Does the Graft Source Really Matter in the Outcome of Patients Undergoing Anterior Cruciate Ligament Reconstruction?

Foster, Timothy E.; Wolfe, Brian; Ryan, Scott P.; Silvestri, Lorenzo; Kaye, Elizabeth Krall

doi:10.1177/0363546509356530

Cited by 142 publications

(128 citation statements)

References 48 publications

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“…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]. This study has several limitations.…”

Section: Discussionsupporting

confidence: 72%

“…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.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2012

International Orthopaedics (SICOT)

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Purpose Although a large number of anterior cruciate ligament (ACL) reconstructions are performed annually, there remains a considerable amount of controversy over whether an autograft or an allograft should be used. The aim of this meta-analysis was to compare the clinical outcomes of allograft and autograft in primary ACL reconstruction. Methods The authors systematically searched electronic databases to identify prospective studies which compared allografts with autografts for primary ACL reconstruction. The results of the eligible studies were analysed in terms of instrumented laxity measurements, Lachman test, Pivot Shift test, objective International Knee Documentation Committee (IKDC) Scores, Lysholm Scores, Tegner Scores, and clinical failures. Study quality was assessed and relevant data were extracted independently by two reviewers. A random effect model was used to pool the data. Statistical heterogeneity between trials was evaluated by the chi-square and I-square tests. Results Nine studies, with 410 patients in the autograft and 408 patients in the allograft group, met the inclusion criteria. Five studies compared bone-patellar tendon-bone (BPTB) grafts, and four compared soft-tissue grafts. Four studies were randomized controlled trials, and five were prospective cohort studies. The results of the meta-analysis showed that there were no significant differences between allograft and autograft on all the outcomes in terms of instrumented laxity measurements (P 00.59), Lachman test (P 00.41), Pivot

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Section: Discussionsupporting

confidence: 72%

Section: Introductionmentioning

confidence: 99%

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

et al. 2012

International Orthopaedics (SICOT)

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“…Kleipool et al [36] again compared small numbers 26 autograft vs 36 BPTB with 46 mo follow-up and reported 85% IKDC grade A or B compared to 70% in the autograft group, however, these results were not statistically significant. Foster et al [37] performed a systematic review of allograft vs autograft and found little difference between the two and reported pooled results of 82.9% IKDC grades A or B (compared to 87.2% for autograft). They also pooled failures and showed a graft failure rate of 8.2 per 100 reconstructions which performed poorly compared to 4.7 per 100 reconstructions for autograft.…”

Section: Graft Choicementioning

confidence: 99%

Anterior cruciate ligament reconstruction best practice: A review of graft choice

Shaerf

Pastides

Sarraf

et al. 2014

WJO

123

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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.

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“…Allografts, ipsilateral bone-patellar tendon-bone (BPTB) autografts and quadruple hamstring tendon (HT) autografts are currently the most commonly used procedures 62,63 . Recent meta-analyses have suggested that although the three procedures produce similar long-term functional outcomes, allografts and HT autografts may be associated with lower rates of anterior knee pain [63][64][65][66] .…”

Section: Surgical Vs Non-surgical Treatmentmentioning

confidence: 99%

The Health and Structural Consequences of Acute Knee Injuries Involving Rupture of the Anterior Cruciate Ligament

Riordan

Frobell

Roemer

et al. 2013

Rheumatic Disease Clinics of North America

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Word Count: 4183 2 3 SynopsisAlthough there is an abundance of literature regarding the development of knee osteoarthritis following rupture of the anterior cruciate ligament (ACL), the exact mechanism underlying this link is still not clear.Recent studies have reported that a number of factors may be predictive of the subsequent development of osteoarthritis, with damage to the menisci and articular cartilage during the initial trauma, altered knee biomechanics post-injury, and episodic instability chief among them. This article summarizes recent developments in the understanding of the joint damage resulting from an ACL tear, and the influence that current and future treatment methods may have on the long-term progression to osteoarthritis.

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Does the Graft Source Really Matter in the Outcome of Patients Undergoing Anterior Cruciate Ligament Reconstruction?

Cited by 142 publications

References 48 publications

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

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

Anterior cruciate ligament reconstruction best practice: A review of graft choice

The Health and Structural Consequences of Acute Knee Injuries Involving Rupture of the Anterior Cruciate Ligament

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