A meta-analysis of stability of autografts compared to allografts after anterior cruciate ligament reconstruction

Knee

Abstract

Allografts have recently become increasingly popular for anterior cruciate ligament reconstruction (ACLR) in the United States even though many studies have shown high allograft failure rates (Gorschewsky et al. in Am J Sports Med 33:1202, 2005; Pritchard et al. in Am J Sports Med 23:593, 2005; Roberts et al. in Am J Sports Med 19:35, 2006) and no meta-analysis or systematic review of allograft clinical stability rates in comparison to autog rafts has previously been performed. We hypothesized that allografts would demonstrate overall lower objective stability rates compared to autografts. To test this hypothesis we performed a meta-analysis of autograft and allograft stability data. A pubmed literature search of all allograft series in humans published in English was performed. Articles were then bibliographically cross-referenced to identify additional studies. Series inclusion criteria were arthrometric follow-up data using at least 30 lb or maximum manual force, stratified presentation of stability data and minimum two-year follow-up. Twenty allograft series were thus selected and compared to a previously published data set of all BPTB and Hamstring (HS) autograft ACLR series using the same study inclusion criteria and analytic and statistical methodology. IKDC standards of 0–2 mm (normal) and >5 mm (abnormal) side-to-side differences were adopted to compare studies. Normal stability for all autografts was 72 versus 59% for all allografts (P < 0.01). Abnormal stability was 5% for all autografts versus 14% for all allografts (P < 0.01). Bone-patellar-tendon-bone (BPTB) autograft normal stability was 66% versus 57% for BPTB allografts (P < 0.01). Abnormal BPTB autograft stability was 6 versus 16% for BPTB allograft. Hamstring autograft normal or abnormal stability rates were 77% and 4% and were compared to soft tissue allografts as a group which were 64% and 12% (P < 0.01). This is the first meta-analysis comparing autograft to allograft stability in ACLR. Allografts had significantly lower normal stability rates than autografts. The allograft abnormal stability rate, which usually represents graft failure, was significantly higher than that of autografts: nearly three times greater. It would therefore appear that autografts are the graft of choice for routine ACLR with allografts better reserved for multiple ligament-injured knees where extra tissue may be required.

