Graft choice has no significant influence on the rate of return to sport at the preinjury level after revision anterior cruciate ligament reconstruction: a systematic review and meta-analysis
Bibliographic record
Abstract
Importance For an athlete undergoing anterior cruciate ligament (ACL) reconstruction, regardless of the level of play, often the most patient-important outcome is the ability to return to sport. Various graft types are currently being used in revision ACL reconstruction; however, it remains unclear how graft choice affects the ability of athletes to return to sporting activities. Objective To evaluate the rate at which patients return to sport after revision ACL reconstruction based on the graft choice. Evidence review The databases PubMed (MEDLINE), Ovid (MEDLINE) and EMBASE were searched from database inception until 18 March 2016 by 2 reviewers independently. The systematic electronic search yielded 2666 studies. Inclusion criteria were English-language studies investigating revision ACL surgery on humans of all ages participating in sports of all levels with reported return to sport outcomes for patients stratified by graft choice. Conference papers, book chapters, review articles and technical reports were excluded. Findings 16 studies (n=944 patients) met the inclusion criteria for our analyses with a mean follow-up of 60.7 months (range: 12–1008 months). 1 study was of level II evidence, 2 were level III and 13 were level IV. A meta-analysis of proportions was used to combine the rate of return to preinjury level for each graft type using a random effects model. The pooled rate of return to preinjury sporting level was 67% (95% CI 62% to 72%; I 2 =14.64%) for patients with a bone-patellar-tendon bone autograft, 55% (95% CI 39% to 71%; I 2 =76.71%) for patients with a hamstring tendon autograft and 64% (95% CI 56% to 74%; I 2 =82.12%) for patients with allografts. Conclusions and relevance Pooled estimates suggest no significant influence of graft choice on the rate of return to sport at the preinjury level after revision ACL reconstruction. However, there is a lack of high quality, prospective, comparative studies evaluating the rate of return to sport from which to derive definitive conclusions on the efficacy of different graft choices. Level of evidence Level IV, systematic review of level II to IV studies.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.016 | 0.043 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.017 | 0.042 |
| Bibliometrics | 0.005 | 0.006 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".