Thirteen studies (n=1,145) were included in the review.
The quality of all the included studies was moderate, with the scores ranging from 6 to 16 out of a possible 24.
Return to pre-injury level of sporting activity: 9 studies were found. All 5 studies assessing outcomes using the Tegner activity score found no significant difference between PT and HT grafts. Two further studies reported that most patients returned to their pre-injury level of activity. Another study reported no significant difference in the return to sporting activity between the HT and PT groups. The final study found that more patients in the PT group returned to grade 3 and grade 4 activity levels, but there was no significant difference in the intensity of return to specific sport participation.
Pain: 8 studies were found. Three studies found no difference with respect to discomfort between PT and HT grafts. Studies found different results according to the site of pain. One study reported a difference in the site of pain experienced, with anterior pain worse after a PT graft and posterior pain worse after an HT graft. Over time, both groups reported anterior pain as worse. Two studies reported that patellofemoral pain was worse after a PT graft, whilst another 2 studies reported no difference.
Muscle strength: 9 studies were found. Six studies reported no difference in peak extension and flexion between PT and HT grafts. One study reported better isokinetic knee extension strength and endurance after 6 months in those with a PT graft, but this was no longer evident at 12 or 24 months.
Knee stability: 8 studies were found. Four studies found less residual anterior translation and, therefore, increased knee stability with a PT graft than with an HT graft. The other 4 studies found no difference in residual laxity. All 6 studies using the pivitol shift to assess stability reported that the majority of participants had a normal pivot shift 2 years post-surgery.
Range of motion: 11 studies were found. Seven studies found no significant difference in range of motion between PT and HT grafts. The other 4 studies found some differences in range of motion with PT and HT grafts, with mixed results: one reported no difference between the groups, one that flexion deficit was greater in the PT group, one that extension deficit was greater in the PT group, and one that extension deficit was greater in the HT group.
IKDC score: 7 studies were found. Four studies reported no difference in IKDC scores between PT and HT grafts. One study reported a higher incidence of A or B results after a PT graft. One study reported higher scores after a HT graft, but this was considered to be due to the underlying different general pain scores between the two groups.
Reoperation: 6 studies were found. Fifty-four patients who underwent a HT graft required additional surgery, compared with 20 patients after a PT graft.
Complications: 7 studies were found. Seven patients suffered complications after a HT graft versus 7 after a PT graft.