Anterior Cruciate Ligament (ACL) rupture is common but severe injury and may lead to knee joint instability. Therefore, it requires surgical reconstruction in many cases to provide preinjury stability, especially for patients with a high level of activity. While arthroscopic reconstruction of the ACL is nowadays the gold standard, graft choice remains controversial. Quadriceps, hamstring and patella autograft tendons are most commonly used. Nowadays Allografts with the advantages of missing donor-site-morbidity, secured graft thickness, careful storage and unrestricted availability gaining upcoming popularity again after improvement regarding storage and surgical techniques. The aim of this study was to evaluate clinical outcome and HRQOL of Allografts, compared to hamstring Autografts used in primary ACL reconstruction.
Material And Methods
A total of 30 patients were included in this present randomized prospective study during the follow-up period of 13 months. 15 patients were operated using an Allograft and 15 patients were treated with an Autograft tendon. Preoperative, 6 and 12 weeks as well as 6 and 13 months postoperative all patients were examined regarding knee function, health related quality of life, range of motion, knee stability, pain and radiographic imaging. Therefore, the IKDC, the KOOS, the Lysholm Score, the Tegner-Activity-Scale, the VAS and the SF-36 were applied. An MRI was made preoperative as well as six months and one year after surgery. Allografts processing was constant and the operation technique (all-Inside-Technique) was the same in both groups.
Baseline characteristics were the same in both groups. The mean age of patients included was 35±7 years. At the end of the follow-up period 13 months after surgery no significant differences between the 2 study groups was seen regarding IKDC, KOOS, Lysom, TAS and the SF-36. The mean IKDC was 84±7 in the Allograft and 87±5 in the Autograft group (p=0.98) and at the KOOS presented 77±12 in the Allograft and 80 ± 6 (p=0.32) in the Autograft group. Postoperative SF-36 results showed a mean MCS of 54±12 and mean PCS of 47±4 in the Allograft compared to a mean MCS 55±6 and mean PCS of 50±6 in the Autograft group (p =0.67 and p=0.12). No instability or radiographic sign of re-rupture was detected in both groups. The operation time was significantly shorter in the Allograft group.
The results of the present study show comparable results between the 2 study groups. Hamstring Allografts provided no significant differences to Autografts in all applied Scores. However, the use of Allografts presented a operation time. In conclusion, the use of Allografts in primary ACL reconstruction could be considered as an alternative to Autografts, however results in the long term have to be waited for.