Controversies in Soft-tissue Anterior Cruciate Ligament Reconstruction: Grafts, Bundles, Tunnels, Fixation, and Harvest

Prodromos, Chadwick C.; Fu, Freddie H.; Howell, Stephen M.; Johnson, Donald D.; Lawhorn, Keith W.

doi:10.5435/00124635-200807000-00003

Cited by 91 publications

(83 citation statements)

References 43 publications

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“…Since then there has been increasing interest in the use of allografts for primary ACL reconstruction, and its role is expanding. There are several published clinical studies (Olson et al, 1992;Pritchard et al, 1995;Siebold et al, 2003;Nyland et al, 2003;Lawhorn and Howell, 2003;Chang et al, 2003;Kustos et al, 2004;Prodromos et al, 2006) evaluating autograft and allograft used in ACL reconstruction, but the findings vary greatly. These discrepancies are due in a large part to the variety of tissues used, and the tremendous variation in surgical technique, fixation, and postoperative protocols.…”

Section: Discussionmentioning

confidence: 99%

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ACL reconstruction with BPTB autograft and irradiated fresh frozen allograft

Kim

Tian

Zhang

et al. 2009

J. Zhejiang Univ. Sci. B

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Abstract:Objective: To analyze the clinical outcomes of arthroscopic anterior cruciate ligament (ACL) reconstruction with irradiated bone-patellar tendon-bone (BPTB) allograft compared with non-irradiated allograft and autograft. Methods: All BPTB allografts were obtained from a single tissue bank and the irradiated allografts were sterilized with 2.5 mrad of irradiation prior to distribution. A total of 68 patients undergoing arthroscopic ACL reconstruction were prospectively randomized consecutively into one of the two groups (autograft and irradiated allograft groups). The same surgical technique was used in all operations done by the same senior surgeon. Before surgery and at the average of 31 months of follow-up (ranging from 24 to 47 months), patients were evaluated by the same observer according to objective and subjective clinical evaluations. Results: Of these patients, 65 (autograft 33, irradiated allograft 32) were available for full evaluation. When the irradiated allograft group was compared to the autograft group at the 31-month follow-up by the Lachman test, the anterior drawer test (ADT), the pivot shift test, and KT-2000 arthrometer test, statistically significant differences were found. Most importantly, 87.8% of patients in the autograft group and just only 31.3% in the irradiated allograft group had a side-to-side difference of less than 3 mm according to KT-2000. The failure rate of the ACL reconstruction with irradiated allograft (34.4%) was higher than that with autograft (6.1%). The anterior and rotational stabilities decreased significantly in the irradiated allograft group. According to the overall International Knee Documentation Committee (IKDC), functional and subjective evaluations, and activity level testing, no statistically significant differences were found between the two groups. Besides, patients in the irradiated allograft group had a shorter operation time and a longer duration of postoperative fever. When the patients had a fever, the laboratory examinations of all patients were almost normal. Blood routine was normal, the values of erythrocyte sedimentation rate (ESR) were 5~16 mm/h and the contents of C reactive protein (CRP) were 3~10 mg/L. Conclusion: We conclude that the short term clinical outcomes of the ACL reconstruction with irradiated BPTB allograft were adversely affected. The less than satisfactory results led the senior authors to discontinue the use of irradiated BPTB allograft in ACL surgery and not to advocate using the gamma irradiation as a secondary sterilizing method.

