Analysis of outcomes of anterior cruciate ligament repair with 5-year follow-up: Allograft versus autograft

Gary G. Poehling, Walton W. Curl, Cassandra A Lee, T. Adam Ginn, Julia T. Rushing, Michelle J. Naughton, Martha B. Holden, David F. Martin, Beth P. Smith

Research output: Contribution to journalArticle

147 Scopus citations

Abstract

Purpose: To prospectively compare outcomes of primary anterior cruciate ligament (ACL) reconstruction with either Achilles tendon allograft with soft-tissue fixation or standard bone-patellar tendon-bone autograft with interference screw fixation. Type of Study: Prospective comparative case series. Methods: A group of 41 patients who underwent soft-tissue allograft reconstruction and a group of 118 patients who underwent autograft bone-patellar tendon-bone reconstruction were included in the final results. Patients were evaluated preoperatively and postoperatively at 1 to 2 weeks, 6 weeks, 3 months, 6 months, and then annually for 5 years. Objective measures of outcome included KT-1000 measurements, range of motion, ligamentous integrity, thigh atrophy, and International Knee Documentation Committee score. Subjective evaluations included patient completion of 5 questionnaires documenting functional status, pain, and health-related quality of life: (1) the short-form McGill Pain Questionnaire, (2) a patient subjective assessment of knee function and symptoms, (3) a patient subjective assessment follow-up, (4) a knee pain scale, and (5) the RAND 36-Item Health Survey. Mixed models analysis of variance was used to compare the outcomes of the treatment groups using baseline values of the study variables as a covariate. Results: Autograft patients reported significantly more pain on the bodily pain subscale of the RAND-36 than the allograft group at 1 week (P = .0006), 6 weeks (P = .0007), and 3 months (P = .0270). Autograft patients reported more pain than allograft patients on the McGill Pain Scale visual analog scale at 1 to 2 weeks (P < .0001) and 6 weeks (P = .0147). Patient assessment of function and symptoms showed that a higher proportion of patients reported normal or nearly normal knee function in the allograft group than in the autograft group at 3 months (33% v 14%, P = .0558, respectively). Fewer activity limitations were reported by allograft patients than autograft patients at 6 weeks (P = .0501), 3 months (P = .0431), and 6 months (P = .0014). After reconstruction, the allograft group displayed significantly more laxity in KT-1000 measurements at all time points than the autograft group (P = .0520). These measurements decreased over time for both groups (P < .0001). Conclusions: Five-year follow-up of patients undergoing ACL reconstruction with allograft versus autograft were compared objectively and subjectively. Both groups of patients achieved similar long-term outcomes. Overall, the allograft patients reported less pain at 1 and 6 weeks after surgery, better function at 1 week, 3 months, and 1 year, and fewer activity limitations throughout the follow-up period. Level of Evidence: Level II, prospective cohort study.

Original languageEnglish (US)
Pages (from-to)774-785
Number of pages12
JournalArthroscopy - Journal of Arthroscopic and Related Surgery
Volume21
Issue number7
DOIs
StatePublished - Jul 2005
Externally publishedYes

Keywords

  • Allograft
  • Anterior cruciate ligament reconstruction
  • Autograft
  • Health-related quality of life
  • Outcomes

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Surgery

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    Poehling, G. G., Curl, W. W., Lee, C. A., Ginn, T. A., Rushing, J. T., Naughton, M. J., Holden, M. B., Martin, D. F., & Smith, B. P. (2005). Analysis of outcomes of anterior cruciate ligament repair with 5-year follow-up: Allograft versus autograft. Arthroscopy - Journal of Arthroscopic and Related Surgery, 21(7), 774-785. https://doi.org/10.1016/j.arthro.2005.04.112