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Functional results of allograft vs. autograft tendons in anterior cruciate ligament (ACL) reconstruction at 10-year follow-up

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

The anterior cruciate ligament (ACL) tear is one of the most common sports injuries of the knee, and the arthroscopic reconstruction is the gold standard. Nevertheless, controversies about the surgical techniques and the type of graft still exist. Allografts have been considered by many surgeons as valid alternative to autografts. The aim of this study was to assess the effectiveness of allografts compared to autografts at approximately 10 years of follow-up, investigating the level of physical activity currently performed by patients of each group.

Methods

Ninety-four patients, divided into two groups (allografts and autografts), have been retrospectively studied. The two groups did not significantly differ in preoperative sport activity level, age (mean 40.70 years for autografts and 41.23 for allografts) and characteristics. Allograft group received a fresh-frozen graft from the musculoskeletal tissues bank. Evaluations were made using the International Knee Documentation Committee (IKDC) and Lysholm score; every patient was interviewed for complications.

Results

The mean follow-up time was approximately 10 years for both groups, with a minimum of 8 years. There were no statistically significant differences between the two groups. Average IKDC scores were 75.21 (SD 15.36) and 80.69 (SD 13.65) for the allograft and autograft groups, respectively. The mean Lysholm score was 87.57 (SD 9.43) for the allografts and 89.10 (SD 8.33) for the autografts. No major complications linked to the allograft tissue arose.

Conclusion

Both groups achieved almost the same functional outcomes at an average 10 years of follow-up, indicating fresh-frozen allografts as a reasonable alternative for ACL reconstruction.

Level of evidence

IV, Retrospective case–control study

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References

  1. Gans I, Retzky JS, Jones LC, Tanaka MJ (2018) Epidemiology of recurrent anterior cruciate ligament injuries in national collegiate athletic association sports: the injury surveillance program, 2004–2014. Orthop J Sports Med 6(6):1–7

    Article  Google Scholar 

  2. Jianzhong Hu, Jin Qu, DaqiXu, (2012) Allograft versus Autograft for anterior cruciate ligament reconstruction: an up-to-date meta-analysis of prospective studies. Int Orthop 37:311–320

    Google Scholar 

  3. Wang S, Zhang C, Cai Y, Lin X (2018) Autograft or Allograft? Irradiated or not? a contrast between autograft and allograft in anterior cruciate ligament reconstruction: a meta-analysis. Arthroscopy 34(12):3258–3265

    Article  Google Scholar 

  4. Drocco L, Camazzola D, Ferracini R, Lustig S, Massè A, Bistolfi A et al (2018) Tripled semitendinosus with single harvesting is as effective but less invasive compared to standard gracilis-semitendinosus harvesting. Muscles Ligaments Tend J 7(4):564–572

    Article  Google Scholar 

  5. Barrett GR, Luber K, Replogle WH, Manley JL (2010) Allograft anterior cruciate ligament reconstruction in the young, active patient: Tegner activity level and failure rate. Arthroscopy 26:1593–1601

    Article  Google Scholar 

  6. Harner CD, Irrgang JJ, Paul J, Dearwater S, Fu FH (1992) Loss of motion after anterior cruciate ligament reconstruction. Am J Sports Med 20:499–506

    Article  CAS  Google Scholar 

  7. Jackson DW, Grood ES, Goldstein JD, Rosen MA, Kurzweil PR, Cummings JF, Simon TM (1993) A comparison of patellar tendon autograft and allograft used for anterior cruciate ligament reconstruction in the goat model. Am J Sports Med 21:176–185

    Article  CAS  Google Scholar 

  8. Malinin TI, Levitt RL, Bashore C, Temple HT, Mnaymneh W (2002) A study of retrieved allografts used to replace anterior cruciate ligaments. Arthroscopy 18:163–170

    Article  Google Scholar 

  9. Mroz TE, Joyce MJ, Steinmetz MP, Lieberman IH, Wang JC (2008) Musculoskeletal allograft risks and recalls in the United States. J Am Acad Orthop Surg 16:559–565

