Abstract
BackgroundThere is no consensus as to the choice of grafts for primary anterior cruciate ligament (ACL) reconstruction. The purpose of this study was to compare the clinical and second-look arthroscopic outcomes after ACL reconstruction by use of autograft, hybrid graft, and γ-irradiated allograft.MethodsNinety-seven patients who underwent second-look arthroscopy after ACL reconstruction with autografts (28 patients, hamstring autograft), hybrid grafts (32 patients, hamstring autograft augmented with γ-irradiated tibialis anterior tendon allograft), or γ-irradiated allografts (37 patients, tibialis anterior tendons) were included in this study. The clinical outcomes were compared by using Lysholm score, International Knee Documentation Committee (IKDC) score, and Tegner activity score, and the side-to-side differences of KT-1000 measurement. Second-look arthroscopic findings were compared in terms of synovial coverage and graft tension.ResultsThere were no statistical significances among the three groups in Lysholm score, IKDC score, or Tegner activity score (P > 0.05). The KT-1000 examination showed more anterior laxity in the γ-irradiated allograft group than in the autograft or hybrid graft groups (P = 0.006, and P = 0.013, respectively). Two patients in the autograft group, 2 patients in the hybrid graft group and 4 patients in the allograft group were evaluated as graft failure on second-look arthroscopy. The synovial coverage was superior in the autograft group than that in the hybrid graft group or the allograft group (P = 0.013 and P = 0.010, respectively), and was comparable between the hybrid graft group and allograft group (P = 0.876). With regard to graft tension, the autograft group and hybrid group were comparable (P = 0.883) but showed better results than the allograft group (P = 0.011 and P = 0.007, respectively).ConclusionThe hamstring autografts and hybrid grafts used for ACL reconstruction produced equal efficacy but provided better knee stability than allografts. In addition, the hamstring autografts showed better synovial coverage than the other two graft types.
Highlights
There is no consensus as to the choice of grafts for primary anterior cruciate ligament (ACL) reconstruction
Only a few studies compared the clinical outcomes between hamstring autografts and hybrid grafts used for ACL reconstruction, and whether allograft augmented hamstrings are effective is still debatable
Patients who underwent second-look arthroscopy after anatomic single-bundle ACL reconstruction were retrospectively reviewed, and signed informed consent was obtained from each participant
Summary
There is no consensus as to the choice of grafts for primary anterior cruciate ligament (ACL) reconstruction. Some controlled clinical studies have reported comparable results with soft-tissue allografts and hamstring tendon autografts [8, 9], whereas others reported that the allograft tendons might have inferior graft maturity, higher risk of graft failure, and increased knee laxity than autograft tendons in ACL reconstruction [2, 10, 11]. Another solution to an inadequate graft diameter is hybrid graft which comprises autograft hamstrings and allograft soft tissues. It is still unclear which of the three types of grafts, including hamstring autograft, hybrid graft, and soft-tissue allograft, is the optimal option for primary ACL reconstruction
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