Non-detached hamstring tendon anterior cruciate ligament reconstruction demonstrates comparable outcomes to the traditional detached hamstring tendon technique: A systematic review and meta-analysis.

Abstract

To compare clinical and radiological outcomes of anterior cruciate ligament reconstruction (ACLR) using non-detached hamstring tendon (NDHT) versus conventional detached hamstring tendon (DHT) technique. Embase, PubMed, Ovid Medline and CINAHL databases were searched from inception to October 2025. Inclusion criteria included comparative studies of clinical or radiographic outcomes between NDHT and DHT. Studies were excluded if they were non-comparative or if they involved extra-articular procedures. The primary outcome was the post-operative International Knee Documentation Committee (IKDC) score. Secondary outcomes included Lysholm, Tegner, KT-1000 (knee testing 1000 [laxity arthrometer]) scores, rate of return-to-sport (RTS), retear rate and graft maturation. Data were pooled using random-effects models with significance set at <i>p</i> < 0.05. Sensitivity analyses included randomized trials only. A total of 11 studies (<i>n</i> = 731; 354 NDHT, 377 DHT patients) met inclusion criteria. IKDC scores at ≥12 months (mean difference [MD] = 0.67, 95% confidence interval [CI]: -2.67 to 3.94, <i>p</i> = 0.69), Lysholm scores at ≥6 months (MD = -1.02, 95% CI: -2.52 to 0.49, <i>p</i> = 0.19), Tegner scores at ≥6 months (MD = 0.18, 95% CI: -0.19 to 0.55, <i>p</i> = 0.34), KT-1000 arthrometer at ≥24 months (MD = -0.29, 95% CI: -0.67 to 0.30, <i>p</i> = 0.14), RTS rates at ≥12 months (risk ratio [RR] = 1.00, 95% CI: 0.94 to 1.07, <i>p</i> = 0.89) and retear rates at ≥12 months (RR = 0.63, 95% CI: 0.17 to 2.40, <i>p</i> = 0.50). None of these findings changed in sensitivity analysis. The NDHT demonstrated significantly better graft maturation at 6 and 12 months (<i>p</i> < 0.05), but these differences disappeared by 24 months. Preserving the tibial insertion of the hamstring graft in ACLR (NDHT) resulted in comparable clinical outcomes to those of the detached technique (DHT), with no significant differences observed between the two approaches. Future studies should assess potential cost and time benefits of NDHT. Level IV.