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Interference screws are more likely to perform better than cortical button and cross-pin fixation for hamstring autograft in ACL reconstruction: a Bayesian network meta-analysis

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Anterior cruciate ligament (ACL) reconstruction is widely accepted as the first choice of treatment for ACL injury, but there is disagreement in the literature regarding the optimal femoral fixation method. This meta-analysis assesses the evidence surrounding three common femoral fixation methods: cortical button (CB), cross-pin (CP) and interference screws (IS).

Methods

A systematic search was conducted in Medline, EMBASE and the Cochrane Library to identify studies with evidence level I or II that compared at least two femoral fixation methods with hamstring autograft for ACL reconstruction. Ten primary outcomes were collected. Risk of bias was assessed following the Cochrane Handbook for Systematic Reviews of Interventions. Standardized mean differences (SMD) were estimated using random-effects network meta-analysis in a Bayesian framework. Probability of ranking best (ProBest) and surface under the cumulative ranking curve (SUCRA) were used to rank all treatments. Funnel plots were used to identify publication bias and small-study effects.

Results

Sixteen clinical trials were included for analysis out of 2536 retrieved studies. Bayesian network meta-analysis showed no significant differences among the three fixation methods for the ten primary outcome measures. Based on the 10 outcome measures, the IS, CB and CP had the highest ProBest in 5, 5 and 0 outcomes, and the highest SUCRA values in 5, 4 and 1 outcomes, respectively. No substantial inconsistency between direct and indirect evidence, or publication bias was detected in the outcomes.

Conclusion

There were no statistical differences in performance among the CP, CB and IS femoral fixation methods with hamstring autograft in ACL reconstruction, although the IS was more likely to perform better than CB and CP based on the analysis of outcome measures from the included studies.

Level of evidence

1.

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Funding

This study was supported by the National Natural Science Foundation of China (81802204), China Postdoctoral Science Foundation (2020M671453), Natural Science Foundation of Shanxi Province (201801D221117), Shanxi Medical University Second Affiliated Hospital Doctor’s Funds (2017-105, 201702-3), Program for the Outstanding Innovative Teams of Higher Learning Institutions of Shanxi (2019L0410), and the Australian National Health and Medical Research Council (APP1120249).

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Author notes

  1. Lei Yan and Jiao Jiao Li Equal first authors.

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Shanxi Medical University Second Affiliated Hospital, Taiyuan, China

    Lei Yan, Haifeng Liu, Ruxing Liu, Bin Zhao & Bin Wang

  2. Shanxi Medical University, Taiyuan, China

    Lei Yan

  3. Kolling Institute, University of Sydney, Sydney, NSW, Australia

    Jiao Jiao Li

  4. School of Biomedical Engineering, Faculty of Engineering and IT, University of Technology Sydney (UTS), Ultimo, NSW, Australia

    Jiao Jiao Li

  5. Department of Pharmacy, Shanxi Medical University Second Affiliated Hospital, Taiyuan, China

    Yuanyuan Zhu

  6. Department of Sports Medicine and Adult Reconstruction Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, China

    Bin Wang

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  1. Lei Yan
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Correspondence to Bin Zhao or Bin Wang.

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This study was carried out with ethical approval from the ethics committee of Shanxi Medical University (2018LL036).

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Yan, L., Li, J.J., Zhu, Y. et al. Interference screws are more likely to perform better than cortical button and cross-pin fixation for hamstring autograft in ACL reconstruction: a Bayesian network meta-analysis. Knee Surg Sports Traumatol Arthrosc 29, 1850–1861 (2021). https://doi.org/10.1007/s00167-020-06231-x

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  • DOI: https://doi.org/10.1007/s00167-020-06231-x

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