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Arthroscopic anatomic double-bundle ACL reconstruction using irradiated versus non-irradiated hamstring tendon allograft

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To analyse the clinical outcome of anatomic double-bundle anterior cruciate ligament (ACL) reconstruction with irradiated versus non-irradiated hamstring allograft.

Methods

One hundred and twelve patients who met the inclusion and exclusion criteria of the study were prospectively randomized consecutively into irradiated hamstring tendon allograft (Ir-Allo) group and non-irradiated allograft (Non-ir-Allo) group. All surgeries were done by the same senior surgeon with double-bundle reconstruction technique. Before surgery and at follow-up points, patients were evaluated by the same observer according to clinical evaluations.

Results

Eighty-three patients (Non-ir-Allo, 44; Ir-Allo, 39) fulfilled complete follow-up and got full clinical evaluations. The mean follow-up period was 5.7 years (ranging from 5.0 to 6.5 years). At the final follow-up, significant differences were found when comparing the results of the two groups according to Lachman test, ADT, pivot shift test and KT-2000 arthrometer testing (P < 0.05). According to KT-2000, 86.4 % of patients in the Non-ir-Auto group and 35.9 % in the Ir-Allo group had a side-to-side difference of <3 mm. According to the overall IKDC, functional, subjective evaluations and activity level testing, no significant differences were found between the two groups. Regarding the arthritic progression, there was significant difference between the two groups (Ir-Allo group: 30.8 %, Non-ir-Allo group: 11.4 %, P < 0.05).

Conclusion

A significant increase in anterior and rotational laxity in patients of the Ir-Allo group was found according to evaluations. No significant differences in activity level and functional scores were found between the two groups. We do not advocate the irradiated hamstring tendon allograft for ACL reconstruction.

Level of evidence

I.

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References

  1. Amano H, Toritsuka Y, Uchida R et al (2015) Outcome of anatomical double-bundle ACL reconstruction using hamstring tendons via an outside-in approach. Knee Surg Sports Traumatol Arthrosc 23:1222–1230

    Article  PubMed  Google Scholar 

  2. Araujo PH, van Eck CF, Macalena JA et al (2011) Advances in the three-portal technique for anatomical single- or double-bundle ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 19:1239–1242

    Article  PubMed  PubMed Central  Google Scholar 

  3. Bhatia S, Bell R, Frank RM et al (2012) Bony incorporation of soft tissue anterior cruciate ligament grafts in an animal model: autograft versus allograft with low-dose gamma irradiation. Am J Sports Med 40:1789–1798

    Article  PubMed  Google Scholar 

  4. Bottoni CR, Smith EL, Shaha J et al (2015) Autograft versus allograft anterior cruciate ligament reconstruction: a prospective, randomized clinical study with a minimum 10-year follow-up. Am J Sports Med 43:2501–2509

    Article  PubMed  Google Scholar 

  5. Buck BE, Malinin TI, Brown MD (1989) Bone transplantation and human immunodeficiency virus: an estimate of risk of acquired immunodeficiency syndrome (AIDS). Clin Orthop Relat Res 240:129–136

    Google Scholar 

  6. Cohen SB, Fu FH (2007) Three-portal technique for anterior cruciate ligament reconstruction: use of a central medial portal. Arthroscopy 23:325.e1–325.e5

    Google Scholar 

  7. Crawford C, Kainer M, Jernigan D et al (2005) Investigation of postoperative allograft-associated infections in patients who underwent musculoskeletal allograft implantation. Clin Infect Dis 41:195–200

    Article  PubMed  Google Scholar 

  8. Curran AR, Adams DJ, Gill JL et al (2004) The biomechanical effects of low-dose irradiation on bone-patellar tendon-bone allografts. Am J Sports Med 32:1131–1135

    Article  PubMed  Google Scholar 

  9. Dai C, Wang F, Wang X et al (2015). Arthroscopic single-bundle anterior cruciate ligament reconstruction with six-strand hamstring tendon allograft versus bone-patellar tendon-bone allograft. Knee Surg Sports Traumatol Arthrosc [Epub ahead of print]

  10. Fideler BM, Vangsness CT Jr, Lu B et al (1995) Gamma irradiation: effects on biomechanical properties of human bone-patellar tendon- bone allografts. Am J Sports Med 23:643–646

    Article  CAS  PubMed  Google Scholar 

  11. Grieb TA, Forng RY, Bogdansky S et al (2006) High-dose gamma irradiation for soft tissue allografts: high margin of safety with biomechanical integrity. J Orthop Res 24:1011–1018

    Article  PubMed  Google Scholar 

  12. Harner CD, Olson E, Irrgang JJ et al (1996) Allograft versus autograft anterior cruciate ligament reconstruction: 3- to 5-year outcome. Clin Orthop Relat Res 324:134–144

    Article  Google Scholar 

  13. Hussein M, van Eck CF, Cretnik A et al (2012) Individualized anterior cruciate ligament surgery: a prospective study comparing anatomic single-and double-bundle reconstruction. Am J Sports Med 40:1781–1788

    Article  PubMed  Google Scholar 

  14. Kocher MS, Steadman JR, Briggs KK et al (2004) Relationships between objective assessment of ligament stability and subjective assessment of symptoms and function after anterior cruciate ligament reconstruction. Am J Sports Med 32:629–634

    Article  PubMed  Google Scholar 

  15. Liden M, Sernert N, Rostgard-Christensen L et al (2008) Osteoarthritic changes after anterior cruciate ligament reconstruction using bone–patellar tendon–bone or hamstring tendon autografts: a retrospective, 7-year radiographic and clinical follow-up study. Arthroscopy 24:899–908

