[Allograft for surgical reconstruction of the cruciate ligaments of the knee - part 1].

PURPOSE OF THE STUDY: The growing numbers of anterior cruciate ligament (ACL) reconstructions performed by an increasing number of surgeons have resulted in an increased number of failed reconstructed ligaments. For repeat surgery, autologous tissues are most frequently used, namely BTB graft, hamstring tendons or quadriceps tendon construct. However, these alternative methods have certain disadvantages and therefore we decided to use BTB allografts from cadaverous donors. The risk of disease transmission due to allograft implantation has been reported to be low, but a thorough serological screening of donors is the prerequisite. We used BTB allografts first in revision ACL surgery only, but because of good results we started using theme for reconstruction of both cruciate ligaments and, in some cases, also for primary reconstruction.

MATERIAL: In the period from 2002 to 2004, patellar ligaments harvested from 23 cadaverous donors were used at the orthopedic ward of the Ceské Budejovice hospital to prepare 87 BTB grafts, of which 42 were implanted. In 57 % of the procedures, an allograft was used in revision surgery carried out for the failure of a ;previously reconstructed ACL in 10 % it was used in complete reconstruction of both cruciate ligaments, and in 14 % it was used for primary ACL reconstruction in indicated cases. In 19 % of the cases, allograft was used when autologous graft failed or was damaged during the primary operation.

METHODS: Graft harvesting, storage, handling and implantation have been carried out in accordance with the practices included in Act no. 285/2002 Coll. Serological examination of the donors and bacteriological assays of the grafts were performed according to the current regulations. The implantation of BTB allografts in ACL reconstruction was carried out by the standard method used in reconstructive procedures.

RESULTS: Out of 87 BTB allografts prepared, 16 were discarded because of positive culture findings. Two allografts could not be used because the screening was positive for CMV infection. No infectious complications, poor healing or a systemic response to the allograft implanted were recorded in any of the patients.

DISCUSSION: The use of allografts is a method suitable for revision surgery in failed ACL reconstruction. It allows us to avoid further weakening of the structures associated with the knee joint. The size of allograft bony blocks permits treatment of defects in the tibial or the femoral tunnel.

CONCLUSIONS: The use of a BTB allograft is a reliable and safe procedure. It has advantages not only in revision ACL reconstruction, but also in reconstruction of both cruciate ligaments. Also primary ACL reconstruction in indicated cases achieved good results.