Comparison of clinical outcomes after anterior cruciate ligament reconstruction with hamstring tendon autograft versus soft-tissue allograft: A meta-analysis of randomised controlled trials

Wang, Hongde; Zhang, Hao; Wang, Tianrui; Zhang, Weifei; Wang, Fushun; Zhang, Yingze

doi:10.1016/j.ijsu.2018.06.030

Cited by 24 publications

(21 citation statements)

References 45 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although the literature on SCR with fascia lata is limited, the healing rate of autografts seems to be far better. The same is known for anterior cruciate ligament reconstruction where the use of allografts is known to be safe, but can be associated with a significantly higher failure and reoperation rate and postoperative stability [2,9,31]. Allograft incorporation to host tissue, which can be up to 1 year, takes much longer compared with autografts [5].…”

Section: Discussionmentioning

confidence: 99%

Arthroscopic superior capsular reconstruction using a human dermal allograft in patients with and without preoperative pseudoparalysis

et al. 2019

View full text Add to dashboard Cite

Background Massive irreparable rotator cuff tears (RCT) may cause severe functional impairment and pain as a result of loss of superior humeral stability. Reconstruction of the superior capsule (SCR) has been reported to restore glenohumeral stability and function. Objective The purpose of this study was to investigate short-term functional and radiological outcome after arthroscopic SCR with a human dermal allograft for irreparable RCT. Methods In total, 21 patients (mean age 65.9 years, 50–77), who underwent arthroscopic SCR were prospectively enrolled in the present study. Magnetic resonance images (MRI) were obtained before and 12 months after surgery to evaluate graft survival. Functional and subjective outcome including the Constant score (CS), the American Shoulder and Elbow Surgeons score (ASES), and the Simple Shoulder Test (SST) was evaluated preoperatively as well as 3–6 and 12 months postoperatively and was compared between patients with and without preoperative pseudoparalysis. Complications were recorded. Results The MRI evaluation revealed intact grafts in 71.4% of patients 1 year postoperatively; these patients showed significant improvements from baseline to follow-up time points regarding the total CS and its subgroups pain, activity of living, range of motion, strength, ASES, and SST (p < 0.01). Pseudoparalysis was present in 57.1% of cases preoperatively, but was reversed in 100% of cases with intact graft at the 1‑year follow-up. The outcome was similar between groups at final follow-up. Complications occurred in 29% (one infection, five graft failures) of patients and were indications for treatment with reverse shoulder arthroplasty. Conclusion Arthroscopic SCR with a human dermal allograft in patients with irreparable RCT restored shoulder function and relieved pain in patients without and with preoperative pseudoparalysis.

show abstract

Section: Discussionmentioning

confidence: 99%

Arthroscopic superior capsular reconstruction using a human dermal allograft in patients with and without preoperative pseudoparalysis

et al. 2019

View full text Add to dashboard Cite

show abstract

“…Similarly, the meta-analysis found statistically significant difference in subjective IKDC, with a mean difference of 2.43 to the detriment of allografts (95% CI 0.69-4.18; P ¼ .006) and a marginal mean difference in Tegner score (mean difference 0.24; 95% CI 0.03-0.45; P ¼ .03) as well as in side-to-side differences (mean difference À1.37; 95% CI À2.44 to 0.30; P ¼ .01). Wang et al 36 did not find significant differences between groups when comparing the Lysholm score, complications, pivot shift test, anterior drawer test, Lachman test, overall IKDC score, or range of motion. Based on their findings, the authors concluded that soft-tissue allografts are inferior to hamstring tendon autografts with respect to subjective patient evaluation and knee stability but superior in the complication of hypoesthesia for patients undergoing ACLR.…”

Section: Discussionmentioning

confidence: 93%

“…Based on their findings, the authors concluded that soft-tissue allografts are inferior to hamstring tendon autografts with respect to subjective patient evaluation and knee stability but superior in the complication of hypoesthesia for patients undergoing ACLR. 36 Yet, some shortcomings must be noted hereby. First, it is questionable as to whether these differences are actually outside the noninferiority margin, that is, as to whether the aforementioned differences within effectiveness outcomes are clinically relevant.…”

Section: Discussionmentioning

confidence: 99%

Allograft for Anterior Cruciate Ligament Reconstruction (ACLR): A Systematic Review and Meta-Analysis of Long-Term Comparative Effectiveness and Safety. Results of a Health Technology Assessment

