ReviewJournal of orthopaedics2026
Quadrupled semitendinosus anterior cruciate ligament graft compared to a bone-patellar tendon bone approach: A systematic review and meta-analysis of functional outcomes.
Review in Journal of orthopaedics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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6 authors.
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Abstract
Background: The choice of graft in anterior cruciate ligament (ACL) reconstruction influences postoperative pain, stability, and functional outcomes. Bone-patellar tendon-bone (BTB) autografts provide robust reconstructions but may increase anterior knee pain whereas quadrupled semitendinosus (ST) grafts may reduce morbidity while maintaining comparable function. However, direct comparisons of BTB and quadrupled ST remain limited. The primary objective of this systematic review and meta-analysis was to compare postoperative pain between BTB and quadrupled ST autografts. Secondary objectives were to evaluate instrumented stability (KT-1000), clinical stability (Lachman), patient-reported outcomes (Lysholm, Tegner, IKDC grades), and graft rupture rates. Methods: Following PRISMA guidelines, MEDLINE/PubMed, EMBASE, SCOPUS, and Cochrane Central were searched through March 1, 2026, for randomized and comparative cohort studies of primary ACL reconstruction comparing BTB and quadrupled ST autografts. Eligible studies involved patients ≥16 years with or without meniscal or chondral pathology and ≥3-month follow-up. Continuous and dichotomous outcomes were pooled as mean or standardized mean differences (SMD) and odds ratios (OR) with 95% confidence interval (CI) using random-effects models. Statistical heterogeneity was quantified using I Results: Ten studies were included (n = 1029), comprising 692 males (67%) and 337 females (33%). The mean ages across studies ranged from 17.7 to 49.4 years, with follow-up periods spanning 6 months to 8 years. ST reduced postoperative pain (SMD 0.44; 95% CI 0.09-0.80, p = 0.015), whereas BTB improved KT-1000 stability (SMD -0.70; 95% CI -1.02 to -0.38, p < 0.0001). IKDC Grade A favored ST (OR 1.31; 95% CI 1.03-1.66, p = 0.039). Lachman, Lysholm, Tegner, and graft rupture did not differ between groups. Conclusion: Both BTB and quadrupled ST autografts are effective for ACL reconstruction. BTB provides greater anterior stability, while ST is associated with less postoperative pain and higher odds of achieving IKDC Grade A outcomes without increasing failure risk. These findings highlight the importance of individualized graft selection to balance mechanical stability with patient-reported recovery and donor-site morbidity.
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