J Korean Orthop Assoc.  2008 Oct;43(5):618-624. 10.4055/jkoa.2008.43.5.618.

Comparison of Clinical Results in Anterior Cruciate Ligament Reconstruction Using Bone-Patellar Tendon-Bone Autograft and Using Achilles Tendon Allograft

• Choi HR
• Choi SW
• Kwon SW
• Park JS
• Lee BI

• KMID: 2186424
• DOI: http://doi.org/10.4055/jkoa.2008.43.5.618

Abstract

PURPOSE: To compare clinical outcomes after arthroscopic ACL reconstruction using bone-patellar tendon- bone autograft and using fresh-frozen Achilles tendon allograft.
MATERIALS AND METHODS
We enrolled 61 patients who underwent anterior cruciate ligament reconstruction by means of bone-patellar tendon-bone autograft or Achilles tendon allograft between March, 2002 and December, 2006. The bone-patellar tendon-bone group included 29 patients (mean age 30.4 years), and the Achilles tendon allograft group included 32 patients (mean age 32.5 years). The mean follow-up was 18.2 months and 25.7 months in each group, respectively. Preoperative and last follow-up clinical results were evaluated through physical examination, KT-2000 arthrometer, stress roentgenogram, IKDC knee rating system, and Lysholm knee score.
RESULTS
The mean side-to-side difference in anterior translation, as measured by KT-2000 arthrometer, was significantly improved from 6.4 mm+/-3.0 to 3.2 mm+/-1.9 in the bone-patellar tendon-bone group, and from 7.6 mm+/-3.1 to 2.9 mm+/-2.0 in the Achilles tendon allograft group (p<0.001). The Achilles tendon allograft group improved more significantly than did the bone-patellar tendon-bone group (p=0.045). The mean side-to-side difference on stress roentgenogram was significantly improved from 5.3 mm+/-2.5 to 2.0 mm+/-2.1 in the bone-patellar tendon-bone group, and from 6.0 mm+/-3.4 to 2.2 mm+/-2.1 in the Achilles tendon allograft group (p<0.001). There was no significant difference between the two groups. According to the IKDC knee rating system at last follow-up, 26 (89.7%) patients in the bone-patellar tendon-bone group and 28 (87.5%) patients in the Achilles allograft group were normal or nearly normal. The mean Lysholm knee score significantly improved from 69.9 to 90.2 in the bone-patellar tendon-bone group, and from 64.4 to 91.4 in the Achilles tendon allograft group (p<0.001).
CONCLUSION
Both bone-patellar tendon-bone and Achilles tendon allograft groups showed satisfactory clinical results, with no significant difference in outcomes between the groups. We suggest that both bone-patellar tendon-bone autograft and Achilles tendon allograft be considered as graft substitutes for anterior cruciate ligament reconstruction.

Keyword

Anterior cruciate ligament reconstruction; Bone-patellar tendon-bone autograft; Achilles tendon allograft

MeSH Terms

Achilles Tendon
Anterior Cruciate Ligament
Anterior Cruciate Ligament Reconstruction
Follow-Up Studies
Humans
Knee
Physical Examination
Transplantation, Homologous
Transplants

Reference

1. Baer GS, Harner CD. Clinical outcomes of allograft versus autograft in anterior cruciate ligament reconstruction. Clin Sports Med. 2007. 26:661–681.

2. Chang SKY, Egami DK, Shaieb MD, Kan DM, Richardson AB. Anterior cruciate ligament reconstruction: allograft versus autograft. Arthroscopy. 2003. 19:453–462.

3. Chon JG, Kim ES, Lee JG, et al. Comparison of ACL reconstruction using autograft of BPTB and allograft of BPTB and Achilles tendon. J Korean Knee Soc. 2001. 13:189–195.

4. Chung SW, Hahn SH, Yang BK, et al. Second-look arthroscopic findings after anterior cruciate ligament reconstruction: comparison between Achilles allograft and bonepatella tendon-bone autograft. J Korean Knee Soc. 2003. 15:102–110.

5. Cooper DE, Deng XH, Burstein AL, Warren RF. The strength of the central third patellar tendon graft. A biomechanical study. Am J Sports Med. 1993. 21:818–823.

6. Harner CD, Olson E, Irrgang JJ, Silverstein S, Fu FH, Silbey M. Allograft versus autograft anterior cruciate ligament reconstruction: 3- to 5-year outcome. Clin Orthop Relat Res. 1996. 324:134–144.

7. Kim JH, Lee YS, Rhee SY, Chung JH. Comparison of clinical outcomes in ACL reconstruction using auto-hamstring tendon and allo-tibialis tendon. J Korean Arthroscopy Soc. 2007. 11:104–110.

8. Lee CW, Kim YE. Arthroscopic ACL reconstruction using fresh-frozen Achilles allograft. J Kor Musculoskelet Transplant Soc. 2005. 5:15–20.

9. Lephart SM, Kocher MS, Harner CD, Fu FH. Quadriceps strength and functional capacity after anterior cruciate ligament reconstruction. Patellar tendon autograft versus allograft. Am J Sports Med. 1993. 21:738–743.

10. Marrale J, Morrissey MC, Haddad FS. A literature review of autograft and allograft anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2007. 15:690–704.

11. Peterson RK, Shelton WR, Bomboy AL. Allograft versus autograft patellar tendon anterior cruciate ligament reconstruction: a 5-year follow-up. Arthroscopy. 2001. 17:9–13.

12. Poehling GG, Curl WW, Lee CA, et al. Analysis of outcomes of anterior cruciate ligament repair with 5-year follow-up: allograft versus autograft. Arthroscopy. 2005. 21:774–785.

13. Seo JB, Jung HG, Kim MH, et al. Comparison study of anterior cruciate ligament reconstruction using bone-patella tendon-bone autograft and Achilles tendon allograft. J Korean Arthroscopy Soc. 2005. 9:132–136.

14. Victor J, Bellemans J, Witvrouw E, Govaers K, Fabry G. Graft selection in anterior cruciate ligament reconstruction - prospective analysis of patellar tendon autografts compared with allografts. Int Orthop. 1997. 21:93–97.

15. Yoo JD, Kim SI. Results of the reconstruction of anterior cruciate ligament with freshfrozen achilles allograft and of second-look arthroscopy. J Korean Arthroscopy Soc. 2007. 11:111–116.

16. Yoon KH, Bae DK, So DH, Lee JH, Kim JW, Park SY. Clinical results after ACL reconstruction using tibialis anterior tendon allograft and hamstring tendon autograft. J Korean Arthroscopy Soc. 2007. 11:85–91.