Clinical Outcomes After Anterior Cruciate Ligament Reconstruction: A Meta-Analysis of Autograft Versus Allograft Tissue

Abstract

Background:Clinical outcomes of autograft and allograft anterior cruciate ligament (ACL) reconstructions are mixed, with some reports of excellent to good outcomes and other reports of early graft failure or significant donor site morbidity.Objective:To determine if there is a difference in functional outcomes, failure rates, and stability between autograft and allograft ACL reconstructions.Data Sources:Medline, Cochrane Central Register of Controlled Trials (Evidence Based Medicine Reviews Collection), Cochrane Database of Systematic Reviews, Web of Science, CINAHL, and SPORTDiscus were searched for articles on ACL reconstruction. Abstracts from annual meetings of the American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America were searched for relevant studies.Study Selection:Inclusion criteria for studies were as follows: primary unilateral ACL injuries, mean patient age less than 41 years, and follow-up for at least 24 months postreconstruction. Exclusion criteria for studies included the following: skeletally immature patients, multiligament injuries, and publication dates before 1990.Data Extraction:Joint stability measures included Lachman test, pivot-shift test, KT-1000 arthrometer assessment, and frequency of graft failures. Functional outcome measures included Tegner activity scores, Cincinnati knee scores, Lysholm scores, and IKDC (International Knee Documentation Committee) total scores.Results:More than 5000 studies were identified. After full text review of 576 studies, 56 were included, of which only 1 directly compared autograft and allograft reconstruction. Allograft ACL reconstructions were more lax when assessed by the KT-1000 arthrometer. For all other outcome measures, there was no statistically significant difference between autograft and allograft ACL reconstruction. For all outcome measures, there was strong evidence of statistical heterogeneity between studies. The sample size necessary for a randomized clinical trial to detect a difference between autograft and allograft reconstruction varied, depending on the outcome.Conclusions:With the current literature, only KT-1000 arthrometer assessment demonstrated more laxity with allograft reconstruction. A randomized clinical trial directly comparing allograft to autograft ACL reconstruction is warranted, but a multicenter study would be required to obtain an adequate sample size.

Allograft versus autograft for anterior cruciate ligament reconstruction: an up-to-date meta-analysis of prospective studies

“…While no statistically IKDC International Knee Documentation Committee; BPTB Bone-patellar tendon-bone; NA Not available significant differences were found on all the other outcomes between autograft and allograft ACL reconstruction. Although this meta-analysis included 56 studies, none of the eligible studies was a prospective comparative study (allograft versus autograft) [16]. As to the other three systematic reviews and meta-analyses, when those studies involving the irradiated allografts were excluded for analysis, their findings were consistent with the results of our study [14,15,17].…”

“…However, the findings of this study were compromised by the selection bias and questionable statistical methods. Another meta-analysis found that patients with allografts reconstruction might have increased joint laxity as measured by the KT-1000 arthrometer [16]. While no statistically IKDC International Knee Documentation Committee; BPTB Bone-patellar tendon-bone; NA Not available significant differences were found on all the other outcomes between autograft and allograft ACL reconstruction.…”

“…However, there is still considerable controversy regarding the use of allografts versus autografts in ACL reconstruction, because most of the publications are low-quality studies or different graft procurement and secondary sterilization techniques have been used in those studies. Until now, five previous studies systematically reviewed the clinical outcomes of allograft versus autograft for ACL reconstruction [13][14][15][16][17]. However, all the five systematic reviews were conducted over three years ago and the findings of those studies were compromised by the limited availability of high-quality trials.…”

Is There a Higher Failure Rate of Allografts Compared With Autografts in Anterior Cruciate Ligament Reconstruction: A Systematic Review of Overlapping Meta-analyses

“…The second systematic review evaluated only boneepatellar tendonebone grafts, and the outcomes of interest did not include patient-oriented outcomes or instrumented laxity." Foster 17 None NA Tibor 21 Prodromos, Krych "Two meta-analyses comparing autograft and allograft results have been reported, one with inconclusive results and another that had significant methodological limitations." Hu 18 Prodromos, Krych, Carey, Foster, Tibor "The first meta-analysis .…”

Outcome Analysis of Anterior Cruciate Ligament Reconstruction Fixed by Varying Modalities: A Retrospective and Prospective StudyOutcome Analysis of Anterior Cruciate Ligament Reconstruction Fixed by Varying Modalities: A Retrospective and Prospective Study

“…William G Clancy, Jr Devon A. Nelson, Bruce Reider and Rajesh G Narechania (1982) had 50 patients in their study, 88% of their cases the mode of injury was sports especially football, as popular in western world, contrary to our study. [12] Li et al [13] conducted a study on 25 patients with ACL deficiency and treated with arthroscopy, ranging in age from 17-43 years with an average of 25.8 years. There were 17 patients (68%) caused by sports injury, 24% patients caused by accidental falling and 8% patients caused by traffic injury.…”