A long-term study of anterior cruciate ligament allograft reconstruction

  • K. F. AlmqvistEmail author
  • Pieter Willaert
  • S. De Brabandere
  • K. Criel
  • R. Verdonk


We retrospectively reviewed the long-term clinical outcome of unilateral arthroscopic anterior cruciate ligament (ACL) allograft reconstruction. From October 1995 to December 1997, 64 arthroscopic ACL reconstructions were performed. Multiligamentous knee injuries and ACL injuries in polytrauma patients were excluded and out of the remaining 60 patients 55 were available for follow-up. Three patients had suffered a rerupture caused by major trauma. One patient had a rerupture without significant trauma and one failure was caused by deep infection. These five patients were revised. Fifty patients (36 males, 14 females) were included in the final follow-up. At the time of evaluation, the mean duration of follow-up was 10 years and 6 months. All patients were examined by an independent examiner. Seven patients had an extension lag (<5°) and all patients had a knee flexion of at least 120°, with a mean flexion of 135 ± 5° compared to 135 ± 8°. At the time of follow-up, the median IKDC score was 97 (74–100). The Lysholm scoring scale had a median value of 95 (76–100). The median sports level on the Tegner scale was 6 (4–9). The one-leg-hop test showed a mean value of 95 ± 5%. One patient did not perform the one-leg-hop test because of recent surgery to the Achilles tendon. In conclusion, the tibialis anterior or tibialis posterior tendon allograft ACL reconstruction produced good clinical results in the majority of patients at long-term follow-up.


ACL Arthroscopy Knee Allograft 



The authors would like to thank Mrs. Iris Wojtowicz for editorial and translational help in writing this paper. No funding was received by any of the authors. All of the investigations performed comply with current Belgian laws.


