Graft Considerations in Posterior Cruciate Ligament Reconstruction

Johnson, Pierce; Mitchell, Sean M.; Görtz, Simon

doi:10.1007/s12178-018-9506-z

Cited by 18 publications

(28 citation statements)

References 48 publications

(49 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The study by Wang et al, 26 however, reported no statistically significant difference between the groups: 2.8 AE 1.7 versus 3.2 AE 2.6 (P > 0.05) as measured by the KT-1000 arthrometer. assessed with: Lysholm score) 2 1,2,25,26 Randomized trials assessed by Tegner score) 2 1,2,25,26 Randomized trials 25,26 Randomized trials 25,26 Randomized trials In Li et al, it was unclear whether the random sequence generation was adequate (selection bias), and whether patients were blinded.…”

Section: Results Of Studies Effectiveness Outcomementioning

confidence: 99%

“…7,8 Y-irradiated allografts were included in the primary study by Li et al 25 The authors acknowledged the limitations of this graft type, such as disease transmission, longer remodeling times and graft integration in the tunnels, as mentioned in other reviews. 2,11,12 However, the main focus of this review was on measuring the stability outcomes and safety measures, such as no additional surgery needed due to posterior laxity, no cases of major infections and no vascular or wound complications, which were poorly measured and reported. No statistical testing was performed on group results, and a low GRADE judgment suggests caution in judging these findings because they might be substantially different from the true results.…”

Section: Discussionmentioning

confidence: 99%

“…9 A careful consideration of surgical-intervention decisions should, therefore, include multiple factors, such as the patient's level of activity, the functional demands on the knee, the surgeon's experience, and the presentation of other associated meniscal or ligament injuries. 2 The graft type to be used is a further decision to consider because autografts and allografts are potential sources of PCL reconstructions. The chosen graft should resemble the original PCL anatomy, taking into consideration that each graft is associated with different benefits and limitations.…”

mentioning

confidence: 99%

“…11,13 Limited graft availability and the associated costs are also factors to consider with the choice of allograft. 2 The current literature concerning systematic reviews reports postoperative improvement of clinical and patient-reported outcomes following PCL reconstructions in both allograft and autograft groups. 12,14,15 Controversy remains in regard to whether 1 graft type provides better outcomes and is superior to the other in PCL reconstruction.…”

mentioning

confidence: 99%

“…An annual incidence rate of 2 cases per 100,000 individuals is reported for isolated posterior cruciate ligament ruptures. 1 Historically, a conservative management approach has been followed and because of the intrinsic healing capability of the PCL, 2 surgical intervention has been reserved mainly in the event of failed conservative management or for the treatment of associated injuries. 2 , 3 PCL reconstruction as first-line routine care is still debated 4 because surgical intervention is not without its own challenges; there is a reported graft failure rate of 11.6% (range of 2.3%-30%) 5 and a revision rate of 12.6% in a highly active military population.…”

mentioning

confidence: 99%

See 4 more Smart Citations

Comparative Effectiveness and Safety of Allografts and Autografts in Posterior Cruciate Ligament Reconstruction Surgery: A Systematic Review

Villiers

Goetz

Sadoghi

et al. 2020

Arthroscopy, Sports Medicine, and Rehabilitation

View full text Add to dashboard Cite

To evaluate the evidence of the effectiveness and safety of allografts compared to autografts in posterior cruciate ligament reconstruction. Methods: Four electronic databases were systematically searched for eligible randomized controlled studies. Crucial effectiveness outcomes included patient-reported function, activity level and symptoms, clinical knee stability, health-related quality of life, and patient satisfaction. Safety was evaluated through graft failures, revisions, reruptures and complications. The internal validity of the studies was assessed by the Cochrane risk of bias tool, and the strength of the evidence was judged according to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE). Results: Two randomized controlled studies were included: 50 patients were analyzed in the allograft group and 58 in the autograft group. No statistically significant postoperative differences were reported between the groups for patient-reported function, activity levels or symptoms. One study reported a statistically significant difference in instrumented postoperative anteroposterior knee laxity favoring stability in autografts. This difference is, however, not relevant in the clinical setting. Insufficient evidence was found to judge safety outcomes and because complications were poorly measured, and none of the studies reported on graft failure, revision or rerupture rates. The studies were judged with unclear to high risk of bias. The strength of the evidence for effectiveness and safety was judged to be low to very low, according to GRADE. Conclusions: Allografts may be comparable to autografts for crucial effectiveness outcomes, but insufficient evidence was found to judge crucial safety outcomes due to poor reporting of safety measures and outcomes. Results should be interpreted with caution because there is lack of good-quality evidence to support the superiority of allografts over autografts due to the high risk of bias in the primary studies and overall very low strength of the body of evidence according to GRADE. Level of Evidence: Systematic review of Level II studies.

show abstract