Keywords

Anterior cruciate ligament Knee Allograft 

References

  1. 1.
    Bach BR Jr, Aadalen KJ, Dennis MG et al (2005) Primary anterior cruciate ligament reconstruction using fresh-frozen, nonirradiated patellar tendon allograft: Minimum 2-yeasr follow-up. Am J Sports Med 33:284–292PubMedCrossRefGoogle Scholar
  2. 2.
    Barrett G, Stokes D, White M (2005) Anterior cruciate ligament reconstruction in patients older than 40 years: allograft versus autograft patellar tendon. Am J Sports Med 33:1505–1512PubMedCrossRefGoogle Scholar
  3. 3.
    Carpenter JE, Wojtys EM, Pribble JM (1993) Significance of culture positive patella tendon allografts in ACL reconstruction. In: Presented at the 12th annual meeting of the Arthroscopy Association of North AmericaGoogle Scholar
  4. 4.
    Chang SKY, Egami DK, Shaib MD, Kan DM, Richardson AB (2003) Anterior cruciate ligament reconstruction: allograft versus autograft. Arthroscopy 19:453–462PubMedCrossRefGoogle Scholar
  5. 5.
    Clavert P, Kempf JF, Bonnomet F, Boutemy P, Marcelin L, Kahn JL (2001) Effects of freezing/thawing on the biomechanical properties of human tendons. Surg Radiol Anat 23:259–262PubMedCrossRefGoogle Scholar
  6. 6.
    Gorschewsky O, Klakow A, Riechert K, Pitzl M, Becker R (2005) Clinical comparison of the tutoplasty allograft and autologous patellar tendon (Bone-Patellar Tendon-Bone) for the reconstruction of the anterior cruciate ligament: 2- and 6-year results. Am J Sports Med 33:1202–1209PubMedCrossRefGoogle Scholar
  7. 7.
    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 24:1011–1018PubMedCrossRefGoogle Scholar
  8. 8.
    Harner CD, Olson E, Irrgang JJ, Silverstein S, Fu FH, Silbey M (1996) Allograft versus autograft anterior cruciate ligament reconstruction: 3- to 5-year outcome. Clin Orthop Relat Res 324:134–144PubMedCrossRefGoogle Scholar
  9. 9.
    Indelli PF, Dillingham MF, Fanton GS, Schurman DJ (2004) Anterior cruciate ligament reconstruction using cryopreserved allografts. Clin Orthop Relat Res 420:268–275PubMedCrossRefGoogle Scholar
  10. 10.
    Jackson DW, Grood ES, Goldstein JD et al (1993) A comparison of patellar tendon autograft and allograft used for anterior cruciate ligament reconstruction in the goat model. Am J Sports Med 21:176–185PubMedCrossRefGoogle Scholar
  11. 11.
    King W, Mangan D, Endean T et al. (2004) Microbial sterilization and viral inactivation in soft tissue allografts using novel applications of high-dose gamma irradiation: Report of a new graft preparation technique and early clinical follow-up. Presented at 2004 meeting of the American Academy of Orthopaedic SurgeonsGoogle Scholar
  12. 12.
    Kleipool AEB, Zijl JAC, Willems WJ (1998) Arthroscopic anterior cruciate ligament reconstruction with bone-patellar tendon-bone allograft or autograft: a prospective study with an average follow up of 4 years. Knee Surg Sports Traumatol Arthrosc 6:224–230PubMedCrossRefGoogle Scholar
  13. 13.
    Kurzweil PR, Grafe MW (2005) ACL reconstruction with achilles tendon allografts in revisions and patients over 30. Presented at 2005 meeting of the Arthroscopy Association of North AmericaGoogle Scholar
  14. 14.
    Levitt RL, Malinin T, Posada A, Michalow A (1994) Reconstruction of anterior cruciate ligaments with bone-patellar tendon-bone and achilles tendon allografts. Clin Orthop Relat Res 303:67–78PubMedGoogle Scholar
  15. 15.
    Malinin T, Levitt RL, Mnaymneh W, Temple T (2000) Study of retrieved whole ACL replacement allografts five years post implantation. In: Presented at the 19th annual meeting of the Arthroscopy Association of North AmericaGoogle Scholar
  16. 16.
    Nikolaou PK, Seaber AV, Glisson RR, Ribbeck BM, Bassett FH (1986) Anterior cruciate ligament allograft transplantation: long-term function, histology, revascularization, and operative technique. Am J Sports Med 14:348–360PubMedCrossRefGoogle Scholar
  17. 17.
    Noyes FR, Barber SD (1991) The effect of an extra-articular procedure on allograft reconstructions for chronic ruptures of the anterior cruciate ligament. J Bone Joint Surg Am 73-A:882–892Google Scholar
  18. 18.
    Noyes FR, Barber-Westin SD (1996) Reconstruction of the anterior cruciate ligament with human allograft: comparison of early and later results. J Bone Joint Surg Am 78-A:524–537Google Scholar
  19. 19.
    Noyes FR, Barber-Westin SD (1997) Arthroscopic-assisted allograft anterior cruciate ligament reconstruction in patients with symptomatic arthrosis. Arthroscopy 13:24–32PubMedCrossRefGoogle Scholar