  1. 1.
    Aglietti P, Giron F, Buzzi R et al (2004) Anterior cruciate ligament reconstruction: bone-patellar tendon-bone compared with double semitendinosus and gracilis tendon grafts. J Bone Joint Surg 86A:2143–2155Google Scholar
  2. 2.
    Allen C, Livesay G, Wong E et al (1999) Injury and reconstruction of the anterior cruciate ligament and knee osteoarthritis. Osteoarthr Cartil 7:110–121PubMedCrossRefGoogle Scholar
  3. 3.
    Almqvist KF, Jan H, Vercruysse C et al (2007) The tibialis tendon as a valuable anterior cruciate ligament allograft substitute: biomechanical properties. Knee Surg Sports Traumatol Arthrosc 15:1326–1330PubMedCrossRefGoogle Scholar
  4. 4.
    Almqvist KF, Verdonk P, Verdonk R (2006) A prospective study of alginate seeded with mature allogenic human chondrocytes in the treatment of articular cartilage defects. Presented at the 6th congress of International Cartilage Repair Society, San Diego, January 8–11, 2006Google Scholar
  5. 5.
    Arnauw G, Verdonk R, Harth A et al (1991) Prosthetic versus tendon allograft replacement of ACL-deficient knees. Acta Orthop Belg 57:67–74PubMedGoogle Scholar
  6. 6.
    Brettler D, Soudry M (1995) Tibial bone plug resorption with extra-articular cyst: a rare complication of anterior cruciate ligament reconstruction. Arthroscopy 11:478–481PubMedGoogle Scholar
  7. 7.
    Casteleyn PP (1999) Management of anterior cruciate ligament lesions: surgical fashion, personal whim or scientific evidence? Study of medium- and long-term results. Acta Orthop Belg 65:327–339PubMedGoogle Scholar
  8. 8.
    Casteleyn PP, Handelberg F (1996) Non-operative management of anterior cruciate ligament injuries in the general population. J Bone Joint Surg Br 78B:446–451Google Scholar
  9. 9.
    Colombet P, Allard M, Bousquet V et al (2002) Anterior cruciate ligament reconstruction using four-strand semitendinosus and gracilis tendon grafts and metal interference screw fixation. Arthroscopy 18:232–237PubMedGoogle Scholar
  10. 10.
    Eriksson K, Kindblom L, Wredmark T (2000) Semitendinosus tendon graft ingrowth in tibial tunnel following ACL reconstruction. Acta Orthop Scand 71:275–279PubMedCrossRefGoogle Scholar
  11. 11.
    Gobbi A, Domzalski M, Pascual J et al (2005) Hamstring anterior cruciate ligament reconstruction: is it necessary to sacrifice the gracilis? Arthroscopy 21:275–280PubMedCrossRefGoogle Scholar
  12. 12.
    Haut Donahue T, Howell S, Hull M et al (2002) A biomechanical evaluation of anterior and posterior tibialis tendons as suitable single-loop anterior cruciate ligament grafts. Arthroscopy 18:589–597PubMedGoogle Scholar
  13. 13.
    Indelli P, Dillingham M, Fanton G et al (2004) Anterior cruciate ligament reconstruction using cryopreserved allografts. Clin Orthop Relat Res 420:268–275PubMedCrossRefGoogle Scholar
  14. 14.
    Irrgang JJ, Anderson AF, Boland AL et al (2006) Responsiveness of the International Knee Documentation Committee Subjective Knee Form. Am J Sports Med 34:1567–1573PubMedCrossRefGoogle Scholar
  15. 15.
    Jackson D, Corsetti J, Simon T (1996) Biologic incorporation of allograft anterior cruciate ligament replacements. Clin Orthop Relat Res 324:126–133PubMedCrossRefGoogle Scholar
  16. 16.
    Johma N, Borton D, Clingeleffer A et al (1999) Long term osteoarthritic changes in anterior cruciate ligament reconstructed knees. Clin Orthop Relat Res 358:188–193Google Scholar
  17. 17.
    Lee C, Meyer J, Shilt J et al (2004) Allograft maturation in anterior cruciate ligament reconstruction. Arthroscopy 20:46–49PubMedCrossRefGoogle Scholar
  18. 18.
    Marrale J, Morrissey MC, Haddad FS (2007) A literature review of autograft and allograft anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 15:690–704PubMedCrossRefGoogle Scholar
  19. 19.
    Nyland J, Caborn D, Rothbauer J et al (2003) Two-year outcomes following ACL reconstruction with allograft tibialis anterior tendons: a retrospective study. Knee Surg Sports Traumatol Arthrosc 11:212–218PubMedCrossRefGoogle Scholar
  20. 20.
    Poehling G, Curl W, 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
  21. 21.
    Saris D, Vanlauwe J, Victor J et al (2008) Characterized chondrocyte implantation results in better structural repair when treating symptomatic cartilage defects of the knee in a randomized controlled trial versus microfracture. Am J Sports Med 36:235–246PubMedCrossRefGoogle Scholar
  22. 22.
    Shelton W, Papendick L, Dukes A (1997) Autograft versus allograft anterior cruciate ligament reconstruction. Arthroscopy 13:446–449PubMedCrossRefGoogle Scholar
  23. 23.
    Singhal M, Gardiner J, Johnson D (2007) Failure of primary anterior cruciate ligament surgery using anterior tibialis allograft. Arthroscopy 23:469–475PubMedCrossRefGoogle Scholar
  24. 24.
    Steenbrugge F, Van Nieuwenhuyse W, Verdonk R et al (2005) Arthroscopic meniscus repair in the ACL-deficient knee. Int Orthop 29:109–112PubMedCrossRefGoogle Scholar
  25. 25.
    Steenbrugge F, Verdonk R, Hürel C et al (2004) Arthroscopic meniscus repair: inside-out technique vs. Biofix meniscus arrow. Knee Surg Sports Traumatol Arthrosc 12:43–49PubMedCrossRefGoogle Scholar
  26. 26.
    Steenbrugge F, Verdonk R, Vorlat P et al (2001) Repair of chronic ruptures of the anterior cruciate ligament using allograft reconstruction and a ligament augmentation device. Acta Orthop Belg 67:252–258PubMedGoogle Scholar
  27. 27.
    Vanlauwe J, Almqvist KF, Bellemans J et al (2007) Repair of symptomatic cartilage lesions of the knee. The place of autologous chondrocyte implantation. Acta Orthop Belg 73:145–158PubMedGoogle Scholar
  28. 28.
    Victor J, Bellemans J, Witvrouw E et al (1997) Graft selection in anterior cruciate ligament reconstruction—prospective analysis of patellar tendon autografts compared with allografts. Int Orthop 21:93–97PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • K. F. Almqvist
    • 1
    Email author
  • Pieter Willaert
    • 1
  • S. De Brabandere
    • 1
  • K. Criel
    • 1
  • R. Verdonk
    • 1
  1. 1.Department of Orthopaedic Surgery and Traumatology, Ghent University HospitalGhent UniversityGhentBelgium

Personalised recommendations