Graft Options for the Reconstruction of Multi-ligament Knee Injury: A Systematic Review.

Introduction: The literature lacks enough synthesis on which autograft option is suitable for a particular ligament reconstruction during multi-ligament reconstruction. This study aims to conduct a systematic review of existing literature to determine graft options available for the reconstruction of various ligaments in the context of multi-ligament knee injury. Methods: A systematic review was conducted following the preferred research items for systematic reviews and meta-analyses (PRISMA) guidelines. It was registered in PROSPERO (CRD42024498917). Studies that met the predefined inclusion and exclusion criteria were included in this systematic review. Results: Out of 8070 identified citations, 16 studies with a total of 640 patients(645 knees), including 420(65.6%) males and 220(34.4%) females, with a mean age of 35.1 years were included. Among 16 papers included in this review, combining autografts, allografts, or synthetic grafts was the preferred choice in seven studies. Autografts were chosen in five research studies, while allografts were preferred in four. For Anterior Cruciate Ligament (ACL) reconstruction: Eleven studies used only autografts, two used only allografts, and 1 study used both autografts and allografts. For Posterior Cruciate Ligament (PCL) reconstruction, nine studies used allografts, six used autografts, and 1 study used synthetic graft. For Posterior Lateral Corner (PLC) reconstruction, six studies used allografts, five used autografts, and 1 study used synthetic graft. For posterior medial corner (PMC) reconstruction, eight studies used autografts, five used allografts, and only one used synthetic grafts. Conclusion: A combination of autografts, allografts, or synthetic grafts was the preferred graft option for multi-ligament knee reconstruction. Autografts are the most preferred option for ACL and PMC reconstruction, whereas allografts are the most preferred option for PCL and PLC reconstruction. The most preferred autograft was the Hamstring Tendon (HT) autograft. Similarly, the tendoachillies (TA) was the most used allograft. However, the strength of the evidence in this review is moderate to low.