Regarding “Does Gracilis Preservation Matter in Anterior Cruciate Ligament Reconstruction? A Systematic Review”

Abstract

If I may, I would like to propose a comment on the article “Does Gracilis Preservation Matter in Anterior Cruciate Ligament Reconstruction? A Systematic Review,” which was published last month in Arthroscopy.1Sharma A. Flanigan D.C. Randall K. Magnussen R.A. Does gracilis preservation matter in anterior cruciate ligament reconstruction? A systematic review.Arthroscopy. 2016; 32: 1165-1173Abstract Full Text Full Text PDF PubMed Scopus (36) Google Scholar This is a well-written article that is of great importance in the clinical research work concerning the surgery of anterior cruciate ligament reconstruction, but there is some confusion I would like to mention. First, Figure 5 is expected to be the meta-analysis of “Isometric Strength 105°-110°” of the data of Table 5. However, as may be seen from Table 5, the values for ST and ST-G are 85.2 and 72.5 in Ardern et al.'s study, and 82 and 68 in Tashiro et al.'s study, respectively. However, a confusion might have been made by mixing these 2 studies up in the meta-analysis in Figure 5, which might lead to an improper meta-analysis and a different conclusion. After looking up the original articles,2Ardern C.L. Webster K.E. Taylor N.F. Feller J.A. Hamstring strength recovery after hamstring tendon harvest for anterior cruciate ligament reconstruction: A comparison between graft types.Arthroscopy. 2010; 26: 462-469Abstract Full Text Full Text PDF PubMed Scopus (81) Google Scholar, 3Tashiro T. Kurosawa H. Kawakami A. Hikita A. Fukui N. Influence of medial hamstring tendon harvest on knee flexor strength after anterior cruciate ligament reconstruction. A detailed evaluation with comparison of single- and double-tendon harvest.Am J Sports Med. 2003; 31: 522-529Crossref PubMed Scopus (172) Google Scholar I may believe that Table 5 is the one with the correct data. Secondly, Figure 6 is expected to be the meta-analysis of the “Active Knee Flexion Angle Loss” column in Table 5. However, the data of ST Harvest and ST-G Harvest listed in Table 5 are shown reversely in Figure 6. It might have just been a “coincidence” that the PLUS numbers of “loss” were considered as “GAIN” by the software Review Manager, eventually leading to the result that the ST Harvest group is favored, which is fortunate to be the expected RIGHT answer. I would like to make a suggestion that if data of “Active Knee Flexion Angle Loss” could be extracted from the original articles as MINUS values, the confusion might be avoided and the problem solved. Thirdly, in the paragraph beginning “Instrumented anterior laxity was reported…,” the “Anterior Laxity” is actually listed in Table 4 instead of Table 6. This might just be a slight editing overlook, which brings about no big influence to the understanding of the article. Besides the first concern, the other 2 concerns are quite minor but still might be able to cause confusion. I sincerely wish that a proper revision could be made. I am also looking forward to the next outstanding piece of work of the research team. Thank you for your contribution to the field. Does Gracilis Preservation Matter in Anterior Cruciate Ligament Reconstruction? A Systematic ReviewArthroscopyVol. 32Issue 6PreviewTo analyze the effect of gracilis harvest on hamstring strength, patient-reported outcomes, and anterior knee laxity after anterior cruciate ligament (ACL) reconstruction. Full-Text PDF Authors' ReplyArthroscopyVol. 32Issue 7PreviewWe thank Dr. Ma for his detailed attention to our recent review on the subject of the effects of gracilis harvest after anterior cruciate ligament reconstruction. Full-Text PDF