Clinical Research
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Long Term Comparison of Hamstring Tendon Autograft and Tibialis Anterior Tendon Allograft Use in ACL Reconstruction

Year 2024, Volume: 6 Issue: 2, 152 - 158, 16.05.2024
https://doi.org/10.37990/medr.1396427

Abstract

Aim: In the early 2000s, the optimal graft for anterior cruciate ligament (ACL) reconstruction was a subject of uncertainty. Today, autografts have become the gold standard in this procedure. Aim of this study is to contribute to the existing knowledge by conducting a comprehensive comparison of the long-term clinical outcomes between hamstring allografts and anterior tibialis tendon allografts (ATT) in the context of ACL reconstruction.
Material and Method: This study was conducted based on individuals who were operated on with the diagnosis of symptomatic ACL rupture 10 years ago. Participants were randomly assigned to undergo ACL reconstruction using either hamstring autografts or anterior tibialis allografts. All allografts were procured from a single tissue bank, underwent aseptic processing, and were fresh-frozen without terminal irradiation. Patient assessments included questionnaires based on the Lysholm knee scoring scale (LKSS) and the International Knee Documentation Committee (IKDC) subjective knee score. Objective functional tests, such as the Lachman test and pivot-shift, were performed, accompanied by a comprehensive physical examination of the knee.
Results: A total of 60 patients, comprising 58 males and 2 females, with a mean age of 29.48±6.2, were included in the study. Predominant symptoms reported were pain and giving-way phenomena. Significantly different LKSS values were observed between the preoperative and postoperative periods for both anterior tibialis allograft and hamstring autograft patients (p<0.001). Similarly, a significant difference was noted in the preoperative and postoperative IKDC scores for all patients (p<0.001).
Conclusion: Based on our research findings, both the hamstring autograft and allograft methods demonstrate success in improving LKSS and IKDC scores for patients undergoing ACL repair surgery. Notably, the autograft group exhibits a more pronounced improvement compared to the allograft group.

