Eoghan T Hurley1, Arianna L Gianakos2, Utkarsh Anil3, Eric J Strauss3, Guillem Gonzalez-Lomas2. 1. Department of Orthopaedic Surgery, New York University Langone Health, NY, New York, United States of America; Department of Trauma & Orthopaedic Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland. Electronic address: eoghanhurley@rcsi.ie. 2. Department of Orthopaedic Surgery, New York University Langone Health, NY, New York, United States of America; Department of Orthopaedic Surgery, RWJ Barnabas Health - Jersey City Medical Center, Jersey City, New Jersey. 3. Department of Orthopaedic Surgery, New York University Langone Health, NY, New York, United States of America.
Abstract
BACKGROUND: There is mixed opinion regarding the optimal femoral fixation method for hamstring tendon autograft in anterior cruciate ligament (ACL) reconstruction. Currently, no study exists showing a superior method of femoral fixation, and thus the topic has remained controversial. The purpose of this study is to network meta-analyze the randomized control trials comparing cortical-button (CB), cross-pin (CP) and interference screws (IS) for femoral fixation with hamstring tendon autograft in ACL reconstruction. METHODS: The literature review was conducted in accordance with the PRISMA guidelines. Randomized control trials comparing CB, CP and IS were included. Clinical outcomes were compared using a frequentist approach to network meta-analysis, with all statistical analysis performed using R, with a p-value <0.05 being considered statistically significant. RESULTS: There were 11 studies included comparing; 194 patients with CB to 201 patients with CP (6 studies), 48 patients with CB to 50 patients with IS (1 study), and 172 patients with CP to 162 patients with IS (5 studies). One study compared all three groups, including 48 patients with CB, 50 patients with IS, and 52 with CP. There was a mean follow-up time of 26.4 months. No statistically significant difference was found between the fixation methods when evaluating knee stability, functional outcomes, graft failures, or revision procedures. CONCLUSION: Using a network meta-analysis, our study found that, there was no difference in failure rate, knee stability, functional outcomes or incidence of revision procedures between CB, CP or IS femoral fixation techniques of hamstring tendon autografts in ACL reconstruction. LEVEL OF EVIDENCE: Level I, network meta-analysis of Level I studies.
BACKGROUND: There is mixed opinion regarding the optimal femoral fixation method for hamstring tendon autograft in anterior cruciate ligament (ACL) reconstruction. Currently, no study exists showing a superior method of femoral fixation, and thus the topic has remained controversial. The purpose of this study is to network meta-analyze the randomized control trials comparing cortical-button (CB), cross-pin (CP) and interference screws (IS) for femoral fixation with hamstring tendon autograft in ACL reconstruction. METHODS: The literature review was conducted in accordance with the PRISMA guidelines. Randomized control trials comparing CB, CP and IS were included. Clinical outcomes were compared using a frequentist approach to network meta-analysis, with all statistical analysis performed using R, with a p-value <0.05 being considered statistically significant. RESULTS: There were 11 studies included comparing; 194 patients with CB to 201 patients with CP (6 studies), 48 patients with CB to 50 patients with IS (1 study), and 172 patients with CP to 162 patients with IS (5 studies). One study compared all three groups, including 48 patients with CB, 50 patients with IS, and 52 with CP. There was a mean follow-up time of 26.4 months. No statistically significant difference was found between the fixation methods when evaluating knee stability, functional outcomes, graft failures, or revision procedures. CONCLUSION: Using a network meta-analysis, our study found that, there was no difference in failure rate, knee stability, functional outcomes or incidence of revision procedures between CB, CP or IS femoral fixation techniques of hamstring tendon autografts in ACL reconstruction. LEVEL OF EVIDENCE: Level I, network meta-analysis of Level I studies.
Authors: Ahmed Khalil Attia; Hazem Nasef; Kareem Hussein ElSweify; Mohammed A Adam; Faris AbuShaaban; Kariyal Arun Journal: Orthop J Sports Med Date: 2020-08-26