title: Bone-Patellar Tendon-Bone Versus Soft-Tissue Allograft for Anterior Cruciate Ligament Reconstruction: A Systematic Review.
abstract: OBJECTIVE
  To describe the outcomes of bone-patellar tendon-bone (BPTB) and soft-tissue allografts in anterior cruciate ligament (ACL) reconstruction with respect to graft failure risk, physical examination findings, instrumented laxity, and patient-reported outcomes.
  
  
  METHODS
  A search of the PubMed, Scopus, CINAHL (Cumulative Index to Nursing and Allied Health Literature) Complete, Cochrane Collaboration, and SPORTDiscus databases was performed. English-language studies with outcome data on primary ACL reconstruction with nonirradiated BPTB and soft-tissue allografts were identified. Outcome data included failure risk, physical examination findings, instrumented laxity measurements, and patient-reported outcome scores.
  
  
  RESULTS
  Seventeen studies met the inclusion criteria. Of these studies, 11 reported on BPTB allografts exclusively, 5 reported on soft-tissue allografts exclusively, and 1 compared both types. The comparative study showed no difference in failure risk, Lachman grade, pivot-shift grade, instrumented laxity, or overall International Knee Documentation Committee score between the 2 allograft types. Data from all studies yielded a failure risk of 10.3% (95% confidence interval [CI], 4.5% to 18.1%) in the soft-tissue group and 15.2% (95% CI, 11.3% to 19.6%) in the BPTB group. The risk of a Lachman grade greater than 5 mm was 6.4% (95% CI, 1.7% to 13.7%) in the soft-tissue group and 8.6% (95% CI, 6.3% to 11.2%) in the BPTB group. The risk of a grade 2 or 3 pivot shift was 1.4% (95% CI, 0.3% to 3.3%) in the soft-tissue group and 4.1% (95% CI, 1.9% to 7.2%) in the BPTB group.
  
  
  CONCLUSIONS
  One comparative study showed no difference in results after ACL reconstruction with nonirradiated BPTB and soft-tissue allografts. Inclusion of case series in the analysis showed qualitatively similar outcomes with the 2 graft types.
authors.affiliation: The Ohio State University Sports Medicine Center and Cartilage Restoration Program, Columbus, Ohio, U.S.A.
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Joyce
authors.affiliation: The Ohio State University Sports Medicine Center and Cartilage Restoration Program, Columbus, Ohio, U.S.A.
authors.forename: Kyle L
authors.initials: KL
authors.lastname: Randall
authors.affiliation: The Ohio State University Sports Medicine Center and Cartilage Restoration Program, Columbus, Ohio, U.S.A.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Mariscalco
authors.affiliation: The Ohio State University Sports Medicine Center and Cartilage Restoration Program, Columbus, Ohio, U.S.A.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Magnussen
authors.affiliation: The Ohio State University Sports Medicine Center and Cartilage Restoration Program, Columbus, Ohio, U.S.A.. Electronic address: david.flanigan@osumc.edu.
authors.forename: David C
authors.initials: DC
authors.lastname: Flanigan
mesh_terms: D064591:Allografts; D059549:Anterior Cruciate Ligament Reconstruction / Q000009:adverse effects / Q000379:methods*; D050376:Bone-Patellar Tendon-Bone Grafting / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007593:Joint Instability / Q000209:etiology; D007719:Knee Joint / Q000601:surgery; D017847:Patellar Ligament / Q000637:transplantation; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous; D016896:Treatment Outcome