    Article  Google Scholar 

  10. Vangsness CT Jr, Garcia IA, Mills CR, Kainer MA, Roberts MR, Moore TM (2003) Allograft transplantation in the knee: tissue regulation, procurement, processing, and sterilization. Am J Sports Med 31:474–481

    Article  Google Scholar 

  11. McAllister DR, Joyce MJ, Mann BJ, Vangsness CT Jr (2007) Allograft update: the current status of tissue regulation, procurement, processing, and sterilization. Am J Sports Med 35:2148–2158

    Article  Google Scholar 

  12. Padua R, Bondi R, Ceccarelli E, Bondi L, Romanini E, Zanoli G et al (2004) Italian version of the international knee documentation committee subjective knee form: cross-cultural adaptation and validation. Arthroscopy 20(8):819–823

    Article  Google Scholar 

  13. Cerciello S, Corona K, Morris BJ, Visonà E, Maccauro G, Maffulli N (2018) Cross-cultural adaptation and validation of the Italian versions of the kujala, larsen, lysholm and fulkerson scores in patients with patellofemoral disorders. J OrthopTraumatol 19(1):18

    Google Scholar 

  14. Sun K, Zhang J, Wang Y, Xia C, Zhang C, Yu T, Tian S (2011) Arthroscopic anterior cruciate ligament reconstruction with at least 2.5 years’ follow-up comparing hamstring tendon autograft and irradiated allograft. Arthroscopy 27(9):1430–1438

    Article  Google Scholar 

  15. Samuelsen B, Webster K, Johnson N, Hewett T, Krych A (2017) Hamstring autograft versus patellar tendon autograft for acl reconstruction: Is there a difference in graft failure rate? a meta-analysis of 47.613 patients. Clin Orthop Relat Res 475(10):2459–2468

    Article  Google Scholar 

  16. Aglietti P, Buzzi R, Zaccherotti G, De Biase P (1994) Patellar tendon versus doubled semitendinosus and gracilis tendons for anterior cruciate ligament reconstruction. Am J Sports Med 22:211–217

    Article  CAS  Google Scholar 

  17. Andrade R, Pereira R, van Cingel R, Staal JB, Espregueira-Mendes J (2019) How should clinicians rehabilitate patients after ACL reconstruction? A systematic review of clinical practice guidelines with a focus on quality appraisal (AGREE II). Br J Sports Med 0: 1–9

  18. Tibor LM, Long JL, Schilling PL, Lilly RJ, Carpenter JE, Miller BS (2010) Clinical outcomes after anterior cruciate ligament reconstruction: a meta-analysis of autograft versus allograft tissue. Sports Health 2(1):56–72

    Article  Google Scholar 

  19. Bottoni CR, Smith EL, Shaha J, Shaha SS, Raybin SG, Tokish JM 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(10):2501–2509

    Article  Google Scholar 

  20. Bisciotti GN, Quaglia A, Belli A, Carimati G, Volpi P (2016) Return to sports after ACL reconstruction: a new functional test protocol. Muscles Ligaments Tend 12–6(4):499–509

    Google Scholar 

  21. Prodromos C, 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(7):851–856

    Article  Google Scholar 

  22. DiBartola AC, Everhart JS, Kaeding CC, Magnussen RA, Flanigan DC (2016) Maximum load to failure of high dose versus low dose gamma irradiation of anterior cruciate ligament allografts: a meta-analysis. Knee 23(5):755–762

    Article  Google Scholar 

  23. Zeng C, Gao SG, Li H, Yang T, Luo W, Li YS 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(1):153–163

    Article  Google Scholar 

  24. Yao LW, Wang Q, Zhang L, Zhang C, Zhang B, Zhang YJ et al (2015) Patellar tendon autograft versus patellar tendon allograft in anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Eur J Orthop Surg Traumatol 25(2):355–365

