Meta-Analysis
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Aug 18, 2017; 8(8): 644-650
Published online Aug 18, 2017. doi: 10.5312/wjo.v8.i8.644
Femoral positioning influences ipsi-and contralateral anterior cruciate ligament rupture following its reconstruction: Systematic review and meta-analysis
Gustavo Constantino de Campos, Paulo Eduardo Portes Teixeira, Alex Castro, Wilson de Mello Alves Junior
Gustavo Constantino de Campos, Department of Orthopaedics, Campinas’s State University (UNICAMP), Campinas 13083-970, Brazil
Gustavo Constantino de Campos, Paulo Eduardo Portes Teixeira, Alex Castro, Wilson de Mello Alves Junior, Instituto Wilson Mello, Research and Study Center, Campinas 13080-650, Brazil
Author contributions: de Campos GC contributed to literature search, data extraction, data analysis and interpretation, article draft, article revision, final approval; Teixeira PEP contributed to literature search, data extraction, data analysis and interpretation, article draft, final approval; Castro A contributed to statistical analysis, data interpretation, article revision, final approval; Alves Junior WM contributed to conception and design of the study, critical revision, final approval.
Conflict-of-interest statement: The authors deny any conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Gustavo Constantino de Campos, MD, PhD, Instituto Wilson Mello, Research and Study Center, Rua José Rocha Bonfim, 214, ed. Chicago, 1o. andar, Campinas 13080-650, Brazil. gustavoccampos@terra.com.br
Telephone: +55-19-35212121 Fax: +55-19-35212121
Received: January 20, 2017
Peer-review started: January 20, 2017
First decision: February 15, 2017
Revised: March 9, 2017
Accepted: March 23, 2017
Article in press: March 25, 2017
Published online: August 18, 2017
Processing time: 202 Days and 22.5 Hours
Abstract
AIM

To systematically review the incidence of ipsilateral graft re-rupture and contralateral anterior cruciate ligament (ACL) rupture following its reconstruction, with special attention to the femoral drilling technique.

METHODS

Systematic review and meta-analysis of high-level prospective studies searched in MEDLINE database following PRISMA statement. The rate of ipsilateral graft re-rupture and contralateral rupture in patients submitted to either transtibial (TT) technique (isometric) or anteromedial (AM) technique (anatomic) was compared.

RESULTS

Eleven studies met the criteria and were included in final analysis. Reconstructions using the AM technique had a similar chance of contralateral ACL rupture when compared to the chance of ipsilateral graft failure (OR = 1.08, P = 0.746). In reconstructions using TT technique, the chance of contralateral ACL rupture was approximately 1.5 times higher than ipsilateral graft failure (OR = 1.49, P = 0.048). Incidence of contralateral lesions were similar among the techniques TT (7.4%) and AM (7.0%) (P = 0.963), but a trend could be noticed with a lower incidence of lesion in the ipsilateral limb when using the TT technique (4.9%) compared to the AM technique (6.5%) (P = 0.081).

CONCLUSION

ACL reconstruction by TT technique leads to lower incidence of graft re-injury than contralateral ACL lesion. There is no difference between the chance of re-injury after AM technique and the chance of contralateral ACL lesion (native ligament) with either technique.

Keywords: Anterior cruciate ligament; Anterior cruciate ligament reconstruction; Arthroscopy; Graft survival

Core tip: There is no convincing evidence that anatomic reconstruction leads to better clinical outcomes than transtibial (TT) reconstruction. Moreover, data suggests that it could lead to an increased risk of graft re-rupture. We found that anterior cruciate ligament (ACL) reconstruction by TT technique led to lower incidence of graft re-rupture than contralateral ACL lesion. The chance of graft re-rupture after anteromedial (AM) technique was the same of contralateral ACL lesion. There was no difference between contralateral lesion after both techniques and re-rupture after AM technique, what could mean that re-rupture chance after AM technique is indeed closer to normal knee, and, in fact, it is the TT technique’s re-tear incidence that is lower than it should be.