Current status of graft choice in adults for anterior cruciate ligament reconstruction: a systematic review and meta-analysis

Authors

  • Mahantesh Magadum Department of Orthopedics Surgery, Meenakshi Medical College Hospital and Research Institute, Kanchipuram, Tamil Nadu, India
  • Joshua Smith High Performance Manager, AmaZulu Football Club, South Africa
  • Karl J. New Faculty of Life Science and Education, University of South Wales, CF371DL, United Kingdom

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20240673

Keywords:

ACLR, Autograft, Allograft, Randomized clinical trials, Adults

Abstract

The anterior cruciate ligament (ACL) is a frequently performed surgical procedure in the field of sports medicine, and graft selection is an essential aspect of ACL reconstruction (ACLR) that has been shown to optimize post-operative rehabilitation, facilitate return to full sporting function and reduce the risk of complications. However, there needs to be more agreement regarding optimal graft choice. The present study aims to identify the optimal graft choice in the adult population undergoing ACLR. The current systematic review explores the electronic database of online libraries of academic institutions from 2011 to 30 September 2022 and compared the clinical outcomes of autograft and allograft for ACLR, which provides an evidence-based approach for graft selection. The findings of our present study delineate that ACLR in adult populations with autograft is the most promising choice for ligament tear over allograft based on lower failure rate, reduced complications, and high cost-effectiveness. However, there was no significant difference in overall IKDC, pivot shift, Lachman test, and Tegner activity. This critical analysis recommends that for an adult population, ACLR with autograft can provide better clinical results than an allograft, but further studies carried out about other parameters affecting the long-term stability, quick return, and physical therapy adopted outside the supervision of the respective surgeon would be required.

References

Domnick C, Raschke MJ, Herbort M. Biomechanics of the anterior cruciate ligament: Physiology, rupture and reconstruction techniques. World J Orthop. 2016;7(2):82.

Kaeding CC, Léger-St-Jean B, Magnussen RA. Epidemiology and Diagnosis of Anterior Cruciate Ligament Injuries. Clin Sports Med. 2017;36(1):1-8.

Sanders TL, Maradit Kremers H, Bryan AJ, Larson DR, Dahm DL, Levy BA, et al. Incidence of Anterior Cruciate Ligament Tears and Reconstruction: A 21-Year Population-Based Study. Am J Sports Med. 2016;44(6):1502-7.

Negahi Shirazi A, Chrzanowski W, Khademhosseini A, Dehghani F. Anterior Cruciate Ligament: Structure, Injuries and Regenerative Treatments. In: Advances in Experimental Medicine and Biology. 2015;161-86.

Krause M, Freudenthaler F, Frosch KH, Achtnich A, Petersen W, Akoto R. Operative Versus Conservative Treatment of Anterior Cruciate Ligament Rupture. Dtsch Arztebl Int. 2018;115(51-52):855-88.

Hardy A, Casabianca L, Andrieu K, Baverel L, Noailles T, Junior French Arthroscopy Society. Complications following harvesting of patellar tendon or hamstring tendon grafts for anterior cruciate ligament reconstruction: Systematic review of literature. Orthop Traumatol Surg Res. 2017;103(8S):S245-8.

Goetz G, De Villiers C, Sadoghi P, Geiger-Gritsch S. Allograft for Anterior Cruciate Ligament Reconstruction (ACLR): A Systematic Review and Meta-Analysis of Long-Term Comparative Effectiveness and Safety. Results of a Health Technology Assessment. Arthrosc Sport Med Rehabil. 2020;2(6):e873-91.

Noh JH, Yi SR, Song SJ, Kim SW, Kim W. Comparison between hamstring autograft and free tendon Achilles allograft: minimum 2-year follow-up after anterior cruciate ligament reconstruction using EndoButton and Intrafix. Knee Surg Sport Traumatol Arthrosc. 2011;19(5):816-22.

Sun K, Zhang J, Wang Y, Xia C, Zhang C, Yu T, et al. Arthroscopic Anterior Cruciate Ligament Reconstruction With at Least 2.5 Years’ Follow-up Comparing Hamstring Tendon Autograft and Irradiated Allograft. Arthrosc J Arthrosc Relat Surg. 2011;27(9):1195-202.

Lawhorn KW, Howell SM, Traina SM, Gottlieb JE, Meade TD, Freedberg HI. The effect of graft tissue on anterior cruciate ligament outcomes: A multicenter, prospective, randomized controlled trial comparing autograft hamstrings with fresh-frozen anterior tibialis allograft. Arthrosc J Arthrosc Relat Surg. 2012;28(8):1079-86.

