Evaluating the functional results and complications of autograft vs allograft use for reconstruction of the anterior cruciate ligament: a systematic review

Abstract

The aim of our review is to identify the reconstruction technique that has a superior functional outcome and decreased number of complications for the anterior cruciate ligament (ACL). We have divided our review into 2 sections. Our primary question evaluates the functional results and complications of autografts compared to allografts for ACL reconstruction. Our subsidiary question evaluates the functional results and complications of bone-patellar tendon-bone (BPTB) autografts compared to hamstring tendon autografts. We conducted a systematic review (SR) based on high quality evidence provided by Cochrane, PubMed and National Health Service evidence searches for papers comparing different ACL reconstruction techniques. Results from 2 primary studies, 1 SR and 1 meta-analysis showed no significant statistical difference when comparing clinical outcomes such as pain, range of motion, laxity, International Knee Documentation Committee score, single assessment numerical evaluation score, Tegner activity score and patient reported satisfaction with regards to autografts vs allografts. Allografts had worse outcomes for postoperative tibial tunnelling and graft failure. Results of 3 SRs showed statistically significant differences in incidence of anterior knee pain, kneeling pain and knee stability, which were all found to be greater amongst those who had received a BPTB autograft. Knee extension was significantly reduced in patients with BPTB grafts when compared to patients with Hamstring tendon autografts. However, with regards to return to prior levels of activity, there was no statistically significant difference between those that received BPTB autografts and those that received Hamstring tendon autografts. Autograft reconstruction of the ACL was shown to provide better postoperative outcomes when compared to allograft reconstruction, although the difference was not statistically significant. When researching different autograft options BPTB autografts were associated with greater pain but also greater stability of the knee joint postoperatively when compared to hamstring tendon autografts.

A Novel Approach for Meniscal Regeneration Using Kartogenin-Treated Autologous Tendon Graft

“…28 Although currently no defining research is available to suggest that one autograft choice is more beneficial than another, patellar tendon autografts are one of the most common graft types used in ligament reconstruction due to their superior functional capacity and lower number of complications. 19 The fact that tendon tissue consists of collagen fiber similar to that of meniscus suggests that the patellar tendon can also be regarded as a favorable graft choice for replacing meniscus.…”

Clinical Outcome Evaluation in Anterior Cruciate Ligament Reconstruction using Transportal Technique Augmented with Platelet Rich Plasma (PRP) Injection

“…The goal of therapy is for prolonged life knee stabilization and prevent meniscal lesion and degenerative joint disease. 9 In young adults that desire to return to pre-injury activity, surgical management of ACL tear is considered the 'gold standard' of care. 10 A more favorable outcome of ACL reconstruction establishes surgery as the firstline treatment for ACL-deficient knees inactive patients.…”

Evaluation of proprioception in patients who underwent ACL reconstruction: measurement in functional position

“…ACL reconstruction (ACLR) is performed in participants with symptomatic instability to restore the function required to return to the pre-injury level of activity [5]. Several studies have reported that the following symptoms may be observed after ACLR: pain [6,7], movement limitations [7,8], muscle strength loss [3,9], atrophy [10], balance problems [11,12], and functional deficiencies [10,13]. Proprioceptive losses are also one of the problems encountered after ACLR [10,11].…”