Corrado Bait1, Pietro Randelli2,3, Riccardo Compagnoni4, Paolo Ferrua5, Rocco Papalia6, Filippo Familiari7, Andrea Tecame6, Paolo Adravanti8, Ezio Adriani9, Enrico Arnaldi10, Franco Benazzo11, Massimo Berruto5, Giovanni Bonaspetti12, Gian Luigi Canata13, Pier Paolo Canè14, Araldo Causero15, Giancarlo Coari16, Matteo Denti17, Maristella Farè18, Andrea Ferretti19, Marco Fravisini14, Francesco Giron20, Alberto Gobbi21, Vincenzo Madonna22, Andrea Manunta23, Pier Paolo Mariani24, Claudio Mazzola25, Giuseppe Milano26, Luigi Pederzini27, Flavio Quaglia28, Mario Ronga29, Herbert Schönhuber30, Giacomo Stefani31, Piero Volpi32, Giacomo Zanon11, Raul Zini33, Claudio Zorzi22, Stefano Zaffagnini34. 1. U.O. Chirurgia Articolare e Traumatologia dello Sport, Istituto Clinico Villa Aprica, Como, Italy. 2. Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy. 3. 1° Clinica Ortopedica, ASST Centro specialistico ortopedico traumatologico Gaetano Pini, CTO, Milan, Italy. 4. 1° Clinica Ortopedica, ASST Centro specialistico ortopedico traumatologico Gaetano Pini, CTO, Milan, Italy. riccardo.compagnoni@gmail.com. 5. ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini, CTO, Milan, Italy. 6. Dipartimento di Ortopedia e Traumatologia, Università Campus biomedico, Rome, Italy. 7. Casa di Cura Villa del Sole, Catanzaro, Italy. 8. U.O. Ortopedia, Clinica "Città di Parma", Parma, Italy. 9. Sport Clinique, Clinica Mater Dei, Rome, Italy. 10. Centro di Chirurgia del Ginocchio, Istituto clinico Humanitas, Rozzano, MI, Italy. 11. Clinica Ortopedica dell'Università degli studi di Pavia, Fondazione policlinico San Matteo, Pavia, Italy. 12. U.O. Ortopedia e Traumatologia 2, Istituto clinico sant'Anna, Brescia, Italy. 13. Centro di Traumatologia dello Sport, Ospedale Koelliker, Turin, Italy. 14. Centro di Artroscopia e Chirurgia del Ginocchio, Clinica "Sol et Salus", Rimini, Italy. 15. Clinica Ortopedica Università di Udine, Udine, Italy. 16. Casa di Cura San Camillo, Forte dei Marmi, Lucca, Italy. 17. Clinica Ars Medica, Lugano, Switzerland. 18. Banca del tessuto muscolo scheletrico, ASST Centro specialistico Ortopedico Traumatologico Gaetano Pini, CTO, Milan, Italy. 19. Ospedale Universitario Sant'Andrea, Rome, Italy. 20. S.O. Ortopedia e Traumatologia, AOU Careggi, Firenze, Italy. 21. Oasi Bioresearch Foundation Gobbi NPO, Milan, Italy. 22. Ospedale Sacro Cuore di Negrar, Verona, Italy. 23. Dipartimento di Ortopedia dell'Università degli Studi di Sassari, Sassari, Italy. 24. Casa di cura villa Stuart, Rome, Italy. 25. S.C. Ortopedia Articolare, Ospedali Galliera, Genoa, Italy. 26. Dipartimento di Ortopedia dell'Università Cattolica di Roma, Rome, Italy. 27. Nuovo ospedale di Sassuolo, Modena, Italy. 28. Centro Sp.Or.T.S., Clinica Fornaca, Turin, Italy. 29. Dipartimento di medicina e scienza della salute (V. Tiberio), Università degli studi del Molise, Campobasso, Italy. 30. Centro di Traumatologia dello Sport, Istituto Ortopedico Galeazzi, Milan, Italy. 31. Centro di Chirurgia del ginocchio, Istituto Clinico "Città di Brescia" Brescia, Brescia, Italy. 32. Centro di Traumatologia dello Sport, Istituto clinico Humanitas, Rozzano, MI, Italy. 33. Villa Maria Cecilia Hospital, Cotignola, Ravenna, Italy. 34. Clinica Ortopedica e Traumatologica II Istituti Ortopedici Rizzoli Bologna, Bologna, Italy.
