Graft sources do not affect to the outcome of transtibial posterior cruciate ligament reconstruction: a systematic review.

INTRODUCTION: Despite numerous published reports on posterior cruciate ligament (PCL) reconstruction in the past 30 years, the ideal graft source remains unclear, and few objective scientific data have been published that thoroughly evaluate the long-term outcomes according to the graft source. We, therefore, conducted a systematic review of available high-quality comparative studies that evaluated clinical and objective stability testing to compare the different graft sources for PCL reconstruction.

MATERIALS AND METHODS: Eight articles were included in the final analysis. There were two level II and six level III studies. Autograft included 4-strand hamstring grafts (SHGs), 7-SHGs, quadriceps tendon, and patellar tendon. Allografts included Achilles tendon and tibialis anterior tendon. Hybrid graft and a ligament advanced reinforcement system (LARS) were used in one study each. Comparison was performed between autografts and allografts in three studies, between different autografts in two studies, between autograft and LARS in one study, among three different grafts in one study, and between 4 and 7-SHGs in one study.

RESULTS: Most studies reported no statistically significant differences in the clinical results, except for one study that compared 4- and 7-SHG. Stability was similar or superior in a comparison between autografts and allografts, and was not statistically different between different autografts or between 4-SHG and LARS. However, more-stranded HG showed better stability than that of the less-stranded HG. Complications were more frequent with autografts.

CONCLUSION: Using a comprehensive analysis of the current literature, the authors could not identify an individual graft source with clearly superior clinical results, compared with other graft sources. However, autografts, especially 4-SHGs, showed similar or superior stability to irradiated allografts. Therefore, the graft source has a minimal effect on the clinical outcome, but it could have some effects on stability in single bundle transtibial PCL reconstruction.