Small Size Autograft versus Large Size Allograft in Anterior Cruciate Ligament Reconstruction

Abstract

Background A small autograft diameter negatively affects functional outcomes, knee stability, and the risk of rerupture after anterior cruciate ligament (ACL) reconstruction, whereas the strength of allograft decreases over time. Therefore, it is not clear whether the use of smaller autografts or the use of larger allografts in ACL yields better results. The aim of this study was to compare the outcome of smaller autografts and larger allografts for ACL reconstruction. Methods Fifty-one patients who underwent ACL reconstruction with hamstring tendon autografts (size ≤ 8 mm) and 21 patients who underwent ACL reconstruction with allografts (size ≥ 10 mm) were included in our study. All patients underwent the same aggressive early postoperative rehabilitation program. There were no significant differences between the autograft and allograft groups regarding the preoperative patient age, sex, time from injury to surgery, and average follow-up time. Results The mean diameter of the 4-stranded hamstring tendon grafts used as autografts was 7.48 ± 0.33 mm and the mean diameter of the allografts was 10.76 ± 0.67 mm. According to specific tests for the ACL (anterior drawer, Lachman, and pivot shift) and clinical evaluation tests (Lysholm knee scoring scale and International Knee Documentation Committee questionnaire), the final follow-up results were significantly better than the preoperative status in both autograft and allograft ACL reconstruction groups. Therefore, there were no significant differences between the autograft and allograft groups preoperatively and at the final follow-up. Conclusions The large size of the graft in ACL reconstruction has been reported to affect results positively. However, in our study, we could not find any significant differences between the smaller size autografts and larger size allografts in terms of inadequacy, rerupture, and final follow-up functional results. Although allografts were significantly larger than autografts, we did not have the positive effect of larger size grafts. Smaller size autografts were as effective as the larger size allografts.

Rectangular-Tunnel Anterior Cruciate Ligament Reconstruction Using Quadriceps Tendon-Patellar Bone Autograft Can Reduce Early Donor Site Morbidity While Maintaining Comparable Short-term Clinical Outcomes

“…It is noteworthy that this smaller cross-sectional area of partial-thickness QTPB (50 mm 2 ) is still larger than the average mid-substance cross-sectional area of native ACL 20) (46.9 mm 2 ) and thus may have led to comparable knee stability in this analysis. In accordance with our study, smaller size autografts were as effective as larger size allografts in a recent study 21) on ACLR. Theoretically, thicker grafts in ACLR may lead to graft impingement and consequently reduce knee ROM.…”

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

“…Theoretically, postoperative tunnel enlargement is a concern after ACL reconstruction with an allograft due to an immune response or delayed engraftment [2, 25]. Contrary to the negative opinions in early studies regarding the use of allografts, it is still controversial whether allografts are significantly inferior to autografts in terms of tunnel widening [10, 17, 19, 23]. A previous study investigated time‐dependent serial tunnel size in autografts [25].…”

“…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].…”

Clinical and MRI Outcomes of Repaired Peripheral Longitudinal Tears of the Posterior Horn of the Medial Meniscus With ACL Reconstruction: Results According to Tear Size

“…Many factors can affect the rate of meniscal healing, such as the stability or length of tears, 1 , 34 , 37 , 50 meniscal repair technique, 37 , 50 , 51 rehabilitation protocol, 37 , 50 chronicity, 1 , 30 or the stability of the ACL. 5 , 14 , 27 Although there is currently no consensus on the role of tear size in determining whether the MMPH peripheral longitudinal tears should be repaired or not, it is obvious that unstable MMPH peripheral longitudinal tears would be better repaired. 5 , 49 , 50 Furthermore, there was a lack of evidence regarding whether the tear size and extension would affect the clinical outcomes and healing rates after meniscal repair.…”