Comment: The quality of evidence is downgraded by study limitations(unclear allocation concealment, lack of blinding, incomplete assessment of outcome, selective outcome reporting)and byindirectness (differences between the population of interest and those studied, inadequate description of study populations).
A Cochrane review [Abstract] 1 comparing the outcomes of anterior cruciate ligament (ACL) reconstruction using either patellar tendon (PT) or hamstring tendon(s) (HT) autografts included 19 trials reporting the outcomes in a total of 1597 young to middle-aged adults. There was no statistically significant differences between the two graft choices for functional assessment (single leg hop test), return to activity, Tegner and Lysholm scores, subjective measures of outcome, rate of re-rupture nor International Knee Documentation Committee scores. PT reconstruction resulted in a more statically stable knee compared with HT reconstruction but the patients experienced more anterior knee problems, especially with kneeling, after PT reconstruction. PT reconstructions resulted in a statistically significant loss of extension range of motion and a trend towards loss of knee extension strength. HT reconstructions demonstrated a trend towards loss of flexion range of motion and a statistically significant loss of knee flexion strength. The clinical importance of the above range of motion losses is unclear. There were inadequate long-term results, such as to assess the development of osteoarthritis.
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