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Section: Discussionmentioning

confidence: 99%

“…Because of this, some studies (Olson et al, 1992;Prodromos et al, 2006) reported that the results of using allograft for ACL reconstruction were not satisfactory and did not advocate the use of allogenic tissue. Surgeons are therefore faced with a dilemma when making a choice to do the reconstruction.…”

Section: Introductionmentioning

confidence: 99%

ACL reconstruction with BPTB autograft and irradiated fresh frozen allograft

Kim

Tian

Zhang

et al. 2009

J. Zhejiang Univ. Sci. B

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“…Earlier studies have explored the importance of tunnel placement, graft selection, graft fixation, and rehabilitation protocols, but recent attention has focused on the role of doublebundle reconstruction [2]. The native ACL consists of two discrete anteromedial and posterolateral bundles, which respectively account for translational and rotational stability [9,10,13]. Double-bundle ACL reconstruction involves reconstructing each of these bundles separately and is purported to more closely restore native knee anatomy and biomechanics.…”

mentioning

confidence: 99%

“…Double-bundle ACL reconstruction involves reconstructing each of these bundles separately and is purported to more closely restore native knee anatomy and biomechanics. However, double-bundle ACL reconstructions are more technically demanding than conventional singlebundle techniques, they require greater operative time, and are more difficult to revise when they fail [10].…”

mentioning

confidence: 99%

Cochrane in CORR ®: Double-bundle Versus Single-bundle Reconstruction for Anterior Cruciate Ligament Rupture in Adults (Review)

Mundi

Bhandari

2016

Clinical Orthopaedics &Amp; Related Research

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“…[30,31] Çalışmamızda ATT allogreft kullandı-ğımız hastaların %92,3'ü, DHT otogreft kullandığımız hastaların %93,4'ü eski aktivitelerine dönmüşlerdir.…”

Section: Discussionunclassified

Anterior cruciate ligament injuries: do affect surgical treatment with otograft and allograft options, clinical results?

Aslan¹,

Özer²,

Baydar³

et al. 2012

Ulus Travma Acil Cerrahi Derg

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AMAÇBu çalışmada, allogreft ya da otogreft ile ön çapraz bağ (ÖÇB) rekonstrüksiyonun klinik sonuçları araştırıldı. GEREÇ VE YÖNTEMAnterior tibial tendon (ATT) allogreft (n=52) ya da dörtlü hamstring (DHT) otogreft (n=30) ile ön çapraz bağ (ÖÇB) rekonstrüksiyonu uygulanan 82 hastanın sonuçları geriye dönük olarak değerlendirildi. Hastalar son kontrolde, Uluslararası Diz Dokümantasyon Komitesi'nin (IKDC) diz skoru ve Lysholm skoru, performans (tek bacak zıplama) ve laksite (pivot-shift, Lachman, öne çekmece) testleri ile değerlendirildi. BULGULARİki grup arasında yaş, cinsiyet dağılımı, ameliyat edilen taraf, ameliyat öncesi süre ve eşlik eden yaralanmalar açısın-dan farklılık yoktu (p>0,05). IKDC, Lysholm, performans ve laksite bakımndan her iki grupta da sonuçlar tatmin ediciydi ancak gruplar arasında anlamlı fark yoktu (p>0,05). Fakat, ATT allogreft grubunda DHT otogreft grubuna göre daha fazla effüzyona rastlandı. SONUÇBu çalışmanın sonuçları ATT allogreft ya da DHT otogreft ile ÖÇB rekonstrüksiyonunun klinik sonuçlarının benzer olduğunu göstermektedir. Bununla birlikte allogreftlerde görülen immün yanıta çözümler geliştirilmesiyle ÖÇB rekonstrüksi-yonunda iyi bir greft alternatifi olabileceğini düşünüyoruz.Anahtar Sözcükler: Anterior tibial tendon allogreft; hamstring tendon otogreft; ön çapraz bağ yaralanması.

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Controversies in Soft-tissue Anterior Cruciate Ligament Reconstruction: Grafts, Bundles, Tunnels, Fixation, and Harvest

Cited by 91 publications

References 43 publications

ACL reconstruction with BPTB autograft and irradiated fresh frozen allograft

ACL reconstruction with BPTB autograft and irradiated fresh frozen allograft

Cochrane in CORR ®: Double-bundle Versus Single-bundle Reconstruction for Anterior Cruciate Ligament Rupture in Adults (Review)

Anterior cruciate ligament injuries: do affect surgical treatment with otograft and allograft options, clinical results?

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