Italian consensus statement for the use of allografts in ACL reconstructive surgery

Bait, Corrado; Randelli, Pietro; Compagnoni, Roberto; Ferrua, Paolo; Papalia, Rocco; Familiari, Filippo; Tecame, Andrea; Adravanti, Paolo; Adriani, Ezio; Arnaldi, Enrico; Benazzo, F.; Berruto, Massimo; Bonaspetti, Giovanni; Canata, Gian Luigi; Cane, P; Causero, Araldo; Coari, Giancarlo; Denti, Matteo; Faré, Maristella; Ferretti, Andrea; Fravisini, M.; Giron, Francesco; Gobbi, Alberto; Madonna, Vincenzo; Manunta, A.; Mariani, Pier Paolo; Mazzola, Claudio; Milano, Giuseppe; Pederzini, Luigi Adriano; Quaglia, Flavio; Ronga, Mario; Schönhuber, Herbert; Stefani, G; Volpi, Piero; Zanon, Giacomo; Zini, Raul; Zorzi, Claudio; Zaffagnini, Stefano

doi:10.1007/s00167-018-5003-6

Cited by 6 publications

(4 citation statements)

References 48 publications

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“…35 Especially in case of multiple failures and when peripheral reconstructions are needed, the use of allograft is strongly reccomended. 31,36 In our experience, we have used a prevalence of autograft BPTB and allograft as graft for the last revision surgery. Albeit the literature shows very good results with both kinds of graft and indicate autograft BPTB as the gold standard, 35 several authors reported a higher failure rate using allograft in comparison to autograft.…”

Section: Discussionmentioning

confidence: 99%

Multiple ACL Revision: Failure Analysis and Clinical Outcomes

et al. 2019

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Anterior cruciate ligament (ACL) reconstruction represents one of the most successful orthopedic surgical procedures. Nevertheless, ACL revisions are still very frequent, with a small but relevant number of failures. The purpose of this study is to analyze the failure causes and the clinical outcomes of patients who underwent a re-revision ACL reconstruction. Between January 2009 and December 2017, 263 ACL revisions were performed by a single senior surgeon. Seventeen patients (12 males and 5 females) underwent re-revision ACL reconstruction meeting the inclusion criteria. The mean age was 28.4 years (range, 19–41 years). Before the re-revision, the patients were evaluated preoperatively and after a mean follow-up of 29 months (range, 13–58 months). Assessment included subjective and objective evaluations (Lysholm and International Knee Documentation Committee [IKDC]), KT-2000 arthrometer, radiographic study, and preoperative computed tomography scan. Five patients showed a too anterior previous femoral tunnel and seven a too vertical and posterior tibial tunnel; eight meniscal tears were found. Five patients had grade III–IV according to Outerbridge cartilage lesions. IKDC showed a statistically significant improvement (A + B 35%, C + D 65% preop, A + B 82%, C + D 18% postop, odds ratio: 0.1169; p = 0.0083). The mean Lysholm score ranged from 43 ± 9 to 87 ± 7 (p < 0.001). The KT-2000 arthrometer showed a statistically significant improvement from a mean of 5.8 ± 1.4 to 1.5 ± 1.1 (p < 0.001) at last follow-up. Out of 17 patients, only 4 returned to sports activity at the same preinjury levels. Postoperatively at the last follow-up after last revision surgery, no osteoarthritis evolution was observed. This study showed good clinical and radiological results after the last revision ACL surgery in patients with multiple failures of ACL reconstruction but only one-fourth of the patients returned to the same preoperative sport level. Traumatic events, technical errors, and untreated peripheral lesions are the main causes of multiple previous failures; the worst clinical outcomes were found in the patients with high grade of chondral lesions.

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Section: Discussionmentioning

confidence: 99%

Multiple ACL Revision: Failure Analysis and Clinical Outcomes

et al. 2019

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“…This could allow an earlier return to levels of activity. Particularly, graft choice by the surgeons changed in the more recent studies to the use of allografts in older and less active patients, which correlated with a significant decrease in risk of graft failure [2, 5, 28].…”

Section: Discussionmentioning

confidence: 99%

“…In order to be considered for inclusion, studies needed to include: (1) patients with a minimum age of 40 years undergoing a primary ACL reconstruction; (2)…”

Section: Inclusion and Exclusion Criteriamentioning

confidence: 99%

Comparable clinical and functional outcomes after anterior cruciate ligament reconstruction over and under 40 years of age

