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No clinical difference in outcomes between allograft, autograft for ACL reconstruction
Fresh frozen allograft and hamstring autograft comparison reveals no difference in test scores.
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Investigators conducting an intermediate-term study on the clinical outcomes of patients receiving either autograft or allograft for ACL reconstruction found no major differences between the two patient groups.
“The conclusions drawn from our study are that there are no significant differences in intermediate-term outcomes between autograft hamstring transfer and posterior tibialis allograft reconstruction in terms of both subjective clinical reports as well as KT1000 testing,” said Tarik M. Husain, MD, of Tripler Army Medical Center, Honolulu. “This data may help guide surgeons in choosing allograft as a primary graft option to reduce donor site pain and morbidity, as well as slightly decrease operative times.”
94% follow-up
Husain, who presented data at the American Academy of Orthopaedic Surgeons 73rd Annual Meeting, prospectively followed 100 patients who were randomly assigned to receive a fresh-frozen posterior tibialis allograft or a quadruple hamstring autograft during a three-month trial period. Ninety-four patients were available for follow-up at a median 25 months postop.
The study population consisted of active duty service men and women and their families, closely matched in demographics and pathologies.
“All patients [who] presented to our clinic with an ACL-deficient knee were asked to participate during our trial period,” Husain said. Exclusionary criteria included patients with previous ACL surgery. Those with previous arthroscopy were not necessarily excluded. The population underwent endoscopic ACL reconstruction using identical fixation methods for both graft materials.
The investigators performed preoperative and postoperative testing using KT-1000 arthrometry and standardized outcomes measures, including Single Assessment Numeric Evaluation (SANE), Lysholm, International Knee Documentation (IKDC) and Tegner scores.
No difference in test scores
Husain and colleagues documented 10 failures at the median 25-month follow-up, including seven in the allograft group and three in the autograft group. That difference was deemed insignificant, since two people in the allograft group had failures in contralateral knees, he said.
The investigators also found that the average KT-1000 side-to-side difference in the autograft group went from an average 5.5 mm preoperatively to 0.56 mm postoperatively. In the allograft group, the same measurements went from an average 6 mm preoperatively to 0.85 mm postoperatively. In both groups, the average SANE, IKDC, Lysholm and Tegner scores also improved.
Husain said autograft hamstring grafts are increasing in popularity among surgeons. “Traditionally, allografts have been reserved for revision cases, multi-lesion knee injuries, and older and more in-demand patients,” he said. Drawbacks for each procedure include the potential for disease transmission when using the allograft tissue, as well as donor-site pain and morbidity with the autograft hamstring grafts, he said.
For more information:
- Husain TM, Bottoni CR, Smith EL, et al.. Autograft vs. allograft ACL reconstructions: a prospective randomized clinical study. #016. Presented at the American Academy of Orthopaedic Surgeons 73rd Annual Meeting. March 22-26, 2006. Chicago.