Autograft or allograft for reconstruction of anterior cruciate ligament: a health economics perspective

Mistry, Hema; Metcalfe, Andrew; Colquitt, Jill L; Loveman, Emma; Smith, Nick; Royle, Pamela; Waugh, Norman

doi:10.1007/s00167-019-05436-z

Cited by 47 publications

(42 citation statements)

References 43 publications

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“…In human medicine, placement of intra‐articular autografts is considered the gold standard for anterior cruciate ligament repair, although allograft placement is a viable alternative and continues to be researched . In veterinary medicine, intra‐articular repairs were historically more commonly performed and preferred in large breeds dogs with acute CCL injuries but have fallen out of favor because of inferior clinical outcomes .…”

Section: Introductionmentioning

confidence: 99%

Long‐term arthroscopic assessment of intra‐articular allografts for treatment of spontaneous cranial cruciate ligament rupture in the dog

Biskup

Conzemius

2020

Veterinary Surgery

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Objective: To assess the 12-month survival of intra-articular, decellularized allografts for the treatment of cranial cruciate ligament disease (CCLD) in dogs. Study design: Prospective case series.Animals: Twenty client-owned dogs with spontaneous CCL rupture. Methods: Affected stifles were treated solely by implantation of an intra-articular, decellularized, deep digital flexor tendon allograft. Functional outcome was evaluated at baseline and at 6 and 12 months after surgery with the Liverpool Osteoarthritis for Dogs questionnaire and force platform gait analysis. At 12 months after surgery, dogs underwent arthroscopy to visually assess the allografts.Results: Scores on owner questionnaires (improved 62.5%; P = .005) and ground reaction forces (improved 34.4%; P = .017) were improved in all dogs 12 months after surgery. Dogs with an intact graft (IG) were more likely to have a successful outcome compared with dogs with a torn graft (P = .011).According to arthroscopy, 45% of grafts seemed to survive at 12 months after surgery. Conclusion: About half of intra-articular allografts survived 12 months after implantation in CCL-deficient stifles. Dogs with IG had successful outcomes at 12 months after surgery according to assessment by force platform gait analysis. Clinical significance: These results preclude immediate clinical application but provide evidence to justify further investigation of intra-articular grafts as a repair option for CLLD.

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Section: Introductionmentioning

confidence: 99%

Long‐term arthroscopic assessment of intra‐articular allografts for treatment of spontaneous cranial cruciate ligament rupture in the dog

Biskup

Conzemius

2020

Veterinary Surgery

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“…For allograft, factors such as availability, cost [ 22 ], and the potential for disease transmission can be the reasons for the decreased use in EMDN. A recent systemic review indicates that autografts lead to better outcomes, are more cost-effective, and should be the first choice [ 23 ]. Using allograft does however save time and avoids the potential for donor site morbidity [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

The management of acute knee dislocations: A global survey of orthopaedic surgeons’ strategies

Venter

Dey

Khanduja

et al. 2021

SICOT-J

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Purpose: Great variety and controversies surround the management strategies of acute multiligament knee injuries (aMKLIs) and no established guidelines exist for resource-limited practices. The aim of this study was to compare the management approach of acute knee dislocations (AKDs) by orthopedic surgeons from nations with different economic status. Methods: This descriptive cross-sectional scenario-based survey compares different management strategies for aMLKIs of surgeons in developed economic nations (DEN) and emerging markets and developing nations (EMDN). The main areas of focus were operative versus non-operative management, timing and staging of surgery, graft choice and vascular assessment strategies. The members of the Societe Internationale de Chirurgie Orthopedique et de Traumatologie (SICOT) were approached to participate and information was collected regarding their demographics, experience, hospital setting and management strategies of aMLKIs. These were analyzed after categorizing participants into DEN and EMDN based on the gross domestic product (GDP) per capita. Results: One-hundred and thirty-eight orthopedic surgeons from 47 countries participated in this study, 67 from DEN and 71 (51.4%) from EMDN. DEN surgeons had more years of experience and were older (p < 0.05). Surgeons from EMDN mostly worked in public sector hospitals, were general orthopedic surgeons and treated patients from a low-income background. They preferred conservative management and delayed reconstruction with autograft (p < 0.05) if surgery was necessary. Surgeons from DEN favored early, single stage arthroscopic ligament reconstruction. Selective Computerized Tomography Angiography (CTA) was the most preferred choice of arterial examination for both groups. Significantly more EMDN surgeons preferred clinical examination (p < 0.05) and duplex doppler scanning (p < 0.05) compared to DEN surgeons. More surgeons from EMDN did not have access to a physiotherapist for their patients. Conclusions: Treatment of aMLKIs vary significantly based on the economic status of the country. Surgeons from DEN prefer early, single stage arthroscopic ligament reconstruction, while conservative management is favored in EMDN. Ligament surgery in EMDN is often delayed and staged. EMDN respondents utilize duplex doppler scanning and clinical examination more readily in their vascular assessment of aMLKIs. These findings highlight very distinct approaches to MLKIs in low-resource settings which are often neglected when guidelines are generated.

