Hamstring tendon autografts and allografts show comparable clinical outcomes and knee stability after anterior cruciate ligament reconstruction in patients over fifty years old with no signs of osteoarthritis progression

Abstract

Purpose The aim of this study is to compare the functional outcomes and osteoarthritis (OA) progression after anterior cruciate ligament (ACL) reconstruction with either hamstring autografts or allografts in people over 50. Methods The clinical records of two consecutive cohorts of 61 cases in total over 50 years of age, undergoing ACL reconstruction, were included. The first cohort consisted of 29 allografts; the second cohort consisted of 32 autologous hamstring tendon grafts. The cases were evaluated pre- (T0) and post-operatively at six months (T1), 12 months (T2) and 24 months (T3). Clinical examination included the Lachman test, pivot shift test and objective (Objective IKDC [The International Knee Documentation Committee] score) and subjective clinical scores (Subjective IKDC score, Lysholm score and Tegner activity score). The degree of OA was evaluated using the Kellgren-Lawrence system at the time of the final follow-up, compared to the pre-operative condition. Results No pre-operative difference was found between the two groups (p > 0.05). No statistical difference was noted between the two groups at each follow-up (p > 0.05). At the final follow-up, both the groups significantly improved statistically in all the clinical and functional scores (p < 0.05). In both groups, one graft re-rupture was noted. No progression of OA was noted in both groups at final follow-up (p > 0.05). Conclusion The graft choice does not influence the outcomes two years after ACL reconstruction in people over 50; thus, both treatments help in regaining knee stability with no signs of OA progression. Registration Researchregistry7539–www.researchregistry.com.

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

“…Allografts offer the advantages of reduced postoperative pain, faster recovery, and improved cosmetic outcomes [5]. Numerous studies have compared autografts and allografts in ACL reconstruction, and some have reported that allografts show favourable postoperative results compared to autografts, except in young and highly active patients [2, 4, 5]. Theoretically, postoperative tunnel enlargement is a concern after ACL reconstruction with an allograft due to an immune response or delayed engraftment [2, 25].…”

“…However, subsequent donor site morbidities cannot be ignored. Allografts offer the advantages of reduced postoperative pain, faster recovery, and improved cosmetic outcomes [5]. Numerous studies have compared autografts and allografts in ACL reconstruction, and some have reported that allografts show favourable postoperative results compared to autografts, except in young and highly active patients [2, 4, 5].…”

“…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.…”

Reconstruction of the anterior cruciate ligament: a historical view

“…Autograft reconstruction necessitates tissue harvesting from the patient, thereby raising the risks of surgical trauma and morbidity at the donor site as well as lengthening the procedure ( 93 ). The avoidance of donor site morbidity, decreased postoperative pain, and shorter operating room times are the main reasons why the usage of allografts has expanded over the past 10 years.…”

“…The avoidance of donor site morbidity, decreased postoperative pain, and shorter operating room times are the main reasons why the usage of allografts has expanded over the past 10 years. Smaller incisions, less donor-site morbidity, greater graft availability, faster postoperative knee range of motion, and shorter surgical times are benefits of using allografts ( 93 ). The possibility of an immune response, bacterial infection, and disease transmission from the graft donor are drawbacks.…”