Meta-analysis of Randomized Controlled Trials

Background. Anterior cruciate ligament (ACL) injuries are prevalent among younger demographics due to sportsrelated incidents, contributing to knee joint instability. Current anterior cruciate ligament reconstruction (ACLR) involves either debriding the stump (standard) or preserving the stump (stump-preserving), which retains the vascular network and mechanoreceptors in the tibial stump, aiming to improve postoperative outcomes. The autologous hamstring tendon graft is the most used, providing a higher maximum load to failure than bonepatellar tendon-bone grafts. Objective. This meta-analysis aimed to compare outcomes between the standard and stump-preserving ACLR techniques using an autologous hamstring tendon graft. The specific objectives were to evaluate primary outcomes (Lysholm Scores and the KT-1000 Arthrometer results), secondary outcomes (International Knee Documentation Committee (IKDC) Scores, results of the Lachman and pivot shift tests), and postoperative complications. Methodology. The authors comprehensively searched PubMed, Embase, Cochrane Library, and grey literature, identifying randomized controlled trials meeting the inclusion criteria. Study characteristics and participant information were extracted, and potential bias was assessed using the Cochrane Collaboration methodology. Result. Ten studies, encompassing 552 patients, met the inclusion criteria. Lysholm score and KT-1000 arthrometer results favored the stump-preserving group, achieving statistical significance. IKDC, pivot shift test and Lachman test favored the stumppreserving group, without statistical significance. Postoperative complications exhibited a higher incidence in the stump-preserving group, favoring the standard group, without statistical significance. Conclusion. The meta-analysis suggested advantages in outcomes for stump-preserving ACLR, achieving statistical significance for the Lysholm scores and the KT-1000 arthrometer results. The stump-preserving group had better results in the IKDC scores, the pivot shift test results and the Lachman test results, while the standard group had fewer postoperative complications, but statistical significance was not achieved. In conclusion, while stump-preserving ACLR demonstrated promising trends in enhancing postoperative outcomes, further studies are necessary.