ABSTRACT
Hamstring anterior cruciate ligament (ACL) reconstructions fixed inside both bone
tunnels have a shorter initial working length, and thus should be stiffer than those
fixed outside both bone tunnels. We used meta-analysis to compare 4-stranded hamstring
ACL reconstructions using the 2 fixation methods with reconstructions using patellar
tendon autografts.
A Medline database search of English-language articles published through June 2004
yielded 36 studies that met the inclusion criteria: 5 intratunnel fixation studies
(569 patients), 10 extratunnel fixation studies (604 patients), and 24 patellar tendon
studies (1592 patients). Three studies included both patellar tendon and hamstring
reconstructions. Demographically, all 3 groups were similar. There was no significant
difference in the percentage of knees restored to normal instrumented laxity measurements
between the 3 groups, nor was there a difference in graft failure rate. Patient satisfaction
and return to preinjury activity rates were similar between the intratunnel fixation
and patellar tendon groups and were significantly lower for the extratunnel fixation
group. Good International Knee Documentation Committee scores did not correlate with
good patient satisfaction or return to preinjury activity.