    Article  PubMed  Google Scholar 

  16. Lohmander LS, Ostenberg A, Englund M (2004) High prevalence of knee osteoarthritis, pain, and functional limitations in female soccer players twelve years after anterior cruciate ligament injury. Arthritis Rheum 50:3145–3152

    Article  CAS  PubMed  Google Scholar 

  17. Mascarenhas R, Erickson BJ, Sayegh ET et al (2015) Is there a higher failure rate of allografts compared with autografts in anterior cruciate ligament reconstruction: a systematic review of overlapping meta-analyses. Arthroscopy 31:364–372

    Article  PubMed  Google Scholar 

  18. Miller SL, Gladstone JN (2002) Graft selection in anterior cruciate ligament reconstruction. Orthop Clin North Am 33:675–683

    Article  PubMed  Google Scholar 

  19. Muller B, Hofbauer M, Wongcharoenwatana J et al (2013) Indications and contraindications for double-bundle ACL reconstruction. Int Orthop 37:239–246

    Article  PubMed  Google Scholar 

  20. Pinczewski LA, Lyman J, Salmon LJ et al (2007) A 10-year comparison of anterior cruciate ligament reconstructions with Hamstring tendon and patellar tendon autograft: a controlled, prospective trial. Am J Sports Med 35:564–574

    Article  PubMed  Google Scholar 

  21. Prodromos CC, Fu FH, Howell SM et al (2008) Controversies in soft-tissue anterior cruciate ligament reconstruction: grafts, bundles, tunnels, fixation, and harvest. J Am Acad Orthop Surg 16:376–384

    Article  PubMed  Google Scholar 

  22. Prodromos CC, Joyce B, Shi K (2007) A meta-analysis of stability of autografts compared to allografts after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 15:851–856

    Article  PubMed  Google Scholar 

  23. Rappé M, Horodyski M, Meister K et al (2007) Nonirradiated versus irradiated Achilles allograft: in vivo failure comparison. Am J Sports Med 35:1653–1658

    Article  PubMed  Google Scholar 

  24. Rihn JA, Irrgang JJ, Chhabra A et al (2006) Does irradiation affect the clinical outcome of patellar tendon allograft ACL reconstruction? Knee Surg Sports Traumatol Arthrosc 14:885–896

    Article  PubMed  Google Scholar 

  25. Rodriguez-Merchan EC (2015) Evidence-based ACL reconstruction. Arch Bone Joint Surg 3:9–12

    PubMed  PubMed Central  Google Scholar 

  26. Sun K, Zhang J, Wang Y et al (2011) Arthroscopic anterior cruciate ligament reconstruction with at least 2.5 years’ follow-up comparing hamstring tendon autograft and irradiated allograft. Arthroscopy 27:1195–1202

    Article  PubMed  Google Scholar 

  27. Sun R, Chen BC, Wang F et al (2015) Prospective randomized comparison of knee stability and joint degeneration for double- and single- bundle ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 23:1171–1178

    Article  PubMed  Google Scholar 

  28. Archibald LK, Jernigan DB, Kainer MA (2002) Update: allograft-associated bacterial infections—United States, 2002. Morb Mortal Wkly Rep 51:207–210

    Google Scholar 

  29. van der Hart CP, van den Bekerom MP, Patt TW (2008) The occurrence of osteoarthritis at a minimum of ten years after reconstruction of the anterior cruciate ligament. J Orthop Surg 3:1749–1759

    Google Scholar 

  30. van Eck CF, Widhalm H, Murawski C et al (2015) Individualized anatomic anterior cruciate ligament reconstruction. Phys Sportsmed 43:87–92

    Article  PubMed  Google Scholar 

  31. von Porat A, Roos EM, Roos H (2004) High prevalence of osteoarthritis 14 years after an anterior cruciate ligament tear in male soccer players: a study of radiographic and patient relevant outcomes. Ann Rheum Dis 63:269–273

    Article  Google Scholar 

  32. West RV, Harner CD (2005) Graft selection in anterior cruciate ligament reconstruction. J Am Acad Orthop Surg 13:197–207

    Article  PubMed  Google Scholar 

  33. Zeng C, Gao SG, Li H et al (2016) Autograft versus allograft in anterior cruciate ligament reconstruction: a meta-analysis of randomized controlled trials and systematic review of overlapping systematic reviews. Arthroscopy 32:153–163

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedics, The Affiliated Hospital of Qingdao University, No. 1677 Wutaishan Road, Huangdao District, Qingdao, 266000, Shandong, China

    Shaoqi Tian, Chengzhi Ha, Yuanhe Wang, Lun Liu, Qicai Li, Xu Yang & Kang Sun

  2. Department of Orthopaedics, Qingdao 3rd People’s Hospital, Qingdao, 266000, Shandong, China

    Bin Wang

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  1. Shaoqi Tian
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  2. Chengzhi Ha
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  3. Bin Wang
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  4. Yuanhe Wang
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  5. Lun Liu
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  8. Kang Sun
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Correspondence to Shaoqi Tian or Kang Sun.

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Tian, S., Ha, C., Wang, B. et al. Arthroscopic anatomic double-bundle ACL reconstruction using irradiated versus non-irradiated hamstring tendon allograft. Knee Surg Sports Traumatol Arthrosc 25, 251–259 (2017). https://doi.org/10.1007/s00167-016-4154-6

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  • DOI: https://doi.org/10.1007/s00167-016-4154-6

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