Goetz

Villiers

Sadoghi

et al. 2020

Arthroscopy, Sports Medicine, and Rehabilitation

View full text Add to dashboard Cite

Purpose: To evaluate whether allograft anterior cruciate ligament reconstruction (ACLR) is superior or inferior to autograft ACLR or conservative management in terms of effectiveness and safety. Methods: A systematic review of the evidence for allograft ACLR was conducted. Randomized controlled trials with a minimum mean follow-up time of 5 years were included. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and the EUnetHTA-Core-Model were used as reporting standards. A meta-analysis was conducted for selected crucial outcomes using a random-effects model. The strength of the available evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. Results: Six randomized trials were included comparing allograft with autograft. Patients were on average between 28 and 32.8 years of age (allograft group) and 28.9 and 31.7 years of age (autograft group). Based on the crucial outcomes, the meta-analyses showed no statistically significant differences in Lysholm score, Tegner score, and Cincinnati Knee Score between groups. A small statistical difference favoring autografts was found across studies in the subjective International Knee Documentation Committee score (e2.25; 95% confidence interval e3.02 to e1.47; I 2 ¼ 0%; range of all scores: 73.7-90). Two of six studies reported on graft failure, with a statistically significant difference to the detriment of using allografts (13/49 [26.5%] vs 4/48 [8.3%] in one study, 13/43 [30.2%] vs 3/40 [7.5%] in the other study). Conclusions: Although no substantial difference in patient-reported function, activity level, and symptoms was demonstrated, evidence from the included studies showed a greater risk for graft failure or revision that may make allograft a less safe treatment modality in ACLR. The strength of available evidence is low based on the crucial outcomes due to the lack of high-quality research and the present increased risk of bias in primary studies. Priority should be shifted toward reflecting on whether there is a subpopulation for whom allograft ACLR may still be advantageous in theory (e.g., less-active older patients) and further conduct RCTs in this population. Level of Evidence: Level II, systematic review of Level II evidence studies.

show abstract

“…Only one of the seven studies included in this systematic review has reported complications related to the harvesting of autografts, which was pain at the donor site following gracilis tendon harvesting (18). However, this may be an underrepresentation of hamstring harvest donor site morbidity, given that larger series involving anterior cruciate ligament reconstructions have reported a higher incidence of donor site morbidity, such as saphenous nerve injury, weakness of knee flexion, and hypoesthesia (42,43). For other autografts such as ITB, Philippon et al (44) pointed out that infection, pain, and muscular hernia are potential complications.…”

Section: Discussionmentioning

confidence: 99%

Indications and Outcomes for Arthroscopic Hip Labral Reconstruction With Autografts: A Systematic Review

Bessa¹,

Williams

Polce

et al. 2020

Front. Surg.

View full text Add to dashboard Cite

Background: The acetabular labrum plays a major role in hip function and stability. The gold standard treatment for labral tears is labral repair, but in cases where tissue is not amenable to repair, reconstruction has been demonstrated to provide superior outcomes compared to debridement. Many types of grafts have been used for reconstruction with good to excellent outcomes. Autograft options include iliotibial band (ITB), semitendinosus, and indirect head of the rectus femoris tendon, while allografts have included fascia lata and gracilis tendon allografts. Questions/Purposes: As allografts are not always readily available and have some inherent disadvantages, the aims of this systematic review were to assess (1) indications for labral reconstruction and (2) summarize outcomes, complications, and reoperation rates after arthroscopic labral reconstruction with autografts. Methods: A systematic review of the literature was performed using six databases (PubMed, CINAHL, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Scopus, and Google Scholar) to identify studies reporting outcomes for arthroscopic labral reconstruction utilizing autografts, with a minimum follow-up of 1 year. Study design, patient demographics, autograft choice, complications, donor site morbidity, reoperation rates, conversion to arthroplasty, and patient reported outcomes were extracted and reported. Results: Seven studies were identified for inclusion with a total of 402 patients (173 females, age range 16-72, follow-up range 12-120 months). The most commonly reported functional outcome score was the modified Harris Hip Score (mHHS), which was reported in six of seven studies. Preoperative mHHS ranged from 56 to 67.3 and improved postoperatively to a range of 81.4-97.8. Conversion to total hip arthroplasty and reoperation rates ranged from 0 to 13.2% and 0 to 11%, respectively. The most common indication for labral reconstruction was an irreparable labrum. Autografts utilized included ITB, hamstring tendons, indirect head of rectus femoris, and capsular tissue. Bessa et al. Arthroscopic Autograft Labral Reconstruction Conclusions: Arthroscopic autograft reconstruction of the acetabular labrum results in significant improvement in the short-and mid-term patient reported outcomes, for properly selected patients presenting with pain and functional limitation in the hip due to an irreparable labral injury.

show abstract

Comparison of clinical outcomes after anterior cruciate ligament reconstruction with hamstring tendon autograft versus soft-tissue allograft: A meta-analysis of randomised controlled trials

Abstract: Soft-tissue allografts are inferior to hamstring tendon autografts with respect to subjective patient evaluation and knee stability but superior in the complication of hypoesthesia for patients undergoing primary ACL reconstruction.

Cited by 24 publications

References 45 publications

Arthroscopic superior capsular reconstruction using a human dermal allograft in patients with and without preoperative pseudoparalysis

Arthroscopic superior capsular reconstruction using a human dermal allograft in patients with and without preoperative pseudoparalysis

Allograft for Anterior Cruciate Ligament Reconstruction (ACLR): A Systematic Review and Meta-Analysis of Long-Term Comparative Effectiveness and Safety. Results of a Health Technology Assessment

Indications and Outcomes for Arthroscopic Hip Labral Reconstruction With Autografts: A Systematic Review

Contact Info

Product

Resources

About