Allograft or autograft in skeletally immature anterior cruciate ligament reconstruction: a prospective evaluation using both partial and complete transphyseal techniques

Mohammad Razi,Haleh Dadgostar,Afsane Safarcherati,Amin Moradi,Elaheh Ziaei Ziabari,Alireza Askari,Peyman Arasteh

doi:10.1186/s13018-019-1128-7

Abstract

ObjectiveWe compared autografts and allograft using partial and complete transphyseal anterior cruciate ligament (ACL) reconstruction techniques among skeletally immature individuals.MethodsMale and females younger than 18 and 16 years old, respectively, diagnosed with ACL tear from April 2006 to March 2012 entered the study. One group had four-strand hamstring autograft, and the other had tibialis posterior allograft reconstruction. Those who had allografts either had hyper-laxity or recurvatum.ResultsAchieved mean (± SD) 2000 International Knee Documentation Committee subjective score was not statistically different (P = 0.385) between allograft (n = 13) (84.3 ± 3.2) and autograft groups (n = 18) (85.6 ± 4.4). Mean Knee injury and Osteoarthritis Outcome Score (KOOS) subscale Knee-Related Quality of Life at 2 years was 78.0 ± 7.2 and 75 ± 7.4 for allograft and autograft groups, respectively (p = 0.261). Mean 2-year KOOS subscale Sports and Recreation was 82.1 ± 5.8 and 84.8 ± 6.6 for allograft and autograft groups, respectively (p = 0.244).No patient reported instability, giving way, or locking of the knee. Pivot shift test was negative in all patients; however, a minor positive Lachman test was found in six cases (46%) within the allograft group and seven cases (39%) in the autograft group. One postoperative septic arthritis was documented in the autograft group.ConclusionConsidering existing concern that joint laxity and recurvatum are among the precursors of non-contact ACL injury in adolescents, bone-patellar-bone autografts are not applicable in this age group because of the open physis; furthermore, considering that hamstring autografts are insufficient (size thickness and stretchability), we recommend soft tissue allografts for ACL reconstruction in skeletally immature patients.

Highlights

Anterior cruciate ligament (ACL) injuries have become more prevalent in the skeletally immature patient over the past 20 years [1]
Tibialis posterior tendon allograft was used for ACL reconstruction in 13 patients
Pivot shift test was negative in all patients, but a minor positive Lachman test was found in six cases (46%) within the allograft group and seven cases (39%) in the autograft group (Table 2)

Summary

Introduction

Anterior cruciate ligament (ACL) injuries have become more prevalent in the skeletally immature patient over the past 20 years [1]. The rate of successful ACL reconstructive surgery has been reported to be about 90% in restoring knee stability and patient satisfaction in the adult population [7, 8]; there is no consensus regarding the best method to treat an ACL tear in the pediatric athletes [9]. In adolescents with mid-substance rupture of ACL, failure of reconstructive surgery is more likely attributable to weakness of collagen fibers and their connections. The selection of allografts for ACL reconstruction for adolescents seems a logical choice. Some recent literature has shown that the use of allografts in the adolescent athlete leads to an unacceptable failure rate [12, 13]

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Discussion

Conclusion