Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
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ISSN 1899–5276 (print)
ISSN 2451-2680 (online)
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Advances in Clinical and Experimental Medicine

2020, vol. 29, nr 10, October, p. 1145–1151

doi: 10.17219/acem/124884

Publication type: original article

Language: English

License: Creative Commons Attribution 3.0 Unported (CC BY 3.0)

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Factors influencing the choice of graft type in ACL reconstruction: Allograft vs autograft

Sebastian Krupa1,A,B,C,D,E,F, Paweł Reichert2,A,C,E,F

1 Trauma and Orthopedics Department, eMKaMED Medical Center, Wrocław, Poland

2 Department of Sports Medicine, Wroclaw Medical University, Poland

Abstract

Background. Anterior cruciate ligament (ACL) reconstruction is the prevailing procedure in cases of ACL rupture.
Objectives. To analyze ACL reconstruction based on time and costs of the surgery, postoperative pain, postoperative complications, time it takes to return to work or other such physical activity, and cosmetic effects.
Material and Methods. The retrospective analysis involved 62 patients who had undergone ACL reconstruction with the same results in clinical and functional assessment, which were then divided into 2 groups. In one group, an allograft was utilized, while in the other group – an autograft. The time it takes to perform the surgery, the cost, pain expected to be experienced, the possibility of postoperative complications, scarring, and the time needed for return to work were all considered and analyzed.
Results. The surgery time was 40.64 ±4.23 min in group I in comparison to 52.48 ±4.92 min in group II (p < 0.05). The cost of surgery was 32% higher in group I. Visual analogue scale (VAS) pain score in group I was from 36.45 ±8.39 mm on the 3rd day to 15.16 ±5.70 mm on the 28th day. In group II, it ranged from 60.67 ±10.15 mm on the 3rd day (p < 0.05) to 18.67 ±6.81 mm on the 28th day. The time of return to office work in group I was 6.96 ±1.9 weeks and 9.27±1.57 weeks in group II (p < 0.05). The time of return to physical work in group I was 19.85 ±2.79 weeks, and 20 ±3 weeks in group II. Postoperative scar and local complications were statistically less pronounced in group I.
Conclusion. Allografts achieve less postoperative pain, smaller local complications, shorter time necessary to return to work, and better cosmetic effect. However, an allograft is more expensive to perform.

Key words

anterior cruciate ligament, allograft, autograft, ACL reconstruction, knee arthroscopy

References (30)

