Fascia lata allograft: a suitable alternative in ligamentous reconstruction for chronic elbow instability?

Abstract

BackgroundUp to now there is no gold standard concerning the optimal graft choice in the surgical therapy of chronic elbow instability. As donor site morbidity represents a rare (1-4%) but severe complication of graft harvest, using an allograft seems favorable. Fascia lata mimics the anatomy through its fan shaped configuration of the ligamentous complex of the elbow joint, making it questionable for use as a graft. The aims of the study are a) to evaluate the biomechanical suitability of fascia lata allograft and b) compare clinical and radiological outcome between ligament reconstruction of the lateral collateral ligament complex (LUCL) using either FibreTape augmented triceps autograft or FibreTape augmented fascia lata allograft. MethodsBiomechanical testing of fascia lata was performed using a 10 kN uniaxial test system with a 1 kN load cell. The retrospective cohort study evaluated all patients who received a ligament reconstruction of the elbow due to chronic instability with allogenic fascia lata or autologous triceps tendon. Exclusion criteria were any type of coexisting fracture or nerval injury. Demographic parameters, patient reported outcome parameters (PROMs) and radiological stability parameters (sonography, fluoroscopy) were evaluated. ResultsTensile testing of 39 fascia lata allografts revealed an ultimate load of 234.8±23.1 N and ultimate strength of 33.4±4.4 MPa. 21 patients were included in the clinical substudy (57.1% men, 42.9% women , age 41.0 ± 12.2 years, BMI 24.9 ± 4.1 kg/m2) with average follow-up of 21.6 ± 17.1 months. No significant differences were found concerning pain level, PROMs or Range of Motion (ROM), between fascia lata and triceps group. There was also no difference concerning sonographic stability of LUCL between the 2 groups (p=0.14). One revision occurred in fascia lata allograft group, 2 in triceps autograft group due to graft elongation. ConclusionCurrently, there is no clinical evidence demonstrating the superiority of either autograft or allograft tissue. Due to its demonstration of sufficient biomechanical properties fascia lata allograft seems an appropriate treatment option for ligamentous reconstruction of chronic elbow instability.