Abstract
To describe the outcomes of autografts and synthetics in anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) reconstruction with respect to instrumented laxity measurements, patient‐reported outcome scores, complications, and graft failure risk. We searched PubMed, Cochrane Library, and EMBASE for published randomized controlled trials (RCT) and case controlled trials (CCTs) to compare the outcomes of the autografts versus synthetics after cruciate ligament reconstruction. Data analyses were performed using Cochrane Collaboration RevMan 5.0. Nine studies were identified from the literature review. Of these studies, three studies compared the results of bone–patellar tendon–bone (BPTB) and ligament augmentation and reconstruction system (LARS), while six studies compared the results of four‐strand hamstring tendon graft (4SHG) and LARS. The comparative study showed no difference in Lysholm score and failure risk between autografts and synthetics. The combined results of the meta‐analysis indicated that there was a significantly lower rate of side‐to‐side difference > 3 mm (Odds Ratio [OR] 2.46, 95% confidence intervals [CI] 1.44–4.22, P = 0.001), overall IKDC (OR 0.40, 95% CI 0.19–0.83, P = 0.01), complications (OR 2.54, 95% CI 1.26–5.14, P = 0.009), and Tegner score (OR −0.31, 95% CI −0.52–0.10, P = 0.004) in the synthetics group than in the autografts group. This systematic review comparing long‐term outcomes after cruciate ligament reconstruction with either autograft or synthetics suggests no significant differences in failure risk. Autografts were inferior to synthetics with respect to restoring knee joint stability and patient‐reported outcome scores, and were also associated with more postoperative complications.
Highlights
Assisted anterior cruciate ligament (ACL) or posterior cruciate ligament (PCL) reconstruction has been widely used for patients with cruciate ligament lesions, and advances in arthroscopic surgery have yielded good clinical results
Meta-analysis allows us to quantitatively analyze multiple prospective comparative studies with similar study objectives to increase sample size and improve statistical power. We performed this up-to-date metaanalysis of comparative studies to assess the safety and efficacy of cruciate ligament reconstruction that use either autografts or synthetics in order to provide a reference for the selection of autograft
Shorter surgical and anesthesia time, fewer postoperative complications, reduced morbidity at the harvest site, faster postoperative recovery and lower incidence of postoperative arthrofibrosis, and less postoperative pain are considered to be the main advantages of allograft usage for ACL replacement[3]
Summary
Assisted anterior cruciate ligament (ACL) or posterior cruciate ligament (PCL) reconstruction has been widely used for patients with cruciate ligament lesions, and advances in arthroscopic surgery have yielded good clinical results. Controversy continues over the choice of graft tissue, including autografts, allografts, and synthetic ligaments. Autograft cruciate reconstruction is the gold standard, providing reliable longterm results. Regardless of its type, autograft harvest can result in a degree of morbidity, which may negatively affect recovery after ACL reconstruction[2]. The use of allografts has increased in recent years because they offer less donor-site morbidity, shorter surgical and anesthesia times, fewer postoperative complications, faster postoperative recovery, lower incidence of postoperative arthrofibrosis, less postoperative pain, and an unlimited graft source in the setting of multi-ligament and revision reconstructions[3,4].
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