    Article  Google Scholar 

  25. 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(9):885–896

    Article  Google Scholar 

  26. Rai S, Jin SY, Rai B, Tamang N, Huang W, Liu XZ et al (2018) A single bundle anterior cruciate ligament reconstruction (ACL-R) using hamstring tendon autograft and tibialis anterior tendon allograft: a comparative study. Curr Med Sci 38(5):818–826

    Article  CAS  Google Scholar 

  27. Mayr HO, Willkomm D, Stoehr A, Schettle M, Suedkamp NP, Bernstein A et al (2012) Revision of anterior cruciate ligament reconstruction with patellar tendon allograft and autograft: 2- and 5-year results. Arch Orthop Trauma Surg 132(6):867–874

    Article  Google Scholar 

  28. Yu-Hua J, Peng-Fei S (2015) Comparison of clinical outcome of autograft and allograft reconstruction for anterior cruciate ligament tears. Chin Med J (Engl) 128(23):3163–3166

    Article  Google Scholar 

  29. Singhal MC, Gardiner JR, Johnson DL (2007) Failure of primary anterior cruciate ligament surgery using anterior tibialis allograft. Arthroscopy 23(5):469–475

    Article  Google Scholar 

  30. Shino K, Inoue M, Horibe S, Hamada M, Ono K (1990) Reconstruction of the anterior cruciate ligament using allogeneic tendon. Long-term followup. Am J Sports Med 18(5):457–465

    Article  CAS  Google Scholar 

  31. Kaeding CC, Pedroza AD, Reinke EK, Huston LJ, Consortium M, Spindler KP (2015) Risk factors and predictors of subsequent ACL injury in either knee after ACL reconstruction: prospective analysis of 2488 primary ACL reconstructions from the MOON cohort. Am J Sports Med 43(7):1583–90

    Article  Google Scholar 

  32. Wasserstein D, Sheth U, Cabrera A, Spindler KP (2015) A Systematic Review of Failed Anterior Cruciate Ligament Reconstruction With Autograft Compared With Allograft in Young Patients. Sports Health 7(3):207–16

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedics, Traumatology and Rehabilitation, C.T.O. Hospital. AOU Città Della Salute E Della Scienza, Via Zuretti 29, 10126, Turin, Italy

    Alessandro Bistolfi, Marcello Capella, Luigi Sabatini, Stefano Artiaco & Alessandro Massè

  2. Faculty of Medicine and Surgery, University of Turin, Turin, Italy

    Claudio Guidotti & Alessandro Massè

  3. Department of Surgical Sciences and Integrated Diagnostics, University of Genova, Largo R. Benzi 10, 16132, Genova, Italy

    Riccardo Ferracini

  4. Orthopaedics, Koelliker Hospital, Turin, Italy

    Riccardo Ferracini

Authors
  1. Alessandro Bistolfi
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  2. Marcello Capella
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  3. Claudio Guidotti
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  4. Luigi Sabatini
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  5. Stefano Artiaco
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  6. Alessandro Massè
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  7. Riccardo Ferracini
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Contributions

All authors contributed to the study.

Corresponding author

Correspondence to Alessandro Bistolfi.

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Conflict of interest

The authors declare that they have no conflict of interest and received no funds for this study.

Ethical approval

The study was authorized by the local Institutional Revision Board (IRB) in accordance with the ethical standards.

Informed consent

Patients gave their informed consent for the treatment of the data before surgery. The study was authorized by the local institutional revision board (IRB) and was performed in accordance with the ethical standards. Data are available upon request. The work has not been published before in any language, is not being considered for publication elsewhere and has been read and approved by all authors. Each author contributed significantly to one or more aspects of the study. No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

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Bistolfi, A., Capella, M., Guidotti, C. et al. Functional results of allograft vs. autograft tendons in anterior cruciate ligament (ACL) reconstruction at 10-year follow-up. Eur J Orthop Surg Traumatol 31, 729–735 (2021). https://doi.org/10.1007/s00590-020-02823-y

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