  20. 20.
    Nyland J, Caborn DNM, Rothbauer J, Kocabey Y, Couch J (2003) Two-year outcomes following ACL reconstruction with allograft tibialis anterior tendons: a retrospective study. Knee Surg Sports Traumatol Arthrosc 11:212–218PubMedCrossRefGoogle Scholar
  21. 21.
    Olson EJ, Fu FH, Irrgang JJ, Harner CD (1992) Anterior cruciate ligament reconstruction with sterilely harvested, fresh frozen allograft: four year results. In: Presented at the 11th annual meeting of the Arthroscopy Association of North AmericaGoogle Scholar
  22. 22.
    Pedowitz RA, Mahar A, Schmizzi A, Wedemeyrs M, Odell T (2006) Effects of novel sterilization process on soft tissue mechanical properties for anterior cruciate ligament repair. Presented at the 25th annual meeting of the Arthroscopy Association of North AmericaGoogle Scholar
  23. 23.
    Peterson RK, Shelton WR, Bomboy AL (2001) Allograft versus autograft patellar tendon anterior cruciate ligament reconstruction: a 5-year follow-up. Arthroscopy 17:9–13PubMedCrossRefGoogle Scholar
  24. 24.
    Poehling GG, Curl WW, Lee C et al (2005) Analysis of outcomes of anterior cruciate ligament repair with 5-year follow-up: allograft versus autograft. Arthroscopy 21:774–785PubMedGoogle Scholar
  25. 25.
    Pritchard JC, Drez D Jr, Moss M, Heck S (1995) Long-term followup of anterior cruciate ligament reconstructions using freeze-dried fascia lata allografts. Am J Sports Med 23:593–596PubMedCrossRefGoogle Scholar
  26. 26.
    Prodromos CC, Han YS, Keller BL, Bolyard RJ (2005) Stability results of hamstring anterior cruciate ligament reconstruction at two- to eight-year follow-up. Arthroscopy 21:138–146PubMedCrossRefGoogle Scholar
  27. 27.
    Prodromos CC, Joyce BT, Shi KS, Keller BL (2005) A meta-analysis of stability after anterior cruciate ligament reconstruction as a function of hamstring versus patellar tendon graft and fixation type. Arthroscopy 21:1202–1208PubMedGoogle Scholar
  28. 28.
    Prodromos CC, Fu F, Howell S, Johnson D, Paulos L (2006) Controversies in soft tissue anterior cruciate ligament reconstruction. Presented at symposium at the 2006 of the American Academy of Orthopaedic SurgeonsGoogle Scholar
  29. 29.
    Rihn JA, Irrgang JJ, Chhabra A, Fu FH, Harner CD (2006) Does irradiation affect the clinical outcome of patellar tendon allograft ACL reconstruction? Knee Surg Sports Traumatol Arthrosc 14:885–896PubMedCrossRefGoogle Scholar
  30. 30.
    Roberts TS, Drez D Jr, McCarthy W, Paine R (1991) Anterior cruciate ligament reconstruction using freeze-dried, ethylene oxide-sterilized, bone-patellar tendon-bone allografts: two year results in thirty-six patients. Am J Sports Med 19:35–41PubMedCrossRefGoogle Scholar
  31. 31.
    Schulte K, Thompson W, Jamison J, Harner CD, Irrgang JJ (1996) The immunologic response to allograft anterior cruciate ligament reconstruction: clinical correlation. In: Presented at the 15th annual meeting of the Arthroscopy Association of North AmericaGoogle Scholar
  32. 32.
    Shelton WR, Papendick L, Dukes AD (1997) Autograft versus allograft anterior cruciate ligament reconstruction. Arthroscopy 13:446–449PubMedCrossRefGoogle Scholar
  33. 33.
    Shino K, Kawasaki T, Hirose H, Gotoh I, Inoue M, Ono K (1984) Replacement of the anterior cruciate ligament by an allogenic tendon graft: an experimental study in the dog. J Bone Joint Surg Br 66-A:672–681Google Scholar
  34. 34.
    Siebold R, Buelow JU, Bos L, Ellerman A (2003) Primary ACL reconstruction with fresh-frozen patellar versus achilles tendon allografts. Arch Orthop Trauma Surg 123:180–185PubMedGoogle Scholar
  35. 35.
    Sterling JC, Meyers MC, Calvo RD (1995) Allograft failure in cruciate ligament reconstruction: follow-up evaluation of eighteen patients. Am J Sports Med 23:173–178PubMedCrossRefGoogle Scholar
  36. 36.
    Thorson E, Rodrigo JJ, Vasseur P, Sharkey N, Heitter D (1989) Replacement of the anterior cruciate ligament: a comparison of autografts and allografts in dogs. Acta Orthop Scand 60:555–560PubMedCrossRefGoogle Scholar
  37. 37.
    Zalavras CG, Patzakis MJ (2006) Infections in anterior cruciate ligament surgery. In: Prodromos C (ed) The anterior cruciate ligament: reconstruction and basic science. Elsevier, Philadelphia, pp 55–65Google Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  1. 1.Illinois Sports Medicine and Orthopaedic CentersRush University Medical CenterGlenviewUSA
  2. 2.Forest Labs IncNew YorkUSA

Personalised recommendations