Allografts as alternative to autografts in primary posterior cruciate ligament reconstruction: a systematic review and meta-analysis

Abstract

Purpose Following posterior cruciate ligament (PCL) rupture, autografts and allografts are routinely used for its reconstruction. This study investigated the efficacy and safety of allografts for primary PCL reconstruction, comparing them to autografts in terms of patient-reported outcome measures (PROMs), functional tests, and complications. Methods This study followed the PRISMA guidelines. PubMed, Web of Science, Google Scholar, Embase, and Scopus were accessed in October 2022. All the clinical studies investigating the outcomes of primary PCL reconstruction using allografts, or comparing the outcomes of allografts versus autografts, were accessed. The outcomes of interests were: instrumental laxity, range of motion (ROM), Telos stress radiography, drawer test, International Knee Documentation Committee (IKDC), Tegner Activity Scale, and the Lysholm Knee Scoring Scale. Data on complications were also recorded. Results A total of 445 patients were included. The mean follow-up was 45.2 ± 23.8 months. The mean age of the patients was 30.6 ± 2.2 years. The time span between the injury and surgical intervention was 12.9 ± 10 months. Overall, 28% (125 of 445 patients) were women. Good baseline comparability was found between the two cohorts. No difference was found in terms of Lysholm Score, ROM, Tegner Scale, IKDC, arthrometer laxity, drawer test, and Telos stress radiography. No difference was found in the rates of anterior knee pain and revision. Conclusion Allografts can be considered a suitable alternative to autografts for PCL reconstruction. Level of evidence III.

The changing trends of the knee function after anterior and posterior cruciate ligaments reconstruction with all-inside arthroscopy technique

“…(5) The posterior compartment of the knee has a complex anatomy structure of vessels and nerves which ACL and PCL reconstruction [10][11] . We agreed with this a higher prevalence for autografts, allografts can be considered a suitable alternative to autografts 12 . In our research, we selected autologous hamstring tendon, and rejection and infectious diseases cases complications were not found after the operation.…”

Anterior cruciate ligament reconstruction in skeletally immature patients is effective: A systematic review

“…A hamstring tendon autograft offers the advantage of a smaller incision and fewer donor‐site complications compared with a bone‐patellar tendon‐bone autograft [29, 103]. The disadvantage of a hamstring tendon graft is the potential for increased anterior laxity over time [103, 105]. A central‐third quadriceps tendon‐bone autograft is a reliable option because it has less donor‐site complications, but a prolonged weakness of the quadriceps muscle has been reported [103, 106].…”

Serial change of femoral and tibial tunnel width after anterior cruciate ligament reconstruction with allograft

“…Despite the popularity of this surgery, considerable controversy exists regarding the surgical techniques. Graft selection is an easily modifiable surgical procedure, and reconstruction using autografts, including bone‐patella tendon‐bone (BPTB), hamstring grafts, and quadriceps tendons, remains the gold standard with major advantages of engraftment and no risk of rejection or disease transmission [17, 19]. However, subsequent donor site morbidities cannot be ignored.…”

“…Theoretically, postoperative tunnel enlargement is a concern after ACL reconstruction with an allograft due to an immune response or delayed engraftment [2, 25]. Contrary to the negative opinions in early studies regarding the use of allografts, it is still controversial whether allografts are significantly inferior to autografts in terms of tunnel widening [10, 17, 19, 23]. A previous study investigated time‐dependent serial tunnel size in autografts [25].…”

“…The choice of ACL graft remains controversial [10, 17, 19, 23]. Allografts have the advantages of less postoperative pain related to graft harvesting, faster recovery, and better cosmetic outcomes; however, their disadvantages include high cost, risk of disease transmission, and tunnel widening [5, 19]. Allograft‐related factors associated with tunnel widening include biological factors and immune responses.…”