Arthroscopic Anterior Cruciate Ligament Reconstruction With at Least 2.5 Years' Follow-up Comparing Hamstring Tendon Autograft and Irradiated Allograft
ABSTRACT To compare the clinical outcomes of arthroscopic anterior cruciate ligament (ACL) reconstruction with hamstring tendon autograft versus irradiated allograft.
All irradiated hamstring tendon allografts (gracilis and semitendinosus), which were sterilized with 2.5 Mrad of irradiation before distribution, were obtained from a single certified tissue bank. A total of 78 patients undergoing arthroscopic ACL reconstruction were prospectively randomized consecutively into 1 of 2 groups: autograft and irradiated allograft. The same surgical technique was used in all operations, which were performed by the same senior surgeon. Before surgery and at a mean of 42.2 months of follow-up, patients were evaluated by the same observer according to objective and subjective clinical evaluations.
Of the patients, 67 (36 in autograft group and 31 in irradiated allograft group) were available for full evaluation. When the irradiated allograft group was compared with the autograft group at the final follow-up by the Lachman test, anterior drawer test, pivot-shift test, and KT-2000 arthrometer (MEDmetric, San Diego, CA) assessment, statistically significant differences were found (P = .00011, P = .00016, P = .008, and P = .00021, respectively). Most importantly, 86.1% of patients in the autograft group and only 32.3% in the irradiated allograft group had a side-to-side difference of less than 3 mm according to KT-2000 assessment. The rate of laxity (side-to-side difference >5 mm) with irradiated allograft (32.3%) was higher than that with autograft (8.3%). The anterior and rotational stabilities decreased significantly in the irradiated allograft group. According to the overall International Knee Documentation Committee rating, functional and subjective evaluations, and activity level testing, no statistically significant differences were found between the 2 groups. However, patients in the irradiated allograft group had a shorter operative time and a longer duration of postoperative fever. When the patients had a fever, the laboratory examination findings of all patients were almost normal (white blood cell count, normal; erythrocyte sedimentation rate, 8 to 20 mm/h; and C-reactive protein level, 4 to 11 mg/L).
The clinical outcome of ACL reconstruction with hamstring tendon autograft was satisfactory, whereas the difference in instrumented laxity between the 2 groups was significant and the difference in functional test results was not significant.
Level II, prospective comparative study.
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ABSTRACT: The aim of this study was to predict the hamstring graft sizes prior to anterior cruciate ligament reconstruction surgery in adults by using preoperative magnetic resonance imaging (MRI). Fifty-one patients with anterior cruciate ligament rupture were prospectively evaluated. Diameter and cross-sectional areas of the gracilis and the semitendinosus tendons at two different levels were measured separately by preoperative MRI. In surgery, harvested gracilis and semitendinosus tendons were measured individually (2-stranded) and together (4-stranded) by using a graft sizing block. Radiological and operative sizes of the grafts were compared by Pearson's correlation test. ROC analysis was done to determine a possible cutoff value for the preoperative measurements. There were statistically significant correlations between the MR cross-sectional areas of gracilis, semitendinosus, gracilis + semitendinosus and intraoperative graft sizes of 2-stranded gracilis, 2-stranded semitendinosus and 4-stranded gracilis + semitendinosus tendons [P < 0.05]. No significant correlation was observed between the MR diameters of the gracilis, semitendinosus, gracilis + semitendinosus tendons and intraoperative graft sizes of 2-stranded gracilis, 2-stranded semitendinosus and 4-stranded gracilis + semitendinosus tendons [n.s]. Cross-sectional areas of the hamstring tendons in MR images can be used to estimate the sizes of hamstring grafts prior to anterior cruciate ligament reconstruction surgery which may be very helpful to predict possible graft insufficiencies and take precautions if needed. Level IV.Knee Surgery Sports Traumatology Arthroscopy 11/2011; 20(7):1293-7. DOI:10.1007/s00167-011-1770-z · 2.84 Impact Factor
