Autografts vs Synthetics for Cruciate Ligament Reconstruction: A Systematic Review and Meta-Analysis

To describe the outcomes of autografts and synthetics in anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) reconstruction with respect to instrumented laxity measurements, patient-reported outcome scores, complications, and graft failure risk. We searched PubMed, Cochrane Library, and EMBASE for published randomized controlled trials (RCT) and case controlled trials (CCTs) to compare the outcomes of the autografts versus synthetics after cruciate ligament reconstruction. Data analyses were performed using Cochrane Collaboration RevMan 5.0. Nine studies were identified from the literature review. Of these studies, three studies compared the results of bone-patellar tendon-bone (BPTB) and ligament augmentation and reconstruction system (LARS), while six studies compared the results of four-strand hamstring tendon graft (4SHG) and LARS. The comparative study showed no difference in Lysholm score and failure risk between autografts and synthetics. The combined results of the meta-analysis indicated that there was a significantly lower rate of side-to-side difference > 3 mm (Odds Ratio [OR] 2.46, 95% confidence intervals [CI] 1.44-4.22, P = 0.001), overall IKDC (OR 0.40, 95% CI 0.19-0.83, P = 0.01), complications (OR 2.54, 95% CI 1.26-5.14, P = 0.009), and Tegner score (OR -0.31, 95% CI -0.52-0.10, P = 0.004) in the synthetics group than in the autografts group. This systematic review comparing long-term outcomes after cruciate ligament reconstruction with either autograft or synthetics suggests no significant differences in failure risk. Autografts were inferior to synthetics with respect to restoring knee joint stability and patient-reported outcome scores, and were also associated with more postoperative complications.