Ethical Statement

Approval from Ankara Bilkent City Hospital 2nd Ethics Commitee

Supporting Institution

No

Project Number

E2-23-4869

References

  • Yasen SK, Borton ZM, Eyre-Brook AI, et al. Clinical outcomes of anatomic, all-inside, anterior cruciate ligament (ACL) reconstruction. The Knee. 2017;24:55-62.
  • Nordenvall R, Bahmanyar S, Adami J et al. A population-based nationwide study of cruciate ligament injury in Sweden, 2001-2009: incidence, treatment, and sex differences. Am J Sports Med. 2012;40:1808-13.
  • Doğan Ö, Çalişkan E, Gencer B. Clinical results of single bundle anterior cruciate ligament reconstruction with hamstring autograft. Akdeniz Tıp Dergisi. 2019;5:504-9.
  • Karakoç Y, Özanlağan E. Comparison of hamstring tendon autograft and tibialis anterior allograft methods in anterior cruciate ligament reconstruction surgery: a retrospective study. Acta Oncologica Turcica. 2021;54:103-10.
  • Burnham JM, Wright V. Update on anterior cruciate ligament rupture and care in the female athlete. Clin Sports Med. 2017;36:703-15.
  • Davies GJ, McCarty E, Provencher M, Manske RC. ACL return to sport guidelines and criteria. Curr Rev Musculoskelet Med. 2017;10:307-14.
  • Vundelinckx B, Herman B, Getgood A, Litchfield R. Surgical indications and technique for anterior cruciate ligament reconstruction combined with lateral extra-articular tenodesis or anterolateral ligament reconstruction. Clin Sports Med. 2017;36:135-53.
  • Karakoç Y, Atalay İB. The role of magnetic resonance imaging and clinical assessments in predicting meniscal tear surgery. Eklem Hastalik Cerrahisi. 2019;30:85-90.
  • Muller B, Hofbauer M, Wongcharoenwatana J, Fu FH. Indications and contraindications for double-bundle ACL reconstruction. International orthopaedics. 2013;37:239-46.
  • Nordenvall R, Bahmanyar S, Adami J, et al. Cruciate ligament reconstruction and risk of knee osteoarthritis: the association between cruciate ligament injury and post-traumatic osteoarthritis. a population based nationwide study in Sweden, 1987–2009. PloS One. 2014;9:e104681.
  • Atik OŞ. Autografts or allografts for anterior cruciate ligament reconstruction?. Eklem Hastalık Cerrahisi. 2013;24:125.
  • Demirağ B, Ermutlu C, Aydemir F, Durak K. A comparison of clinical outcome of augmentation and standard reconstruction techniques for partial anterior cruciate ligament tears. Eklem Hastalik Cerrahisi. 2012;23:140-4.
  • Pujol N, Colombet P, Cucurulo T, et al. Natural history of partial anterior cruciate ligament tears: a systematic literature review. Orthop Traumatol Surg Res. 2012;98:S160-4.
  • Ahldén M, Kartus J, Ejerhed L, et al. Knee laxity measurements after anterior cruciate ligament reconstruction, using either bone–patellar–tendon–bone or hamstring tendon autografts, with special emphasis on comparison over time. Knee Surg Sports Traumatol Arthrosc. 2009;17:1117-24.
  • Biau DJ, Tournoux C, Katsahian S, et al. Bone-patellar tendon-bone autografts versus hamstring autografts for reconstruction of anterior cruciate ligament: meta-analysis. BMJ. 2006;332:995-1001.
  • Forster MC, Forster IW. Patellar tendon or four-strand hamstring? A systematic review of autografts for anterior cruciate ligament reconstruction. Knee. 2005;12:225-30.
  • Goldblatt JP, Fitzsimmons SE, Balk E, Richmond JC. Reconstruction of the anterior cruciate ligament: meta-analysis of patellar tendon versus hamstring tendon autograft. Arthroscopy. 2005;21:791-803.
  • Wagner M, Kääb MJ, Schallock J, et al. Hamstring tendon versus patellar tendon anterior cruciate ligament reconstruction using biodegradable interference fit fixation: a prospective matched-group analysis. Am J Sports Med. 2005;33:1327-36.
  • Maletis GB, Inacio MC, Funahashi TT. Analysis of 16,192 anterior cruciate ligament reconstructions from a community-based registry. Am J Sports Med. 2013;41:2090-8.
  • Caborn DN, Selby JB. Allograft anterior tibialis tendon with bioabsorbable interference screw fixation in anterior cruciate ligament reconstruction. Arthroscopy. 2002;18:102-5.
  • Cole DW, Ginn TA, Chen GJ, et al. Cost comparison of anterior cruciate ligament reconstruction: autograft versus allograft. Arthroscopy. 2005;21:786-90.
  • Pearsall AW 4th, Hollis JM, Russell GV Jr, Scheer Z. A biomechanical comparison of three lower extremity tendons for ligamentous reconstruction about the knee. Arthroscopy. 2003;19:1091-6.
  • Sherman OH, Banffy MB. Anterior cruciate ligament reconstruction: which graft is best? Arthroscopy. 2004;20:974-80.
  • Arnoczky SP. The biology of allograft incorporation. J Knee Surg. 2006;19:207-14.
  • Eagan MJ, McAllister DR. Biology of allograft incorporation. Clin Sports Med. 2009;28:203-14.
  • Genuario JW, Faucett SC, Boublik M, Schlegel TF. A cost-effectiveness analysis comparing 3 anterior cruciate ligament graft types: bone-patellar tendon-bone autograft, hamstring autograft, and allograft. Am J Sports Med. 2012;40:307-14.
  • Liu Y, Liu X, Liu Y, Yang S. Comparison of clinical outcomes of using the nonirradiated and irradiated allograft for anterior cruciate ligament (ACL) reconstruction: A systematic review update and meta-analysis. Medicine (Baltimore). 2022;101:e29990.
  • Chen L, Cooley V, Rosenberg T. ACL reconstruction with hamstring tendon. Orthop Clin North Am. 2003;34:9-18.
  • Tegner Y, Lysholm J. Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res. 1985:43-9.
  • Höher J, Münster A, Klein J, et al. Validation and application of a subjective knee questionnaire. Knee Surg Sports Traumatol Arthrosc. 1995;3:26-33.
Year 2024, Volume: 6 Issue: 2, 152 - 158, 16.05.2024
https://doi.org/10.37990/medr.1396427