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“…The current knowledge in the use of allograft and autograft is that studies verify different outcomes dependent on location. In the cranioplasties, allograft has been shown to be superior [25]; in anterior crucial ligament (ACL), autograft showed better effect on bone formation [26], whereas in the posterior crucial ligament (PCL), the results are equal between the 2 grafts [27,28]. Hence, when comparing results for clinical implementation, using the correct graft is essential for the correct comparisons.…”

Section: Discussionmentioning

confidence: 99%

“…When facing a clinical implementation, it is furthermore required to focus on an economic and patient-related outcome. The cost of using autograft is reported to be lower in, for example, ACL surgeries [26], but the possible side effect in harvesting autograft is associated with rather severe side effects [3]. This gives the dilemma for choosing methodology when harvesting autograft, but it even further requests the need for another substitute to replace both graft materials.…”

Section: Discussionmentioning

confidence: 99%

Comparisons of Efficacy between Autograft and Allograft on Defect Repair In Vivo in Normal and Osteoporotic Rats

Dreyer

Rasmussen

Pedersen

et al. 2020

BioMed Research International

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Introduction. In the field of orthopaedic surgery, the use of osteogenic material in larger defects is essential. Autograft and allograft are both known methods, and autograft is believed to be the best choice. But autograft is associated with additional invasive procedures which can prove difficult in fragile patients and can cause local side effect after bone harvest. For feasible purposes, the use of allograft is hereby rising and comparing efficacies, and the differences between autograft and allograft are essential for the clinical outcome for the patients. Method. 24 female Norwegian brown rats were included, 12 normal rats and 12 induced with osteoporosis (OP). OP inducement was verified in vivo by bone volume fraction (BV/TV) at 90 days after ovariectomy (OVX). The primary surgery in each rat consisted of a 2.5×3 mm hole in the proximal tibia, bilaterally. Autograft and allograft were randomly allocated in the right and left tibia. After an observation of 21 days, the rats were sacrificed. Tibia samples were harvested, micro-CT scanned for bone inducement and microarchitectural properties, and then embedded for histology. Results. The OP induction was verified three months after the OVX by a reduction of 68.5% in the trabecular bone BV/TV compared to normal bone. Microarchitectural analysis and histology showed no significant differences in the bone-forming capabilities between autograft and allograft in normal or osteoporotic bone after 3 weeks. Conclusion. This study did not demonstrate any difference between autograft and allograft in a normal or osteoporotic rat tibial defect model after 21 days, suggesting allograft is a good alternative to autograft.

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Autograft or allograft for reconstruction of anterior cruciate ligament: a health economics perspective

Cited by 47 publications

References 43 publications

Long‐term arthroscopic assessment of intra‐articular allografts for treatment of spontaneous cranial cruciate ligament rupture in the dog

Long‐term arthroscopic assessment of intra‐articular allografts for treatment of spontaneous cranial cruciate ligament rupture in the dog

The management of acute knee dislocations: A global survey of orthopaedic surgeons’ strategies

Comparisons of Efficacy between Autograft and Allograft on Defect Repair In Vivo in Normal and Osteoporotic Rats

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