4-Strand hamstring versus single-bundle quadriceps tendon grafts in anterior cruciate ligament reconstruction at 2 years: A systematic review and meta-analysis of randomised controlled trials

Abstract

Purpose

To compare the 2-year postoperative outcomes of hamstring tendon (HT) grafts to quadriceps tendon (QT) grafts in anterior cruciate ligament (ACL) reconstruction. We hypothesised no significant differences between the two methods.

Methods

A systematic review and meta-analysis were conducted following the 2020 PRISMA guidelines. Five online databases (Cochrane, Embase, PubMed, Scopus and Web of Science) were screened for prospective randomised controlled trials (RCT). IKDC, Lysholm, Tegner, side-to-side KT-1000 scores and ages were collected. Statistical analysis was conducted with SPSS v29. Between the two groups, a test of between-subgroup homogeneity p-value < 0.05 was used to assess statistical significance, while a Δ Cohen's d ≥ 0.8 was used to assess clinical significance.

Results

Five RCTs were included in the final analysis. The HT group included 87 patients, and the QT group included 93 patients. The mean ages for the HT and QT groups were 28.3 ± 6.6 and 26.5 ± 8.4 years, respectively. HTs yielded clinically higher IKDC scores (Δ Cohen's d = 2.27, p = 0.24), clinically lower side-to-side KT-1000 differences (Δ Cohen's d = 1.65, p = 0.08), and clinically and statistically higher Lysholm scores (Δ Cohen's d = 2.93, p = 0.00). However, QT yielded higher Tegner scores (Δ Cohen's d = 1.68, p = 0.00), whereas HT led to a moderate clinical reduction (Cohen's d = −0.55, p = 0.06, 95% CI [−1.11 to 0.02]).

Conclusions

Compared with the use of the QT graft, the HT graft for ACL reconstruction may result in greater knee function and stability, while QT ACL reconstruction may be associated with increased levels of postsurgical activity in terms of return to sports and work. Future long-term RCTs are needed to confirm our findings.

Level of Evidence

Level I.