Single-Bundle Autografts Outperform Single-Bundle Achilles Allograft in Posterior Cruciate Ligament Reconstruction in Terms of Posterior Tibial Translation and Clinical Outcomes, but No Differences Exist Between Double-Bundle Grafts: A Network Meta-analysis

This article focuses on comparing biomechanical and clinical outcomes of different graft types used in posterior cruciate ligament reconstruction (PCLR), specifically evaluating Achilles allografts; hamstring tendon (HST), quadriceps tendon (QT), and bone–patellar tendon–bone (BTB) autografts; and hybrid (HY) grafts in single-bundle (SB) and double-bundle (DB) techniques. The network meta-analysis of 53 studies with 1861 patients found that SB autografts, particularly BTB and HST, demonstrated superior posterior tibial translation (PTT) outcomes, lower failure rates, and higher Lysholm scores compared to SB Achilles allografts, which had the highest odds of failure. DB PCLR showed better biomechanical outcomes than SB reconstruction regardless of graft type, with all graft groups achieving clinically significant improvements in Lysholm and Tegner scores. The study highlights the need for further research to confirm the clinical superiority of DB reconstruction and to clarify outcomes in combined multiligament injuries.