Intratunnel Fixation Versus Extratunnel Fixation of Hamstring Anterior Cruciate Ligament Reconstruction – A Meta-Analysis

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.