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There is no difference in the efficacy of anterior cruciate ligament reconstruction using autograft combined with or without ligament augmentation: a systematic review and meta-analysis

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

This study aims to determine the efficacy of anterior cruciate ligament reconstruction (ACLR) using autograft combined with or without ligament augmentation.

Methods

A computerized search of the databases was conducted, including PubMed, Web of Science, Embase, Scopus and the Cochrane Library. Only prospective or retrospective comparative studies with a minimum 2-year follow-up were considered for inclusion. Two independent reviewers performed data extraction and methodological quality assessment. A Mantel–Haenszel analysis was used for the pooling of results. Sensitivity analysis was performed to maintain the stability of results. The egger test was applied to assess the publication bias.

Results

Fourteen studies were included. The total cohort was 1353 patients (non-augmented group: 763 patients; augmented group: 590 patients). There were three Randomized Controlled Trials (RCTs, Level I), six retrospective comparative studies (Level III) and five case–control studies (Level III). The follow-up rate was ≥ 88% and the follow-up periods were ≥ 24 months in all included studies. The augmented graft used to compare with autograft included the Ligament Augmentation Device (LAD), the Ligament Advanced Reinforcement System (LARS) artificial ligament, FiberTape, hamstring tendon allograft, degradable poly (urethane urea). No significant differences were observed between the augmented and non-augmented groups regarding postoperative patient-reported outcomes (PROs), including the International Knee Documentation Committee score, Lysholm score and Tegner score, knee laxity, including KT-1000, side-to-side difference, Lachman test and pivot shift and rate of graft failure.

Conclusions

ACLR using autografts combined with ligament augmentation shows no advantages in PROs, knee laxity and graft failure rate compared with using autografts only.

Level of evidence

Level III.

Trial registration

The research protocol was registered at the PROSPERO database (CRD42022324784).

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Availability of data and materials

All data generated or analyzed during this study are included in this manuscript.

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Funding

National Natural Science Foundation of China, 81802153, Qingyang Meng.

Author information

Author notes

  1. Qian Man and Yitian Gao have contributed equally to this work.

Authors and Affiliations

  1. Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Bei**g Key Laboratory of Sports Injuries, Hospital, 49 North Garden Road, Haidian District, Bei**g, 100191, People’s Republic of China

    Qian Man, Yong Ma & Qingyang Meng

  2. Peking University Health Science Center, 38 Xueyuan Road, Haidian District, Bei**g, 100191, People’s Republic of China

    Qian Man, Yitian Gao & Hangle Wang

  3. Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Bei**g, People’s Republic of China

    Yong Ma & Qingyang Meng

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Correspondence to Qingyang Meng.

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Man, Q., Gao, Y., Wang, H. et al. There is no difference in the efficacy of anterior cruciate ligament reconstruction using autograft combined with or without ligament augmentation: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 31, 5524–5534 (2023). https://doi.org/10.1007/s00167-023-07605-7

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