  1. Ekstrand J. A 94% return to elite level football after ACL surgery: A proof of possibilities with optimal caretaking or a sign of knee abuse? Knee Surg Sports Traumatol Arthrosc. 2011;19(1):1–2. doi:10.1007/s00167-010-1300-4
  2. Goldblatt JP, Fitzsimmons SE, Balk E, Richmond JC. Reconstruction of the anterior cruciate ligament: Meta-analysis of patellar tendon versus hamstring tendon autograft. Arthroscopy. 2005;21(7):791–803.
  3. Fithian DC, Paxton EW, Stone ML, et al. Prospective trial of a treatment algorithm for the management of the anterior cruciate ligament-injured knee. Am J Sports Med. 2005;33(3):335–346.
  4. Zaffagnini S, Marcacci M, Lo Presti M, Giordano G, Iacono F, Neri MP. Prospective and randomized evaluation of ACL reconstruction with three techniques: A clinical and radiographic evaluation at 5 years follow-up. Knee Surg Sports Traumatol Arthrosc. 2006;14(11):1060–1069.
  5. Marumo K, Saito M, Yamagishi T, Fujii K. The “ligamentization” process in human anterior cruciate ligament reconstruction with autogenous patellar and hamstring tendons: A biochemical study. Am J Sports Med. 2005;33(8):1166–1173.
  6. Goradia VK, Rochat MC, Kida M, Grana WA. Natural history of a hamstring tendon autograft used for anterior cruciate ligament reconstruction in a sheep model. Am J Sports Med. 2000;28(1):40–46.
  7. Ibrahim SA, Al-Kussary IM, Al-Misfer AR, Al-Mutairi HQ, Ghafar SA, El Noor TA. Clinical evaluation of arthroscopically assisted anterior cruciate ligament reconstruction: Patellar tendon versus gracilis and semitendinosus autograft. Arthroscopy. 2005;21(4):412–417.
  8. Czamara A, Królikowska A, Szuba Ł, Widuchowski W, Kentel M. ­Single- vs double-bundle anterior cruciate ligament reconstruction: A new aspect of knee assessment during activities involving dynamic knee rotation. J Strength Cond Res. 2015;29(2):489–499. doi:10.1519/JSC.0000000000000638
  9. Królikowska A, Sikorski Ł, Czamara A, Reichert P. Effects of postoperative physiotherapy supervision duration on clinical outcome, speed, and agility in males 8 months after anterior cruciate ligament reconstruction. Med Sci Monit. 2018;24:6823–6831. doi:10.12659/MSM.912162
  10. Eriksson K, von Essen C, Jönhagen S, Barenius B. No risk of arthrofibrosis after acute anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2018;26(10):2875–2882. doi:10.1007/s00167-017-4814-1
  11. Magarian EM, Fleming BC, Harrison SL, Mastrangelo AN, Badger GJ, Murraymm. Delay of 2 or 6 weeks adversely affects the functional outcome of augmented primary repair of the porcine anterior cruciate ligament. Am J Sports Med. 2010;38(12):2528–2534. doi:10.1177/0363546510377416
  12. Królikowska A, Sikorski Ł, Czamara A, Reichert P. Are the knee extensor and flexor muscles isokinetic parameters affected by the duration of postoperative physiotherapy supervision in patients eight months after ACL reconstruction with the use of semitendinosus and gracilis tendons autograft? Acta Bioeng Biomech. 2018;20(3):89–100.
  13. Cooper MT, Kaeding C. Comparison of the hospital cost of autograft versus allograft soft-tissue anterior cruciate ligament reconstructions. Arthroscopy. 2010;26(11):1478–1482. doi:10.1016/j.arthro.2010.04.004
  14. Greis PE, Koch BS, Adams B. Tibialis anterior or posterior allograft anterior cruciate ligament reconstruction versus hamstring autograft reconstruction: An economic analysis in a hospital-based outpatient setting. Arthroscopy. 2012;28(11):1695–1701. doi:10.1016/j.arthro.2012.04.144
  15. Cole DW, Ginn TA, Chen GJ, et al. Cost comparison of anterior cruciate ligament reconstruction: Autograft versus allograft. Arthroscopy. 2005;21(7):786–790.
  16. Nagda SH, Altobelli GG, Bowdry KA, Brewster CE, Lombardo SJ. Cost analysis of outpatient anterior cruciate ligament reconstruction: Autograft versus allograft. Clin Orthop Relat Res. 2010;468(5):1418–1422. doi:10.1007/s11999-009-1178-y
  17. Mangine RE, Noyes FR. Rehabilitation of the allograft reconstruction. J Orthop Sports Phys Ther. 1992;15(6):294–302.
  18. Królikowska A, Czamara A, Kentel M. Does gracilis tendon harvest during ACL reconstruction with a hamstring autograft affect torque of muscles responsible for shin rotation? Med Sci Monit. 2015;21:2084–2093. doi:10.12659/MSM.893930
  19. Czamara A, Markowska I, Królikowska A, Szopa A, Domagalska-Szopa M. Kinematics of rotation in joints of the lower limbs and pelvis during gait: Early results – SB ACLR approach versus DB ACLR approach. Biomed Res Int. 2015;2015:707168. doi:10.1155/2015/707168
  20. Brown MJ, Carter T. ACL allograft: Advantages and when to use. Sports Med Arthrosc Rev. 2018;26(2):75–78. doi:10.1097/JSA.0000000000000194
  21. Królikowska A, Czamara A, Szuba Ł, Reichert P. The effect of longer versus shorter duration of supervised physiotherapy after ACL reconstruction on the vertical jump landing limb symmetry. Biomed Res Int. 2018;23:7519467.
  22. American Association of Tissue Banks (AATB). Standards and regulations. www.aatb.org/standards
  23. Greenberg DD, Robertson M, Vallurupalli S, White RA, Allen WC. Allograft compared with autograft infection rates in primary anterior cruciate ligament reconstruction. J Bone Joint Surg Am. 2010;92(14):2402–2408. doi:10.2106/JBJS.I.00456
  24. de Padua VB, Nascimento PE, Silva SC, de Gusmão Canuto SM, Zuppi GN, de Carvalho SM. Saphenous nerve injury during harvesting of one or two hamstring tendons for anterior cruciate ligament reconstruction. Rev Bras Ortop. 2015;50(5):546–549. doi:10.1016/j.rboe.2015.08.007
  25. Ochiai S, Hagino T, Senga S, Yamashita T, Oda K, Haro H. Injury to infrapatellar branch of saphenous nerve in anterior cruciate ligament reconstruction using vertical skin incision for hamstring harvesting: Risk factors and the influence of treatment outcome. J Orthop Surg Res. 2017;12(1):101. doi:10.1186/s13018-017-0596-x
  26. Grassi A, Perdisa F, Samuelsson K, et al. Association between incision technique for hamstring tendon harvest in anterior cruciate ligament reconstruction and the risk of injury to the infra-patellar branch of the saphenous nerve: A meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2018;26(8):2410–2423.
  27. Suydam SM, Cortes DH, Axe MJ, Snyder-Mackler L, Buchanan TS. Semitendinosus tendon for ACL reconstruction: Regrowth and mechanical property recovery. Orthop J Sports Med. 2017;5(6):2325967117712944. doi:10.1177/2325967117712944
  28. Konrath JM, Vertullo CJ, Kennedy BA, Bush HS, Barrett RS, Lloyd DG. Morphologic characteristics and strength of the hamstring muscles remain altered at 2 years after use of a hamstring tendon graft in anterior cruciate ligament reconstruction. Am J Sports Med. 2016;44(10):2589–2598.
  29. Carey JL, Dunn WR, Dahm DL, Zeger SL, Spindler KP. A systematic review of anterior cruciate ligament reconstruction with autograft compared with allograft. J Bone Joint Surg Am. 2009;91(9):2242–2250. doi:10.2106/JBJS.I.00610
  30. Groot JA, Jonkers FJ, Kievit AJ, Kuijer PP, Hoozemans MJ. Beneficial and limiting factors for return to work following anterior cruciate ligament reconstruction: A retrospective cohort study. Arch Orthop Trauma Surg. 2017;137(2):155–166. doi:10.1007/s00402-016-2594-6