Hybrid graft vs autograft in anterior cruciate ligament reconstruction: a meta-analysis

Figures & data

Figure 1 Flowchart of the study selection process.

Table 1 Characteristics of included studies

Study	Design	Sample size (H/A)	Mean age, years (H/A)	Female (H/A)	Follow-up (H/A)	Allograft source	Irradiation (Mrad)	Meniscus injury
Burrus et al^Citation7	Retrospective	29/29	26.6/27.2	19/19	44.4/48 months	Semitendinosus or tibialis anterior tendons	1.2–1.9	Yes
Darnley et al^Citation12	Prospective	27/27	20.9/20.9	10/10	2/2 years	Semitendinosus tendon	<2.5	Yes
Jacobs et al	Retrospective	42/46	15/14.6	18/26	31.2/46.7 months	Semitendinosus tendon	1.2–1.9	No
Kraeutler et al ^Citation10	Retrospective	84/119	36.6/35.8	N	3.5/4.7 years	Posterior tibialis or peroneus longus tendons	No	No
Leo et al^Citation13	Retrospective	24/71	28.1/26.9	8/25	2/2 years	Tibialis tendons	No	No
Li et al^Citation6	Prospective	31/32	31.6/29.8	13/15	5.9/5.8 years	Tibialis anterior tendons	2.5	Yes
Pennock et al^Citation11	Retrospective	20/20	15.4/15.9	12/13	3/3 years	Semitendinosus or tibialis anterior	0.9–1.3	Yes
Wang et al^Citation14	Retrospective	28/29	32.6/32.8	19/19	40.6/40.6 months	Tibialis anterior tendons	2.5	No
Xu et al^Citation15	Retrospective	37/31	33.9/32.8	10/15	2/2 years	Tibialis anterior tendons	2.5	No

Abbreviations: A, autograft; H, hybrid graft; NS, not state.

Figure 2 Risk-of-bias summary.

Figure 3 Funnel plot for reoperation.

Table 2 Quality assessment for nonrandomized trials

	Burrus et al^Citation7	Darnley et al^Citation12	Jacobs et al^Citation8	Kraeutler et al^Citation10	Leo et al^Citation13	Pennock et al^Citation11	Wang et al^Citation14	Xu et al^Citation15
Clearly stated aim	2	2	2	2	2	2	2	2
Inclusion of consecutive patients	2	2	2	2	2	2	2	2
Prospective data collection	0	2	0	0	2	0	0	0
End points appropriate to study aims	2	2	2	2	2	2	2	2
Unbiased assessment of study end point	2	2	2	2	2	2	2	2
Follow-up period appropriate to study aims	2	2	2	2	2	2	2	2
Less than 5% loss to follow-up	0	0	2	0	2	0	2	2
Prospective calculation of sample size	0	2	0	0	2	0	0	0
An adequate control group	2	2	2	2	2	2	2	2
Contemporary groups	2	2	2	2	2	2	2	2
Baseline equivalence of groups	2	2	2	2	2	2	2	2
Adequate statistical analyses	2	2	2	2	2	2	2	2
Total score	18	22	20	18	24	18	20	20

Figure 4 Forest plot showing graft diameter.

Figure 5 Forest plot showing failure.

Figure 6 Forest plot showing revision.

Table 3 Meta-analysis results of knee function

Outcome	Studies	Group (hybrid/autograft)	Overall effect			Heterogeneity
			Effect estimate	95% CI	P-value	I^2 (%)	P-value
IKDC	7	212/255	−0.22	−3.38 to 2.94	0.89	81	0.0001
Lysholm score	5	145/141	−4.29	−8.60 to 0.03	0.05	80	0.0004
Tegner score	4	116/112	0	−0.27 to 0.28	0.98	0	0.86
KT-1000 test	3	96/92	0.24	0–0.47	0.05	51	0.13
KOOS – ADL	2	63/63	0.96	−1.78 to 3.70	0.49	42	0.19
KOOS – QOL	2	63/63	7.23	0.07–14.38	0.05	0	0.46
KOOS – sport	2	63/63	4.65	−2.14 to 11.44	0.18	36	0.21
KOOS – symptoms	2	63/63	3.24	−1.47 to 7.94	0.18	36	0.21
VAS pain score	2	44/91	0.14	−0.64 to 0.93	0.72	21	0.26

Abbreviations: ADL, activities of daily living; IKDC, International Knee Documentation Committee; KOOS, Knee Injury and Osteoarthritis Outcome Score; KT, knee test; QOL, quality of life.

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