Abstract
PURPOSE: Graft choice for primary anterior cruciate ligament reconstruction (ACL-R) is debated, with considerable controversy and variability among surgeons. Autograft tendons are actually the most used grafts for primary surgery; however, allografts have been used in greater frequency for both primary and revision ACL surgery over the past decade. Given the great debate on the use of allografts in ACL-R, the "Allografts for Anterior Cruciate Ligament Reconstruction" consensus statement was developed among orthopedic surgeons and members of SIGASCOT (Società Italiana del Ginocchio, Artroscopia, Sport, Cartilagine, Tecnologie Ortopediche), with extensive experience in ACL-R, to investigate their habits in the use of allograft in different clinical situations. The results of this consensus statement will serve as benchmark information for future research and will help surgeons to facilitate the clinical decision making. METHODS: In March 2017, a formal consensus process was developed using a modified Delphi technique method, involving a steering group (9 participants), a rating group (28 participants) and a peer-review group (31 participants). Nine statements were generated and then debated during a SIGASCOT consensus meeting. A manuscript has been then developed to report methodology and results of the consensus process and finally approved by all steering group members. RESULTS: A different level of consensus has been reached among the topics selected. Strong agreement has been reported in considering harvesting, treatment and conservation methods relevant for clinical results, and in considering biological integration longer in allograft compared to autograft. Relative agreement has been reported in using allograft as the first-line graft for revision ACL-R, in considering biological integration a crucial aspect for rehabilitation protocol set-up, and in recommending a delayed return to sport when using allograft. Relative disagreement has been reported in using allograft as the first-line graft for primary ACL-R in patients over 50, and in not considering clinical results of allograft superior to autograft. Strong disagreement has been reported in using allograft as the first-line graft for primary ACL-R and for skeletally immature patients. CONCLUSIONS: Results of this consensus do not represent a guideline for surgeons, but could be used as starting point for an international discussion on use of allografts in ACL-R. LEVEL OF EVIDENCE: IV, consensus of experts.
PURPOSE: Graft choice for primary anterior cruciate ligament reconstruction (ACL-R) is debated, with considerable controversy and variability among surgeons. Autograft tendons are actually the most used grafts for primary surgery; however, allografts have been used in greater frequency for both primary and revision ACL surgery over the past decade. Given the great debate on the use of allografts in ACL-R, the "Allografts for Anterior Cruciate Ligament Reconstruction" consensus statement was developed among orthopedic surgeons and members of SIGASCOT (Società Italiana del Ginocchio, Artroscopia, Sport, Cartilagine, Tecnologie Ortopediche), with extensive experience in ACL-R, to investigate their habits in the use of allograft in different clinical situations. The results of this consensus statement will serve as benchmark information for future research and will help surgeons to facilitate the clinical decision making. METHODS: In March 2017, a formal consensus process was developed using a modified Delphi technique method, involving a steering group (9 participants), a rating group (28 participants) and a peer-review group (31 participants). Nine statements were generated and then debated during a SIGASCOT consensus meeting. A manuscript has been then developed to report methodology and results of the consensus process and finally approved by all steering group members. RESULTS: A different level of consensus has been reached among the topics selected. Strong agreement has been reported in considering harvesting, treatment and conservation methods relevant for clinical results, and in considering biological integration longer in allograft compared to autograft. Relative agreement has been reported in using allograft as the first-line graft for revision ACL-R, in considering biological integration a crucial aspect for rehabilitation protocol set-up, and in recommending a delayed return to sport when using allograft. Relative disagreement has been reported in using allograft as the first-line graft for primary ACL-R in patients over 50, and in not considering clinical results of allograft superior to autograft. Strong disagreement has been reported in using allograft as the first-line graft for primary ACL-R and for skeletally immature patients. CONCLUSIONS: Results of this consensus do not represent a guideline for surgeons, but could be used as starting point for an international discussion on use of allografts in ACL-R. LEVEL OF EVIDENCE: IV, consensus of experts.
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Authors: R J Simonds; S D Holmberg; R L Hurwitz; T R Coleman; S Bottenfield; L J Conley; S H Kohlenberg; K G Castro; B A Dahan; C A Schable Journal: N Engl J Med Date: 1992-03-12 Impact factor: 91.245
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