Arthroscopic All-Inside Anterior Cruciate Ligament Reconstruction: Allograft versus Hamstring Autograft, a Randomized Controlled Pilot Study

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1 Arthroscopic All-Inside Anterior Cruciate Ligament Reconstruction: Allograft versus Hamstring Autograft, a Randomized Controlled Pilot Study Bernhardt GA, Oswald T, Ruckenstuhl P, Baltic A, Seibert FJ, Leithner A, Gruber G. Department of Orthopedics and Trauma, Medical University of Graz, AUSTRIA

2 Disclosure Gerwin A. Bernhardt, MD, MBA I have no financial conflicts to disclose.

3 Introduction Anterior cruciate ligament (ACL) ruptures are one of the most common sports associated knee injuries. A high number of ACL ruptures require ACL reconstruction. Reconstruction with autografts frequently results in muscle weakness and pain at donor site. With the use of allografts donor site morbidity can be avoided. The aim of this study was to investigate the outcome of patients with arthroscopic all-inside ACL allograft versus hamstring autograft reconstruction

4 Methods We performed a randomized controlled pilot study with 30 patients. Patients aged 27 years or older with confirmed ACL ruptures were included. Patients were treated with the same allinside technique (Arthrex) either with a pre-shaped allograft ( graft link, LifeNet Health) or with a 6-fold single hamstring tendon (gracilis or semitendinosus). The Study was approved by the local ethics committee and all patients signed an informed consent.

5 Methods-Data Clinical examination Pre-surgery 6 weeks 12 weeks 6 months 13 months X X X X X VAS X X X X X IKDC X X X X X Lysholm Knee Q X X X X X Tegner Activity Scale X X X X X SF-36 X X X X X X-Ray X X X X X MR-Imaging X X X

6 Results Fifteen patients were included in each group. Basic data did not differ between the two groups. There were more male (67%) than female patients. The mean age was 41.6±9.8 years. There were no re-ruptures in either group. The objective and subjective outcome scorings did not differ significantly between the groups. Operation time was significantly shorter in the allograft group compared to the autograft group (time saving 7.8±4.6 minutes). There were no infections or revisions within the study period of one year.

7 Conclusion Our study results show satisfactory objective and subjective outcomes in both groups. The shorter operation time as well as missing donor site morbidity is in favor the use of allograft. These results need to be confirmed in a larger well powered studies in the long term.

8 Summary Using the all-inside technique ACL allograft reconstruction is superior to hamstring autograft reconstruction in the short term.

9 References Legnani C, Zini S, Borgo E, Ventura A. Can graft choice affect return to sport following revision anterior cruciate ligament reconstruction surgery? Arch Orthop Trauma Surg Apr;136(4): Kan SL, Yuan ZF, Ning GZ, Yang B, Li HL, Sun JC, Feng SQ. Autograft versus allograft in anterior cruciate ligament reconstruction: A meta-analysis with trial sequential analysis. Medicine (Baltimore) Sep;95(38):e4936 Kane PW, Wascher J, Dodson CC, Hammoud S, Cohen SB, Ciccotti MG. Anterior cruciate ligament reconstruction with bone-patellar tendon-bone autograft versus allograft in skeletally mature patients aged 25 years or younger. Knee Surg Sports Traumatol Arthrosc Nov;24(11): Young SW, Valladares RD, Loi F, Dragoo JL. Mechanoreceptor Reinnervation of Autografts Versus Allografts After Anterior Cruciate Ligament Reconstruction. Orthop J Sports Med Oct 20;4(10): Darnley JE, Léger-St-Jean B, Pedroza AD, Flanigan DC, Kaeding CC, Magnussen RA. Anterior Cruciate Ligament Reconstruction Using a Combination of Autograft and Allograft Tendon: A MOON Cohort Study. Orthop J Sports Med Jul 28;4(7): Tian S, Wang B, Liu L, Wang Y, Ha C, Li Q, Yang X, Sun K. Irradiated Hamstring Tendon Allograft Versus Autograft for Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction: Midterm Clinical Outcomes. Am J Sports Med Oct;44(10): Bottoni CR, Smith EL, Shaha J, Shaha SS, Raybin SG, Tokish JM, Rowles DJ. Autograft Versus Allograft Anterior Cruciate Ligament Reconstruction: A Prospective, Randomized Clinical Study With a Minimum 10-Year Follow-up. Am J Sports Med Oct;43(10): Mariscalco MW, Magnussen RA, Mehta D, Hewett TE, Flanigan DC, Kaeding CC. Autograft versus nonirradiated allograft tissue for anterior cruciate ligament reconstruction: a systematic review. Am J Sports Med Feb;42(2): Zeng C, Gao SG, Li H, Yang T, Luo W, Li YS, Lei GH. Autograft Versus Allograft in Anterior Cruciate Ligament Reconstruction: A Meta-analysis of Randomized Controlled Trials and Systematic Review of Overlapping Systematic Reviews. Arthroscopy Jan;32(1): e18. Engelman GH, Carry PM, Hitt KG, Polousky JD, Vidal AF. Comparison of allograft versus autograft anterior cruciate ligament reconstruction graft survival in an active adolescent cohort. Am J Sports Med Oct;42(10):

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