Allograft or autograft in skeletally immature anterior cruciate ligament reconstruction: a prospective evaluation using both partial and complete transphyseal techniques

Razi, Mohammad; Moradi, Amin; Safarcherati, Afsane; Askari, Alireza; Arasteh, Peyman; Ziabari, Elaheh Ziaei; Dadgostar, Haleh

doi:10.1186/s13018-019-1128-7

Cited by 16 publications

(20 citation statements)

References 39 publications

(53 reference statements)

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“…The mean 2-year IKDC Subjective Score was 85 points in the ACLR group in this trial, which is consistent with the 2-year ACLR scores reported by the MOON group (82 points) 8 and others (86 points). 49 The BEAR group had mean scores at 2 years similar to those in the ACLR group and similar to that reported for an age-matched control cohort (88 points). 3 Given that the lower bound of the confidence interval for the difference was 21.5, the pre-specified noninferiority lower bound (211.5) for the IKDC Subjective Score could have been set much tighter and still been satisfied.…”

Section: Discussionsupporting

confidence: 79%

Bridge-Enhanced Anterior Cruciate Ligament Repair Is Not Inferior to Autograft Anterior Cruciate Ligament Reconstruction at 2 Years: Results of a Prospective Randomized Clinical Trial

et al. 2020

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Background: Preclinical studies suggest that for complete midsubstance anterior cruciate ligament (ACL) injuries, a suture repair of the ACL augmented with a protein implant placed in the gap between the torn ends (bridge-enhanced ACL repair [BEAR]) may be a viable alternative to ACL reconstruction (ACLR). Hypothesis: We hypothesized that patients treated with BEAR would have a noninferior patient-reported outcomes (International Knee Documentation Committee [IKDC] Subjective Score; prespecified noninferiority margin, –11.5 points) and instrumented anteroposterior (AP) knee laxity (prespecified noninferiority margin, +2-mm side-to-side difference) and superior muscle strength at 2 years after surgery when compared with patients who underwent ACLR with autograft. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: One hundred patients (median age, 17 years; median preoperative Marx activity score, 16) with complete midsubstance ACL injuries were enrolled and underwent surgery within 45 days of injury. Patients were randomly assigned to receive either BEAR (n = 65) or autograft ACLR (n = 35 [33 with quadrupled semitendinosus-gracilis and 2 with bone–patellar tendon–bone]). Outcomes—including the IKDC Subjective Score, the side-to-side difference in instrumented AP knee laxity, and muscle strength—were assessed at 2 years by an independent examiner blinded to the procedure. Patients were unblinded after their 2-year visit. Results: In total, 96% of the patients returned for 2-year follow-up. Noninferiority criteria were met for both the IKDC Subjective Score (BEAR, 88.9 points; ACLR, 84.8 points; mean difference, 4.1 points [95% CI, –1.5 to 9.7]) and the side-to-side difference in AP knee laxity (BEAR, 1.61 mm; ACLR, 1.77 mm; mean difference, –0.15 mm [95% CI, –1.48 to 1.17]). The BEAR group had a significantly higher mean hamstring muscle strength index than the ACLR group at 2 years (98.2% vs 63.2%; P < .001). In addition, 14% of the BEAR group and 6% of the ACLR group had a reinjury that required a second ipsilateral ACL surgical procedure ( P = .32). Furthermore, the 8 patients who converted from BEAR to ACLR in the study period and returned for the 2-year postoperative visit had similar primary outcomes to patients who had a single ipsilateral ACL procedure. Conclusion: BEAR resulted in noninferior patient-reported outcomes and AP knee laxity and superior hamstring muscle strength when compared with autograft ACLR at 2-year follow-up in a young and active cohort. These promising results suggest that longer-term studies of this technique are justified. Registration: NCT02664545 (ClinicalTrials.gov identifier)

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Section: Discussionsupporting

confidence: 79%

Bridge-Enhanced Anterior Cruciate Ligament Repair Is Not Inferior to Autograft Anterior Cruciate Ligament Reconstruction at 2 Years: Results of a Prospective Randomized Clinical Trial

et al. 2020

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“…Individual study characteristics are summarized in Tables I and II. The average age of participants in individual studies ranged from 14 years 27 to 19 years 38 , and the average duration of follow-up ranged from 24 months 26 to 240 months 34 . The average age of the pediatric/adolescent cohort could not be determined in 3 studies 29 , 34 , 36 .…”

Section: Resultsmentioning

confidence: 99%

“…The sex of participants in individual studies ranged from 25% female 38 to 100% female 31 . One study described allograft ACLR only 30 , 7 studies described autograft ACLR only 27 , 29 , 32 - 34 , 36 , 37 , and 6 studies described both ACL allograft and autograft reconstruction within the same cohort 21 , 26 , 28 , 31 , 35 , 38 .…”

