Comparative Study of Treatment Results for Anterior Cruciate Ligament Reconstruction With Allograft and Auto Graft

Moghtadaee, Mehdi; Farahini, Hossein; Jahansouz, Ali; Mokhtari, Tahmineh; Nabi, Razieh

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Moghtadaee M, Farahini H, Jahansouz A, Mokhtari T, Nabi R. Comparative Study of Treatment Results for Anterior Cruciate Ligament Reconstruction With Allograft and Auto Graft. JROS 2014; 1 (3)
URL: http://jros.iums.ac.ir/article-1-126-en.html

Comparative Study of Treatment Results for Anterior Cruciate Ligament Reconstruction With Allograft and Auto Graft

Mehdi Moghtadaee¹

, Hossein Farahini¹

, Ali Jahansouz²

, Tahmineh Mokhtari³

, Razieh Nabi¹

1- Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, IR Iran
2- Clinical Fellow of the Knee Surgery, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, IR Iran
3- Tehran University of Medical Sciences, Tehran, IR Iran

Keywords: ACL Reconstruction, IKDC Score, Lysholm Score

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Abstract

© 0, Shafa Orthopedic Journal. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.

1. Background

Anterior cruciate ligament (ACL) injury is a common knee ligament injury with unknown exact incidence. The ACL is the main stabilizer in prevention of anterior tibial translation (translocation) and is responsible for 85% of limitation for anterior Tran’s transfer of tibia in regard to femur. It has also role in tibial rotation limitation and varusvalgus stability in full extension (1). The ACL reconstruction has become one of the most common procedures in the knee surgery in recent decades. There are two major source of harvested ligament, auto-graft (from the patient) and allograft (an organ donor) resources (2). The first choice of graft selection in reconstruction is auto graft, but allograft and synthetic grafts are also available. Fewer in-flammatory reactions and viral infection transmission are from the advantages of auto graft use, and on the other side, no morbidity in donor site, smaller surgical incisions, shorter operation and tourniquet time are of the advantages of the allograft (3-5). Numerous studies have been conducted to compare the results of allograft and auto-graft with different and sometimes contradictory results (6-9).

2. Objectives

3. Materials and Methods

The study was approved by our center ethics board. All patients with isolated injury of ACL undergoing arthroscopic ACL reconstruction using auto graft or allograft from 2008 to 2012 with minimum 12 months follows up were enrolled. We reviewed the medical records, demo-graphic data, and imaging files and invited the patients for the last follow up. In last visit we evaluated the operated knee using range of motion (ROM), Lachman test (10), pivot-shift test (11), International Knee Documentation Committee (IKDC) form and Lysholm score.

The IKDC has developed a standard assessment tool for knee injuries. It includes 18 items: 7 regards symptoms, 2 general function, and 9 sport activities. It is a 100-point scale with 100 representing the best possible score and highest knee function (12). The Lysholm scale is based solely on the subjective evaluation of function and has multiple scores with total sum of 100 (12). All data was collected and analyzed by Statistical Package for Social Sciences (SPSS, Chicago, IL, USA) version 16. T-test was used for comparison of means in two groups and a P value of less than 0.05 was considered statistically significant.

4. Results

Total numbers of the patients was 62 but 58 were attended in clinic for final follow up. Twenty patients (34.48%) had ACL reconstruction with allograft and the remaining 38 cases (65.52%) by auto graft. Mean age in allograft group was 27.45(24-38) years, and for auto graft group it was 30.21(19-39). In allograft group 19 (95%) patients were male and one (5%) was female. In auto graft group 36 (94.7%) patients were male and 2 (5.3%) female. Both groups were similar in regard with sex. Fifteen patients (25.86%) in allograft group have had the reconstruction in the right side and 5 patients (8.62%) in the left side. Similarly, in auto graft group, 27 patients (46.55%) have had the reconstruction in right side and 11 patients (18.96%) in the left side. In auto graft group the mean ROM was 123.34 degrees while it was 127.56 degrees in allograft group. There was no significant statistical difference between the two groups (P = 0.128). The Lachman test for all patients, in both allograft and auto graft, showed a negative result. The Pivot shift test was carried out for all patients in allograft and auto graft groups and yielded negative results. The Lysholm scores for allograft, showed that 2 patients (3.44%) had poor results, 13 (22.41%) good and 5 (8.62%) excellent results, while in auto graft group 4 (6.89%) had poor results, 23 (39.65%) good and the remaining 11 (18.96%) had excellent results.

The achieved scores of IKDC in allograft and auto graft groups were 88.7 ± 3.41 and 89.2 ± 4.29 respectively, and there was no statistical significant difference between the two groups (P = 0.341).

5. Discussion

The ACL reconstruction is known as a gold standard for treatment of ACL rupture and its use is estimated about 100,000 cases per year in the USA (1). Although ACL reconstruction is very common by both allograft and auto graft, there is no consensus which one is the preferred method (6, 7, 13-15). According to the study of Mayr et al. (16) who used patellar tendon as allograft and auto graft for the ACL reconstruction, there is no statistical difference of Lysholm and IKDC scores in the two groups (16). Study by Guo et al. (17) showed no significant difference in the methods of auto graft and two types of allograft including Fresh Frozen and Y-Irradiated, in ACL reconstruction (three groups), using Lysholm knee scoring system (17). The same results were reported by Barrett et al. (8) for both allograft and auto graft with patellar tendon in ACL reconstruction in patients older than 40 years using Lysholm scores. Also in a study by Noh et al. (18) Lysholm knee score and IKDC score for patients who had hamstring auto graft and free tendon Achilles allograft operations were good and excellent, with same results (18). On the other hand, Mehta et al. (19) studied revision rate after ACL reconstruction into two groups of allograft and auto graft/bone-patella tendon-bone and reported higher rate of revision when allograft bone-patella ten-don-bone was used for reconstruction (19). Mehta concluded that surgeons should be aware of the higher revision rate with allograft ACL reconstruction when counseling patients on graft options (19). Poehling et al. (20) compared five-year follow-ups of patients undergoing ACL reconstruction with allograft versus auto graft (20). Both groups achieved similar long-term outcomes. Their study showed that, the allograft patients reported less pain at 1 and 6 weeks after surgery, better function at 1 week, 3 months, and 1 year, and fewer activity limitations throughout the follow-up period (20). According to the results of current study, we found no statistically significant difference between the two groups who under-went ACL reconstruction using allograft or auto graft in regard to ROM, Lachman and pivot shift tests, Lysholm and IKDC scores. Our findings were in accordance to the results of other studies in the literature i.e. (17-20). There were some limitations for our study: it was retrospective and with limited number of patients. Prospective studies with larger samples are recommended to compare the different aspects of allograft and auto graft in ACL re-construction.

The current study showed no significant difference in the achieved results through utilization of allograft and auto graft in ACL reconstruction methods.

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Subject: Knee surgery
Received: 2019/09/9 | Published: 2014/08/15

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