT autografts were significantly more likely to have osteoarthritis identified by radiographic findings. Two studies found that patients with PT autografts reported increase kneeling pain, while none of the four studies reported a difference in anterior knee pain. There were no significant differences in graft failure rates. CONCLUSION: This review demonstrates no long-term difference in clinical or functional outcomes between PT and HS autografts. However, radiographic and subjective outcomes indicate that patients with PT autografts may experience greater kneeling pain and osteoarthritis. Therefore, orthopedic surgeons should consider patient-centric factors when discussing graft options with patients

Impact of muscle element removal emulating a posterior surgical approach on HiL-simulated THR load situation with focus on the sitting down phase of the deep maneuver.

<p>The HiL simulations are based on parameter sets ②, ③ from <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0145798#pone.0145798.t001" target="_blank">Table 1</a>. <b>a</b> Comparison between the intact (blue lines) and the resected (red lines) case for hip joint rotations <i>q</i>₃, <i>q</i>₁, <i>q</i>₂, measured displacement |<i><b>c</b></i>| between femoral head and acetabular cup, components of the predicted reaction force <i><b>f</b></i>^<i>r</i> given in the pelvic reference frame [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0145798#pone.0145798.ref049" target="_blank">49</a>], and measured resisting torque |<i><b>τ</b></i>^<i>f</i>|. Impingement occurs at ○ and dislocation at ◇. <b>b</b> Direction of the hip joint reaction force with respect to the frontal plane of the pelvic reference frame [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0145798#pone.0145798.ref049" target="_blank">49</a>] with illustration of the head position at and after impingement for the intact (above) and the resected (below) case.</p

Multibody system of the lower extremity for testing THR.

<p>(a) Multibody topology with illustration of the joint coordinates and the fictive planar joint in the sagittal plane indicated as one revolute (R) and two prismatic (P) joints. (b) Measured and transferred coordinates <math><msub><mi>c</mi><mo>¯</mo><mn>1</mn></msub></math>, <math><msub><mi>c</mi><mo>¯</mo><mn>2</mn></msub></math>, <math><msub><mi>c</mi><mo>¯</mo><mn>3</mn></msub></math> in constrained directions of the THR. (c) Musculoskeletal model with implanted CAD geometries of the THR.</p

Physical setup of the HiL test system for testing THR.

<p>The THR components are fixed on mounting devices attached to the endeffector and the compliant support, respectively. Measurements are taken via the force-torque sensor and displacement sensors.</p

Impact of implant position on HiL-simulated THR load situation for a deep seating-to-rising motion cycle.

<p>Implant positions are defined by inclination <i>ι</i>, cup anteversion <i>β</i>, and stem antetorsion <i>ϑ</i> with parameter sets ③, ④, ⑤, ⑥ from <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0145798#pone.0145798.t001" target="_blank">Table 1</a>. Impingement occurs at ○ and dislocation at ◇. <b>a</b> Flexion angle <i>q</i>₃. <b>b</b> Measured displacement |<i><b>c</b></i>| between femoral head and acetabular cup. <b>c</b> Predicted reaction force |<i><b>f</b></i>^<i>r</i>|. <b>d</b> Measured resisting torque |<i><b>τ</b></i>^<i>f</i>|.</p

Impact of load level adjusted by body mass on HiL-simulated THR load situation for deep seating-to-rising.

<p>The HiL simulations are based on parameter sets ②, ③, ④ from <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0145798#pone.0145798.t001" target="_blank">Table 1</a>. Impingement occurs at ○ and dislocation at ◇. <b>a</b> Predicted reaction force |<i><b>f</b></i>^<i>r</i>| over flexion angle. <b>b</b> Measured resisting torque |<i><b>τ</b></i>^<i>f</i>| over flexion angle.</p

Functional principle of the HiL simulation for testing THR with respect to dislocation.

<p>The transfer between the musculoskeletal model and the physical setup is illustrated within the two control loops on kinematic and force level, respectively. The THR components are attached to mounting devices which are fixed to the endeffector of the robot (stem) and the compliant support (cup).</p

The quality–quantity trade-off in fertility across parent earnings levels: a test for credit market failure

Fertility, Quality–quantity trade-off, Human capital,