Section: Resultsmentioning

confidence: 99%

“…Graft failure was defined as graft rupture/failure explicitly described in each individual study on the basis of clinical or radiographic criteria or a return to the operating room for failed ACLR. All included studies were assimilated in our qualitative analysis 21 , 26 - 38 . All studies included in the qualitative analysis that adequately reported data for our random-effects model were included in our quantitative meta-analysis.…”

Section: Methodsmentioning

confidence: 99%

“…These studies presented data on both ACL autograft and allograft reconstruction within the same study cohort 21 , 28 , 31 , 35 , 38 . Although Razi et al 26 reported on both autograft and allograft in the same cohort, this study was not included in the meta-analysis because there were 0 events of interest (e.g., graft failure) in either group.…”

Section: Methodsmentioning

confidence: 99%

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Failure Rates of Autograft and Allograft ACL Reconstruction in Patients 19 Years of Age and Younger

et al. 2020

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Background: Graft choice for pediatric anterior cruciate ligament reconstruction (ACLR) is determined by several factors. There is limited information on the use and outcomes of allograft ACLR in pediatric patients. The purpose of this systematic review and meta-analysis was to quantify reported failure rates of allograft versus autograft ACLR in patients ≤19 years of age with ≥2 years of follow-up. We hypothesized that there would be higher rates of failure for allograft compared with autograft ACLR in this population. Methods: PubMed/MEDLINE and Embase databases were systematically searched for literature regarding allograft and autograft ACLR in pediatric/adolescent patients. Articles were included if they described a cohort of patients with average age of ≤19 years, had a minimum of 2 years of follow-up, described graft failure as an outcome, and had a Level of Evidence grade of I to III. Qualitative review and quantitative meta-analysis were performed to compare graft failure rates. A random-effects model was created to compare failure events in patients receiving allograft versus autograft in a pairwise fashion. Data analysis was completed using RevMan 5.3 software (The Cochrane Collaboration). Results: The database search identified 1,604 studies; 203 full-text articles were assessed for eligibility. Fourteen studies met the inclusion criteria for qualitative review; 5 studies were included for quantitative meta-analysis. Bone-patellar tendon-bone (BTB) represented 58.2% (n = 1,012) of the autografts, and hamstring grafts represented 41.8% (n = 727). Hybrid allografts (autograft + supplemental allograft) represented 12.8% (n = 18) of all allograft ACLRs (n = 141). The unweighted, pooled failure rate for each graft type was 8.5% for BTB, 16.6% for hamstring, and 25.5% for allograft. Allografts were significantly more likely than autografts to result in graft failure (odds ratio, 3.87; 95% confidence interval, 2.24 to 6.69). Conclusions: Allograft ACLR in pediatric and adolescent patients should be used judiciously, as existing studies revealed a significantly higher failure rate for allograft compared with autograft ACLR in this patient population. Additional studies are needed to improve the understanding of variables associated with the high ACLR failure rate among pediatric and adolescent patients. Level of Evidence: Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.

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Optimizing outcomes of ACL surgery—Is autograft reconstruction the only reasonable option?

Murray

2021

Journal Orthopaedic Research

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Anterior cruciate ligament (ACL) injuries occur at a high frequency in the UnitedStates with approximately 400,000 ACL reconstructions being performed each year. While ACL reconstruction is our current gold standard of treatment, it does not restore joint motion, or prevent the premature development of posttraumatic osteoarthritis (PTOA) in many patients. Thus, new treatments for an ACL injury, which are less invasive and minimize patient morbidity, including cartilage damage, are highly desirable. We have used a tissue-engineered approach to stimulate ligament healing, to improve upon current treatment options. In this review, we describe and discuss our work moving a tissue engineering strategy from the concept to bench, preclinical, clinical trials and ultimately FDA 510(k) de Novo approval, providing clinicians and patients with a viable alternative to ACL reconstruction.

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Allograft or autograft in skeletally immature anterior cruciate ligament reconstruction: a prospective evaluation using both partial and complete transphyseal techniques

Cited by 16 publications

References 39 publications

Bridge-Enhanced Anterior Cruciate Ligament Repair Is Not Inferior to Autograft Anterior Cruciate Ligament Reconstruction at 2 Years: Results of a Prospective Randomized Clinical Trial

Bridge-Enhanced Anterior Cruciate Ligament Repair Is Not Inferior to Autograft Anterior Cruciate Ligament Reconstruction at 2 Years: Results of a Prospective Randomized Clinical Trial

Failure Rates of Autograft and Allograft ACL Reconstruction in Patients 19 Years of Age and Younger

Optimizing outcomes of ACL surgery—Is autograft reconstruction the only reasonable option?

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