Abstract

Project Number

E2-23-4869

References

  • Yasen SK, Borton ZM, Eyre-Brook AI, et al. Clinical outcomes of anatomic, all-inside, anterior cruciate ligament (ACL) reconstruction. The Knee. 2017;24:55-62.
  • Nordenvall R, Bahmanyar S, Adami J et al. A population-based nationwide study of cruciate ligament injury in Sweden, 2001-2009: incidence, treatment, and sex differences. Am J Sports Med. 2012;40:1808-13.
  • Doğan Ö, Çalişkan E, Gencer B. Clinical results of single bundle anterior cruciate ligament reconstruction with hamstring autograft. Akdeniz Tıp Dergisi. 2019;5:504-9.
  • Karakoç Y, Özanlağan E. Comparison of hamstring tendon autograft and tibialis anterior allograft methods in anterior cruciate ligament reconstruction surgery: a retrospective study. Acta Oncologica Turcica. 2021;54:103-10.
  • Burnham JM, Wright V. Update on anterior cruciate ligament rupture and care in the female athlete. Clin Sports Med. 2017;36:703-15.
  • Davies GJ, McCarty E, Provencher M, Manske RC. ACL return to sport guidelines and criteria. Curr Rev Musculoskelet Med. 2017;10:307-14.
  • Vundelinckx B, Herman B, Getgood A, Litchfield R. Surgical indications and technique for anterior cruciate ligament reconstruction combined with lateral extra-articular tenodesis or anterolateral ligament reconstruction. Clin Sports Med. 2017;36:135-53.
  • Karakoç Y, Atalay İB. The role of magnetic resonance imaging and clinical assessments in predicting meniscal tear surgery. Eklem Hastalik Cerrahisi. 2019;30:85-90.
  • Muller B, Hofbauer M, Wongcharoenwatana J, Fu FH. Indications and contraindications for double-bundle ACL reconstruction. International orthopaedics. 2013;37:239-46.
  • Nordenvall R, Bahmanyar S, Adami J, et al. Cruciate ligament reconstruction and risk of knee osteoarthritis: the association between cruciate ligament injury and post-traumatic osteoarthritis. a population based nationwide study in Sweden, 1987–2009. PloS One. 2014;9:e104681.
  • Atik OŞ. Autografts or allografts for anterior cruciate ligament reconstruction?. Eklem Hastalık Cerrahisi. 2013;24:125.
  • Demirağ B, Ermutlu C, Aydemir F, Durak K. A comparison of clinical outcome of augmentation and standard reconstruction techniques for partial anterior cruciate ligament tears. Eklem Hastalik Cerrahisi. 2012;23:140-4.
  • Pujol N, Colombet P, Cucurulo T, et al. Natural history of partial anterior cruciate ligament tears: a systematic literature review. Orthop Traumatol Surg Res. 2012;98:S160-4.
  • Ahldén M, Kartus J, Ejerhed L, et al. Knee laxity measurements after anterior cruciate ligament reconstruction, using either bone–patellar–tendon–bone or hamstring tendon autografts, with special emphasis on comparison over time. Knee Surg Sports Traumatol Arthrosc. 2009;17:1117-24.
  • Biau DJ, Tournoux C, Katsahian S, et al. Bone-patellar tendon-bone autografts versus hamstring autografts for reconstruction of anterior cruciate ligament: meta-analysis. BMJ. 2006;332:995-1001.
  • Forster MC, Forster IW. Patellar tendon or four-strand hamstring? A systematic review of autografts for anterior cruciate ligament reconstruction. Knee. 2005;12:225-30.