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ABSTRACT: Background: The effect of low-dose gamma irradiation on healing of soft tissue allografts remains largely unknown. Hypothesis: The authors hypothesized that soft tissue allograft healing to bone would be delayed compared with that of autograft tissue and that low-dose (1.2 Mrad) gamma irradiation would not affect the healing response of allograft tissue after anterior cruciate ligament (ACL) reconstruction. Study Design: Controlled laboratory study. Methods: Forty-eight New Zealand White rabbits underwent bilateral ACL reconstructions with semitendinosus tendon graft. Sixteen rabbits were reconstructed with autografts and the remainder with allografts. The 32 allograft rabbits each received 1 irradiated allograft (1.2 Mrad), with the contralateral leg receiving a nonirradiated allograft. Animals were euthanized at 2 weeks or 8 weeks postoperatively. Tensile stiffness, maximum load, and displacement at maximum load were measured. Tibial and femoral segments were sectioned perpendicular to the tunnel axis allowing for histologic and histomorphometric analyses at the tendon-bone interface. Results: There were no significant differences between the maximum load or stiffness values among all groups at 8 weeks. At 2 weeks, autograft exhibited significantly (P < .01) lower maximum load than did the nonirradiated grafts. Regarding histology, at both 2- and 8-week time points, autograft tendon displayed more advanced degenerative and remodeling processes in comparison with irradiated allograft and nonirradiated allograft. Discussion: The maximum load and stiffness of a healing tendon allograft in ACL reconstruction appear to be unaltered by low-dose (1.2 Mrad) irradiation. At 8 weeks, there were no biomechanical differences in tendon-bone healing of allografts when compared with autograft controls. Histologic analyses suggested a faster remodeling response in autograft specimens in comparison with allografts at both time points.The American Journal of Sports Medicine 02/2012; 40(8):1789-98. DOI:10.1177/0363546511435637 · 4.70 Impact Factor
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ABSTRACT: There is little information regarding the incremental changes in the postoperative laxity of patellar tendon (PT) autografts versus allografts in anterior cruciate ligament (ACL) reconstruction. (1) There would be no significant increase in laxity between 6 weeks and 1 year postoperatively with PT autografts or allografts, (2) there would be no significant difference in laxity between PT autografts and allografts, (3) there would not be a significant difference in laxity between nonirradiated and low dose-irradiated PT allograft tissues, and (4) the physical examination findings would correlate with the instrumented laxity outcomes. Cohort study; Level of evidence, 3. A retrospective review of 238 ACL-deficient patients who underwent single-incision endoscopic ACL reconstruction with a PT autograft (n = 132) or allograft (n = 106; 58 irradiated and 48 nonirradiated) from a single surgeon was made looking at data from preoperatively and from 6 weeks to 1 year postoperatively. The objective measurements of ligament integrity included range of motion, Lachman test, pivot-shift test, and KT-1000 arthrometer instrumented laxity examination. Failure was defined as arthrometric side-to-side differences (maximum manual difference) ≥3 mm or a positive pivot shift. Statistical significance was defined as P < .05. There were no differences in postoperative examination findings or instrumented laxity between PT autografts and allografts (irradiated or nonirradiated) in either subgroup. The postoperative improvement based on the Lachman examination, pivot-shift test, and arthrometric data in all study groups was significant (P < .001) in 98% (autograft: n = 130; allograft: n = 104) of patients, and arthrometric failure correlated with failure by physical examination. There was no significant change in graft laxity, as measured by KT-1000 arthrometer, from 6 weeks to 1 year postoperatively for 98% of patients. Finally, there was no statistical correlation in instrumented laxity results for either the autograft or allograft group with reference to age, gender, concurrent meniscectomy, meniscal repairs, interval to surgery, postoperative patellar pain, time to surgery, or irradiated versus nonirradiated allograft. Laxity is not increased after the initial 6 weeks for either PT allograft or autograft constructs during the first postoperative year. There was no correlation between age, gender, concomitant injury, interval to surgery, or radiation of the graft with instrumented laxity results. Furthermore, our arthrometric data paralleled our clinical findings of stability at follow-up.The American Journal of Sports Medicine 03/2012; 40(6):1347-54. DOI:10.1177/0363546512440685 · 4.70 Impact Factor