Christophe Hulet1, Bertrand Sonnery-Cottet2, Ciara Stevenson3, Kristian Samuelsson4,5, Lior Laver3, Urszula Zdanowicz6,7, Sjoerd Stufkens8, Jonathan Curado1, Peter Verdonk9, Tim Spalding10. 1. Department of Orthopedics and Traumatology, Caen University Hospital, Avenue Cote de Nacre, 14000, Caen, France. 2. Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France. 3. University Hospital Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry, UK. 4. Sahlgrenska University Hospital, Mölndal, Sweden. 5. Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. 6. Carolina Medical Center, Pory 78, 02-757, Warsaw, Poland. 7. McGowan Institute for Regenerative Medicine, University of Pittsburgh, 450 Technology Drive, Suite 300, Pittsburgh, PA, 15219-3110, USA. 8. Academic Medical Center Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands. 9. Antwerp Orthopedic Center, Monica Hospitals, Antwerp, Belgium. 10. University Hospital Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry, UK. tim.spalding@uhcw.nhs.uk.
Abstract
PURPOSE: Graft choice in primary anterior cruciate ligament (ACL) reconstruction remains controversial. The use of allograft has risen exponentially in recent years with the attraction of absent donor site morbidity, reduced surgical time and reliable graft size. However, the published evidence examining their clinical effectiveness over autograft tendons has been unclear. The aim of this paper is to provide a current review of the clinical evidence available to help guide surgeons through the decision-making process for the use of allografts in primary ACL reconstruction. METHODS: The literature in relation to allograft healing, storage, sterilisation, differences in surgical technique and rehabilitation have been reviewed in addition to recent comparative studies and all clinical systematic reviews and meta-analyses. RESULTS: Early reviews have indicated a higher risk of failure with allografts due to association with irradiation for sterilisation and where rehabilitation programs and post-operative loading may ignore the slower incorporation of allografts. More recent analysis indicates a similar low failure rate for allograft and autograft methods of reconstruction when using non-irradiated allografts that have not undergone chemically processing and where rehabilitation has been slower. However, inferior outcomes with allografts have been reported in young (< 25 years) highly active patients, and also when irradiated or chemically processed grafts are used. CONCLUSION: When considering use of allografts in primary ACL reconstruction, use of irradiation, chemical processing and rehabilitation programs suited to autograft are important negative factors. Allografts, when used for primary ACL reconstruction, should be fresh frozen and non-irradiated. Quantification of the risk of use of allograft in the young requires further evaluation. LEVELS OF EVIDENCE: III.
PURPOSE: Graft choice in primary anterior cruciate ligament (ACL) reconstruction remains controversial. The use of allograft has risen exponentially in recent years with the attraction of absent donor site morbidity, reduced surgical time and reliable graft size. However, the published evidence examining their clinical effectiveness over autograft tendons has been unclear. The aim of this paper is to provide a current review of the clinical evidence available to help guide surgeons through the decision-making process for the use of allografts in primary ACL reconstruction. METHODS: The literature in relation to allograft healing, storage, sterilisation, differences in surgical technique and rehabilitation have been reviewed in addition to recent comparative studies and all clinical systematic reviews and meta-analyses. RESULTS: Early reviews have indicated a higher risk of failure with allografts due to association with irradiation for sterilisation and where rehabilitation programs and post-operative loading may ignore the slower incorporation of allografts. More recent analysis indicates a similar low failure rate for allograft and autograft methods of reconstruction when using non-irradiated allografts that have not undergone chemically processing and where rehabilitation has been slower. However, inferior outcomes with allografts have been reported in young (< 25 years) highly active patients, and also when irradiated or chemically processed grafts are used. CONCLUSION: When considering use of allografts in primary ACL reconstruction, use of irradiation, chemical processing and rehabilitation programs suited to autograft are important negative factors. Allografts, when used for primary ACL reconstruction, should be fresh frozen and non-irradiated. Quantification of the risk of use of allograft in the young requires further evaluation. LEVELS OF EVIDENCE: III.
Authors: Markus P Arnold; Jacob G Calcei; Nicole Vogel; Robert A Magnussen; Mark Clatworthy; Tim Spalding; John D Campbell; John A Bergfeld; Seth L Sherman Journal: Knee Surg Sports Traumatol Arthrosc Date: 2021-01-24 Impact factor: 4.342
Authors: Tim Spalding; Peter Verdonk; Laura de Girolamo; Romain Seil; David Dejour Journal: Knee Surg Sports Traumatol Arthrosc Date: 2019-05-10 Impact factor: 4.342