Bi H yong, Sun X jiang, Mu H jie, Zhang G dong, Yang Y. Prospective comparative study of arthroscopic anterior cruciate ligament construction with autograft and allograft. Zhonghua Wai Ke Za Zhi. 2013;51(1):44-8.

Bottoni CR, Smith EL, Shaha J, Shaha SS, Raybin SG, Tokish JM, et al. Autograft Versus Allograft Anterior Cruciate Ligament Reconstruction: A Prospective, Randomized Clinical Study With a Minimum 10-Year Follow-up. Am J Sport Med. 2015;43(10):2501-9.

Jia YH, Sun PF. Comparison of clinical outcome of autograft and allograft reconstruction for anterior cruciate ligament tears. Chin Med J (Engl). 2015;128(23):3163-6.

Li J, Wang J, Li Y, Shao D, You X, Shen Y. A Prospective Randomized Study of Anterior Cruciate Ligament Reconstruction With Autograft, γ-Irradiated Allograft, and Hybrid Graft. Arthrosc J Arthrosc Relat Surg. 2015;31(7):1296-302.

Yoo SH, Song EK, Shin YR, Kim SK, Seon JK. Comparison of clinical outcomes and second-look arthroscopic findings after ACL reconstruction using a hamstring autograft or a tibialis allograft. Knee Surgery, Sport Traumatol Arthrosc. 2017;25(4):1290-7.

Sun R, Chen B cheng, Wang F, Wang X feng, Chen J qing. Prospective randomized comparison of knee stability and joint degeneration for double- and single-bundle ACL reconstruction. Knee Surg Sports Traumatol Arthrosc. 2015;23(4):1171-8.

Oro FB, Sikka RS, Wolters B, Graver R, Boyd JL, Nelson B, et al. Autograft Versus Allograft: An Economic Cost Comparison of Anterior Cruciate Ligament Reconstruction. Arthrosc J Arthrosc Relat Surg. 2011;27(9):1219-25.

Genuario JW, Faucett SC, Boublik M, Schlegel TF. A Cost-Effectiveness Analysis Comparing 3 Anterior Cruciate Ligament Graft Types. Am J Sports Med. 2012;40(2):307-14.

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. Arthrosc J Arthrosc Relat Surg. 2012;28(11):1695-701.

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 Jt Surgery-American Vol. 2009;91(9):2242-50.

Greenberg DD, Robertson M, Vallurupalli S, White RA, Allen WC. Allograft Compared with Autograft Infection Rates in Primary Anterior Cruciate Ligament Reconstruction. J Bone Jt Surgery-American Vol. 2010;92(14):2402-8.

Cole DW, Ginn TA, Chen GJ, Smith BP, Curl WW, Martin DF, et al. Cost Comparison of Anterior Cruciate Ligament Reconstruction: Autograft Versus Allograft. Arthrosc J Arthrosc Relat Surg. 2005;21(7):786-90.

Jackson DW, Corsetti J, Simon TM. Biologic incorporation of allograft anterior cruciate ligament replacements. Clin Orthop Rel Res. 1996;(324):126-33.

Kaeding CC, Aros B, Pedroza A, Pifel E, Amendola A, Andrish JT, et al. Allograft versus autograft anterior cruciate ligament reconstruction: Predictors of failure from a moon prospective longitudinal cohort. Sports Health. 2011;3(1):73-81.

Niu Y, Niu C, Wang X, Liu J, Cao P, Wang F, et al. Improved ACL reconstruction outcome using double-layer BPTB allograft compared to that using four-strand hamstring tendon allograft. Knee. 2016;23(6):1093-7.

Gifstad T, Sole A, Strand T, Uppheim G, Grøntvedt T, Drogset JO. Long-term follow-up of patellar tendon grafts or hamstring tendon grafts in endoscopic ACL reconstructions. Knee Surgery, Sport Traumatol Arthrosc. 2013;21(3):576-83.

Kraeutler MJ, Bravman JT, McCarty EC. Bone–Patellar Tendon-Bone Autograft Versus Allograft in Outcomes of Anterior Cruciate Ligament Reconstruction. Am J Sports Med. 2013;41(10):2439-48.

Bizzini M, Gorelick M, Munzinger U, Drobny T. Joint Laxity and Isokinetic Thigh Muscle Strength Characteristics After Anterior Cruciate Ligament Reconstruction. Clin J Sport Med. 2006;16(1):4-9.

Cooper MT, Kaeding C. Comparison of the Hospital Cost of Autograft Versus Allograft Soft-Tissue Anterior Cruciate Ligament Reconstructions. Arthrosc J Arthrosc Relat Surg. 2010;26(11):1478-82.

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Published

2024-03-08

Issue

Section

Meta-Analysis