Corona¹,

Ronga²,

Morris³

et al. 2019

Knee Surg Sports Traumatol Arthrosc

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Purpose The aim of the present meta‐analysis was to update the literature on the outcomes and complications of ACL reconstruction in patients aged 40 years and older. It has been hypothesized that patients older than 40 years of age may have comparable clinical outcomes to those of younger patients. Methods A systematic review of articles from 1996 to 2018 was completed using Pubmed, Medline, Cochrane Reviews, and Google Scholar databases using the keyword terms “anterior cruciate ligament reconstruction” and “middle‐aged OR elderly OR over 40 OR age factors.” Functional and clinical outcomes (International Knee Documentation Committee, Lysholm and Tegner score and KT‐1000 arthrometer), complication and graft failure rate were evaluated. Results Eleven articles met inclusion criteria. In total, 306 middle‐aged patients and 566 younger patients were included in this study. The mean age of patients > 40 was 49 ± 7 (range 40–75) years with a mean follow‐up of 25 ± 9 months (range 12–68). The mean age of younger patients was 26 ± 2.7 (range 15–39) years with a mean post‐operative follow‐up of 26.7 ± 11.5 months (range 3–64). The results were slightly higher (but no significantly different) towards the younger group in terms of objective IKDC (P = n.s.), Lysholm (P = n.s.) and Tegner (P = n.s.) scores and knee laxity assessment (P = n.s.). Complication rate (P = n.s.) and graft failure (P = n.s.) were low even in this cohort. Conclusions The present meta‐analysis shows that patients older than 40 years achieve comparable clinical outcomes to those of younger patients following primary ACL reconstruction. This evidence may push the surgeons toward a more aggressive approach in this specific cohort of patients. Level of evidence III.

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“…Anterior cruciate ligament reconstruction (ACLR) with the patient’s own autograft tissue (hamstring or bone patellar tendon bone) is the most common surgical technique to treat ACL complete rupture. Allografts are commonly used in revision and multiligament surgery [ 30 ]; albeit, in the last decades, their use also in primary ACLR is growing [ 1 , 13 , 36 ].…”

Section: Introductionmentioning

confidence: 99%

Different timing in allograft and autograft maturation after primary anterior cruciate ligament reconstruction does not influence the clinical outcome at mid-long-term follow-up

Cusumano

Capitani

Messina

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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PurposeThe use of allografts in primary anterior cruciate ligament reconstruction (ACLR) is increasing although they are still supposed to be associated to greater risk of re‐rupture due to a slower and less efficient graft maturation. The aim of this prospective randomized controlled study was to compare the graft maturation after ACLR with allograft and autograft by MRI at 6‐ and 12‐month follow‐up and integrate these data with the functional and clinical results observed at 6‐, 12‐ and 60‐month follow‐up. MethodsFifty patients with indication to primary ACLR were randomly and equally divided into hamstring autograft or allograft tendon groups. The graft maturation was measured at 6‐ and 12‐month follow‐up by the SNQ score and other radiological parameters on MRI scans. Clinical and functional recovery was evaluated by Lysholm score, Visual Analogues Scale, Tegner activity scale and modified Cincinnati knee rating system at 6, 12 and 60 months after surgery to estimate the predictive value of the radiological parameters for clinical outcomes. Return‐to‐sport (ACL‐RSI) was measured 60 months after surgery. ResultsThree patients had retear of the neo‐ligament (two from Auto group and one from Allo group). All the clinical/functional parameters significantly improved over time, with no statistically significant difference between the groups. At 6 months, the SNQ value was significantly higher in the Auto than in the Allo group (12.9 vs 7.9, p = 0.038), but at 12 months they were comparable (9.8 vs 10.4). The 6‐month SNQ values did not correlate with the clinical scores, whereas the 12‐month SNQ values significantly correlated with the Cincinnati score, Lysholm score and Tegner activity scale collected at 60‐month follow‐up. ConclusionNo clinical or functional differences have been found between the two treatment groups, supporting the suitability of using allograft in primary ACLR, when available. The results at MRI scans showed a different graft maturation trend in the two groups, with allografts being more reactive in the first 6 months. MRI together with the subjective evaluation allows to evaluate objectively the status of the neo‐ligamentization process and therefore helps the surgeon to dictate the individual time for return‐to‐sport. Level of evidenceLevel I.

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Italian consensus statement for the use of allografts in ACL reconstructive surgery

Abstract: IV, consensus of experts.

Cited by 6 publications

References 48 publications

Multiple ACL Revision: Failure Analysis and Clinical Outcomes

Multiple ACL Revision: Failure Analysis and Clinical Outcomes

Comparable clinical and functional outcomes after anterior cruciate ligament reconstruction over and under 40 years of age

Different timing in allograft and autograft maturation after primary anterior cruciate ligament reconstruction does not influence the clinical outcome at mid-long-term follow-up

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