Does the Graft Source Really Matter in the Outcome of Patients Undergoing Anterior Cruciate Ligament Reconstruction?

Background Despite the large number of anterior cruciate ligament reconstructions performed each year, there remains a significant controversy regarding the effect of the graft source on the functional outcome of patients. Hypothesis There is no difference in outcomes of autograft versus allograft a...

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Bibliographic Details
Published in:The American journal of sports medicine 2010-01, Vol.38 (1), p.189
Main Authors: Foster, Timothy E, Wolfe, Brian L, Ryan, Scott, Silvestri, Lorenzo, Krall Kaye, Elizabeth
Format: Article
Language:English
Subjects:
Knee
Ligaments
Skin & tissue grafts
Sports medicine
Statistical analysis
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Summary:Background Despite the large number of anterior cruciate ligament reconstructions performed each year, there remains a significant controversy regarding the effect of the graft source on the functional outcome of patients. Hypothesis There is no difference in outcomes of autograft versus allograft anterior cruciate ligament reconstructions. Study Design Systematic review. Methods The authors systematically identified prospective studies (Oxford level of evidence I or II only) that included autograft patients, allograft patients, or both. Objective outcomes that were reported were meta-analyzed; this included pivot-shift results, KT-1000 arthrometer results, International Knee Documentation Committee (IKDC) scores, Lysholm Scores, graft failures, and postoperative complications. Two statistical analyses were performed. First a primary statistical analysis was performed comparing pooled autograft data (bone–patellar–tendon bone and hamstrings combined) and pooled allograft data (bone–patellar–tendon bone and hamstrings combined). To have a more comprehensive understanding of the differences between each specific graft source, a secondary analysis was performed without pooling the data; this directly compared the 4 types of graft sources that were studied. Results Over 400 scientific manuscripts were initially reviewed; 31 manuscripts fulfilled all of the search criteria. There were very few statistically significant differences between autograft and allograft tissue. The KT-1000 arthrometer laxity testing revealed a mean of 1.4 ± 0.2 mm (weighted mean ± standard error of the mean) for the allograft group compared with 1.8 ± 0.1 mm for the autograft group ( t = 2.40; P .1). The graft failure rate was 4.7 ± 0.5 per 100 for autograft reconstructions and 8.2 ± 2.1 per 100 allograft reconstructions; although this may represent a
ISSN:0363-5465
1552-3365
DOI:10.1177/0363546509356530