Arthroscopic reconstruction of the anterior cruciate ligament with hamstring tendon autograft and fresh-frozen allograft: a prospective, randomized controlled study

Kang Sun, Jihua Zhang, Yan Wang, Changsuo Xia, Cailong Zhang, Tengbo Yu, Shaoqi Tian
American Journal of Sports Medicine 2011, 39 (7): 1430-8

BACKGROUND: Most studies of allograft versus autograft for anterior cruciate ligament reconstruction have been of bone-patellar tendon-bone; outcome reports evaluating anterior cruciate ligament reconstruction with hamstring tendon autograft versus allograft are rare.

PURPOSE: This study was undertaken to compare the clinical outcome of arthroscopic anterior cruciate ligament reconstruction with hamstring tendon autograft versus allograft.

STUDY DESIGN: Randomized controlled trial; Level of evidence, 2.

METHODS: Between 2000 and 2004, 208 patients who met the inclusion and exclusion criteria of the study were prospectively randomized into autograft (n = 104) or allograft (n = 104) groups. All hamstring tendon allografts were fresh-frozen and obtained from a single certified tissue bank. All the operations were done by the same surgeon with the same surgical technique. Femoral and tibial fixation was by means of an EndoButton and a bioabsorbable interference screw augmented with a staple, respectively. Patients were evaluated preoperatively and postoperatively. Evaluations included detailed history, physical examination, functional knee ligament testing, KT-2000 arthrometer testing, Harner vertical jump and Daniel 1-legged hop tests, Lysholm score, Tegner score, the International Knee Documentation Committee (IKDC) standard evaluation form, Cincinnati knee score, and radiographs.

RESULTS: Of these patients, 186 (autograft, n = 91; allograft, n = 95) were available for full evaluation. Demographic data were comparable between groups. The mean follow-up was 7.8 years for both groups. There were no statistically significant differences according to the evaluations of the outcome aforementioned between the 2 groups except that patients in the allograft group had a shorter operation time than the autograft group. Seven patients (7.7%) in the autograft group and 8 (8.4%) in the allograft group had a side-to-side difference >5 mm. Eighty-five patients (93.4%) in the autograft group and 86 (90.5%) in the allograft group were normal or nearly normal according to the overall IKDC. According to the subjective IKDC, the average scores were 89 and 90 points, respectively, for the autograft and allograft groups. The mean Lysholm and Tegner scores were 89 points and 7.7 points, respectively, for the autograft group and 90 points and 7.6 points, respectively, for the allograft group. For the Cincinnati knee score, the average scores were 90 and 91 points, respectively, for the autograft and allograft groups.

CONCLUSION: Both groups of patients achieved almost the same satisfactory outcome at an average of 7.8 years of follow-up. Fresh-frozen hamstring tendon allograft is a reasonable alternative choice to autograft for anterior cruciate ligament reconstruction.

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