CHSU Discovery

Abstract:

Background: Anterior Cruciate Ligament (ACL) reconstruction is one of the most common surgical procedures in the field of orthopedic surgery; this is especially true in younger athletes. Injury to the ACL commonly occurs during load-bearing activities that involve a sudden change in direction, side impacts, or twisting. Loss of ACL function leads to instability, which allows the femur to slide freely posteriorly on the tibial plateau. ACL reconstruction is done using either an autograft or allograft to create a new source of stability between the femur and tibia. In this study, we chose to evaluate two autografts, the Quadriceps Tendon (QT) and the Bone Patellar Tendon Bone (BPTB) graft, in a comparison of graft site morbidity between the two. Graft site morbidity is defined as the damage to the anatomic region from which the graft was harvested. To evaluate this, we conducted a systematic review with the intention of performing a meta-analysis comparing anterior knee pain, return of extensor function, hypoesthesia, and kneeling test results. 

Methods: For our systematic review and meta-analysis, we have adopted the Population, Intervention, Comparison, Outcome (PICO) model and are using the Cochrane Handbook as our guidelines. Our systematic review yielded 31 existing papers and studies that met our inclusion criteria or offered background information for the topic. Our inclusion criteria state that each study must have a population age range of 18-65, have an identified distribution of male and/or female patients, must specifically provide data related to graft site morbidity that can be quantified and compared, and a minimum of 12-month follow up conducted with the patients. We plan to use R to analyze the collected data for statistical differences in the aforementioned categories. Our goal is to keep our findings transparent so that our work can be replicated. 

Expected Results: We expect our results to show a difference between the QT and BPTB grafts with respect to graft site morbidity. Our early findings show that each method of grafting is similar in efficacy, outcomes, and return to play based on extensive pools of existing research; however, we believe there are differences with respect to graft site morbidity that may indicate either graft could be superior depending on the selection of factors we hope to explore. 

Discussion: Our primary question is “how do QT and BPTB Grafts compare to one another when considering graft site morbidity?”. Our goal is to determine if there is a significant difference in any of the categories we evaluate. Based on those findings, we will discuss the need for a standardized scale for evaluating graft site morbidity and how to utilize this information in determining graft choice for patients.