Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Oswald,T.
Allograft versus Hamstring Autograft in primary Anterior Cruciate Ligament Reconstruction
Humanmedizin; [Diplomarbeit] Medical University of Graz;2019. pp. 149
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- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Bernhardt Gerwin
- Gruber Gerald
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- Abstract:
- Introduction. An Anterior Cruciate Ligament (ACL) rupture is a very common but severe injury that requires surgical reconstruction in many cases, to provide preinjury stability to return to sport, especially for patients competing professionally. While arthroscopic reconstruction of the ACL is nowadays the gold standard, graft choice is mainly based on surgeon´s preference. Quadriceps, hamstring and patella tendons are the most commonly used grafts. Allografts may be another alternative with the advantages of missing donor-site-morbidity, secured graft thickness and unrestricted availability. The aim of this study was to evaluate short term clinical outcome and HRQOL of Allografts, compared to hamstring Autografts used in primary ACL reconstruction. Material and Methods. A total of 22 patients out of 30 were available for the 12 weeks follow – up evaluation. Sixteen patients were operated using an Allograft, 6 using an Autograft. Patients under the age of 27 were not included in the study. Preoperative, 6 weeks and 12 weeks postoperative patient´s knee function, health related quality of life, range of motion, knee stability, pain and radiographic data was analysed. We used the IKDC, KOOS, Lysholm Score, Tegner – Activity – Scale, SF – 36 and VAS in addition to clinical examination and radiologic procedures to document the outcomes. All operations were performed by the same surgeon. Allografts processing was constant and the operation technique was the same in both groups. Results. Baseline characteristics were the same in both groups. The mean age was 44 ± 10 in the Allograft and 38 ± 8 in the Autograft group. After 6 weeks mean range of motion in the Allograft group was 107° ± 17°, while it was 98° ± 9° in the Autograft group (p = 0.352). After 12 weeks it was 135° ± 14° and 129° ± 15° (p = 0.391). Mean Lysholm score was 77 ± 11 in the Allograft group and 74 ± 12 in the Autograft group after 6 weeks (p = 0.514). After 12 weeks patients in the Allograft group reached 90 ± 12 and 87 ± 9 in the Autograft group on average (p = 0.572). Mean IKDC was 55 ± 10 in the Allograft and 44 ± 8 in the Autograft group after 6 weeks (p = 0.104). After 12 weeks it was 68 ± 13 and 63 ± 9 (p = 0.412). Mean overall KOOS was 65 ± 10 in the Allograft and 54 ± 11 (p = 0.032) in the Autograft group at the first follow – up. After 12 weeks it increased up to 82 ± 11 in the Allograft and 72 ± 18 in the Autograft group (p = 0.085). SF – 36 results after 6 weeks showed a mean PCS of 41 ± 5 in the Allograft and 38 ± 7 in the Autograft group (p = 0.407). MCS was 55 ± 11 and 54 ± 16 at this point (p = 0.927). PCS was 50 ± 6 and 47 ± 4 after 12 weeks on average (p = 0.122). Mean MCS was 55 ± 6 and 54 ± 12 (p = 0.666). Mean VAS was 2.2 ± 2 in the Allograft group, while it was 1.7 ± 1 in the Autograft group (p = 0.590). After 12 weeks it was 1 ± 1 in the Allograft and 1.5 ± 1 in the Autograft group on average (p = 0.329). Mean operation time was 58 ± 13 minutes using an Allograft and 74 ± 4 minutes when using an Autograft (p = 0.006). No instability or radiographic sign of re-rupture was detected in both groups. The operation time was significantly shorter in the Allograft group. Discussion. This is one of the first studies prospectively comparing Allografts and Autografts in primary ACL reconstruction. We show, that Allografts provide equal results to hamstring Autografts in the short term. We could not detect any significant differences between the groups regarding to standardized outcome scores. However, our data show that using an Allograft significantly shortens the operation time. In conclusion, the use of Allografts in primary ACL reconstruction could be considered as an alternative to Autografts, however results in the long term have to be waited for.