  • Goldblatt JP, Fitzsimmons SE, Balk E, Richmond JC. Reconstruction of the anterior cruciate ligament: meta-analysis of patellar tendon versus hamstring tendon autograft. Arthroscopy. 2005;21:791-803.
  • Wagner M, Kääb MJ, Schallock J, et al. Hamstring tendon versus patellar tendon anterior cruciate ligament reconstruction using biodegradable interference fit fixation: a prospective matched-group analysis. Am J Sports Med. 2005;33:1327-36.
  • Maletis GB, Inacio MC, Funahashi TT. Analysis of 16,192 anterior cruciate ligament reconstructions from a community-based registry. Am J Sports Med. 2013;41:2090-8.
  • Caborn DN, Selby JB. Allograft anterior tibialis tendon with bioabsorbable interference screw fixation in anterior cruciate ligament reconstruction. Arthroscopy. 2002;18:102-5.
  • Cole DW, Ginn TA, Chen GJ, et al. Cost comparison of anterior cruciate ligament reconstruction: autograft versus allograft. Arthroscopy. 2005;21:786-90.
  • Pearsall AW 4th, Hollis JM, Russell GV Jr, Scheer Z. A biomechanical comparison of three lower extremity tendons for ligamentous reconstruction about the knee. Arthroscopy. 2003;19:1091-6.
  • Sherman OH, Banffy MB. Anterior cruciate ligament reconstruction: which graft is best? Arthroscopy. 2004;20:974-80.
  • Arnoczky SP. The biology of allograft incorporation. J Knee Surg. 2006;19:207-14.
  • Eagan MJ, McAllister DR. Biology of allograft incorporation. Clin Sports Med. 2009;28:203-14.
  • Genuario JW, Faucett SC, Boublik M, Schlegel TF. A cost-effectiveness analysis comparing 3 anterior cruciate ligament graft types: bone-patellar tendon-bone autograft, hamstring autograft, and allograft. Am J Sports Med. 2012;40:307-14.
  • Liu Y, Liu X, Liu Y, Yang S. Comparison of clinical outcomes of using the nonirradiated and irradiated allograft for anterior cruciate ligament (ACL) reconstruction: A systematic review update and meta-analysis. Medicine (Baltimore). 2022;101:e29990.
  • Chen L, Cooley V, Rosenberg T. ACL reconstruction with hamstring tendon. Orthop Clin North Am. 2003;34:9-18.
  • Tegner Y, Lysholm J. Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res. 1985:43-9.
  • Höher J, Münster A, Klein J, et al. Validation and application of a subjective knee questionnaire. Knee Surg Sports Traumatol Arthrosc. 1995;3:26-33.
There are 30 citations in total.

Details

Primary Language English
Subjects Orthopaedics, Sports Medicine
Journal Section Original Articles
Authors

Zeki Günsoy 0000-0003-3349-9226

Abdullah Yalçın Tabak 0000-0002-3268-0245

Mustafa Dinç 0000-0002-3002-5028

Ömer Cevdet Soydemir 0000-0001-8493-8562

Project Number E2-23-4869
Publication Date May 16, 2024
Submission Date November 29, 2023
Acceptance Date February 12, 2024
Published in Issue Year 2024 Volume: 6 Issue: 2

Cite

AMA Günsoy Z, Tabak AY, Dinç M, Soydemir ÖC. Long Term Comparison of Hamstring Tendon Autograft and Tibialis Anterior Tendon Allograft Use in ACL Reconstruction. Med Records. May 2024;6(2):152-158. doi:10.37990/medr.1396427

17741

Chief Editors

Assoc. Prof. Zülal Öner
Address: İzmir Bakırçay University, Department of Anatomy, İzmir, Türkiye

Assoc. Prof. Deniz Şenol
Address: Düzce University, Department of Anatomy, Düzce, Türkiye

E-mail: medrecsjournal@gmail.com

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