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: Autogenous hamstring harvesting for knee ligament reconstruction is a well-established standard. Minimally invasive posterior hamstring harvest is a simple, efficient, reproducible technique for harvest of the semitendinosus or gracilis tendon or both medial hamstring tendons. A 2- to 3-cm longitudinal incision from the popliteal crease proximally, in line with the semitendinosus tendon, is sufficient. The deep fascia is bluntly penetrated, and the tendon or tendons are identified. Adhesions are dissected. Then, an open tendon stripper is used to release the tendon or tendons proximally; a closed, sharp tendon stripper is used to release the tendon or tendons from the pes. Layered, absorbable skin closure is performed, and the skin is covered with a skin sealant, bolster dressing, and plastic adhesive bandage for 2 weeks.Arthroscopy techniques. 01/2013; 2(3):e299-e301.
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ABSTRACT: Purpose To compare clinical outcomes and revision rates for anterior cruciate ligament (ACL) reconstructions using bone–patellar tendon–bone (BPTB) allografts versus BPTB autografts in a population of patients aged 25 years and younger. Methods A consecutive series of patients 25 years or younger undergoing ACL reconstruction with either a patient-selected BPTB allograft or BPTB autograft fixed with biocomposite interference screws was retrospectively reviewed. Multiligamentous and posterior cruciate ligament tears were excluded. All allografts were from a single source and not chemically processed or irradiated. Two graft-specific rehabilitation programs were used. The primary outcome measure was graft failure. Failure was defined as a subsequent ACL revision surgery, 2+ Lachman test, positive pivot-shift, or side-to-side KT difference of greater than 5 mm. Secondary outcome measures included Cincinnati, Lysholm, and International Knee Documentation Committee (IKDC) activity scores. Results In 81 patients at least 24 months after surgery (28 allografts; 53 autografts), 7 failures were identified: 2 of 28 (7.1%) allografts and 5 of 53 (9.4%) autografts. Mean Cincinnati scores improved from 54.6 and 39.5 (allografts and autografts, respectively) to 86.2 and 85.1. Mean Lysholm scores improved from 60.3 and 44.8 (allografts and autografts, respectively) to 89.9 and 87.0. Average KT differences were 0.59 mm (allograft) and 0.34 mm (autograft group) (P = .58). IKDC activity scores were 2.9 (allografts) and 3.1 (autografts) postoperatively (P = .32). Conclusions Using a patient-choice ACL graft selection program after appropriate counseling and using graft-specific rehabilitation programs, not chemically processed or irradiated BPTB allograft reconstructions have no greater failure rate than autografts in patients aged 25 years and younger at a minimum 2-year follow-up. No significant differences in Cincinnati, Lysholm, and IKDC activity scores were found between these 2 groups. Level of Evidence Level III, retrospective comparative study.Arthroscopy The Journal of Arthroscopic and Related Surgery 01/2014; 30(4):483–491. · 3.10 Impact Factor
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ABSTRACT: There is much literature about differing grafts used in anterior cruciate ligament (ACL) reconstruction. Much of this is of poor quality and of a low evidence base. We review and summarise the literature looking at the four main classes of grafts used in ACL reconstruction; bone-patella tendon-bone, hamstrings, allograft and synthetic grafts. Each graft has the evidence for its use reviewed and then compared, where possible, to the others. We conclude that although there is no clear "best" graft, there are clear differences between the differing graft choices. Surgeon's need to be aware of the evidence behind these differences, in order to have appropriate discussions with their patients, so as to come to an informed choice of graft type to best suit each individual patient and their requirements.World journal of orthopedics. 01/2014; 5(1):23-29.