Long-Term Physiotherapy Outcomes in Anterior Cruciate Ligament Reconstruction: A Systematic Review with Meta-Analysis of Bone-Patellar-Tendon Bone Versus Four-Strand Hamstring Autografts

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Background. Bone patellar-tendon bone (BPTB) autografts and Hamstring tendon (HT) autografts the two common Anterior cruciate ligament reconstruction (ACLR) procedures have varied outcomes. This review aimed to compare the clinical outcomes of athletic/physically active participants at 2 and > 2 years after ACLR. Methods. Systematic searches were conducted on PubMed, Scopus, PEDro, and Web of Science. For quality assessment we utilized the PEDro scale. Meta-analysis was performed on six out of seven included studies. The primary outcome studied were pain, laxity, Return to sport (RTS), graft re-rupture rate, ROM deficits, functional outcomes and isokinetic strength deficits on athletic/ physically active participants at 2 and > 2 years of ACLR. Results. Thirteen randomised studies comprising 1190 participant, were selected after removal of duplicates and applying exclusion criteria. The meta-analysis showed that BPTB autograft has greater effectiveness in instrumental laxity (SMD = -0.22, 95%CI -0.38 to -0.06, Z = 2.77, p = 0.006), RTS (SMD = -0.42, 95%CI -0.72 to -0.13, Z = 2.84, p = 0.005), Flexion ROM deficit (SMD = -1.82, 95%CI -3.66 to 0.02, Z = 1.94, p = 0.05) and Extension iso-kinetic deficit at 60° (SMD = -3.49, 95%CI -5.80 to -1.17, Z = 2.95, p = 0.003) < 2 year post-ACLR. Whereas, HT autograft shows greater effectiveness in Pain > 2 year (SMD = 0.21, 95%CI -0.00 to 0.42; Z = 1.95, p = 0.05) and Extension ROM deficit at both < 2 year (SMD = 1.36, 95%CI 0.45 to 2.27, Z = 2.93, p = 0.003) and > 2 year (SMD = 1.27, 95%CI 0.02 to 2.52; Z = 1.99, p = 0.05) post-ACLR. Conclusions. Current analysis shows that BPTB autograft at < 2-year post-ACLR have greater effectiveness in instrumental laxity, RTS, Flexion ROM deficit and Extension iso-kinetic deficit at 60°. Whereas HT autograft shows greater effectiveness in pain > 2 year and Extension ROM deficit at both < 2 year and > 2-year post-ACLR. Study registration. The protocol for this review had been published and registered in the International Prospective Register of Systematic Reviews (PROSPERO) as CRD42022297699.

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