Artroskopik Ön Çapraz Rekonstrüksiyonlarında Taze donmuş Allogreft ile Otogreft Karşılaştırması

Öz

Amaç: Bu çalışmanın amacı; taze donmuş allogreft ile anatomik önçapraz bağ rekonsrüksiyonu ile otogreft ile anatomik ön çapraz bağ rekonsrüksiyonu arasındaki klinik sonuçların karşılaştırmasını yapmaktır. Methods: Taze donmuş allogreft (n:49) ve otogreft (n:39) ile ön çapraz bağ rekonsrüksiyonu yapılmış 87 hastanın rertospektif sonuçları çalışmaya dahil edildi. Preoperatif ve postoperatif akvitive düzeyleri Tegner aktivite skalası ile değerlendirilirken, fonksiyonel durum Lsyholm skoru ile değerlendirildi. Klinik instabiliteyi değerlendirmek için preoperatif ve postoperatif Lachman testi, pivot shift testi ve öne çekmece testi kullanıldı. Bulgular: Hastaların yaş ortalaması 28.3±7(16-49) idi. 87 erkek hasta çalışmaya dahil edildi. Ön çapraz bağ yaralanması ile cerrahi arasında geçen süre 13,4 (2ay-10 yıl) aydı. Lsyholm diz skoru, Tegner aktivite skalası, instabilite testi sonuçları preopartif değerlere göre tatminkardı ve iki grup arasında anlamlı bir fark saptanmadı(p>0.05). Sonuç: Çalışılan parametreler açısından taze donmuş allogreft ve otogreft ile ACL rekonstrüksiyonları arasında fark görülmedi.

Anahtar Kelimeler

• ön çapraz bağ
• allogreft
• otogreft
• artroskopi

A comparison of fresh-frozen allograft and autograft results in arthroscopic anterior cruciate ligament reconstruction

Öz

Objectives: This study’s goal was to make a comparison of clinical outcomes between anatomic ACL reconstruction with fresh-frozen allograft and anatomic ACL reconstruction with autograft. Methods: The retrospective results of 87 patients, who had undergone anterior cruciate ligament (ACL) reconstruction with fresh-frozen allograft (n: 49) or autograft (n: 38), were included in the study. While preoperative and postoperative levels of activity were assessed using the Tegner activity scale, the functional status was used by the Lysholm knee score. The preoperative and postoperative Lachman test, pivot shift test, and anterior drawer test were used to evaluate clinical instability. Results: The patients’ mean age was 28.3 ± 7 years (16-49). There were 87 male patients. The average time between the ACL injury and surgery was 13.4 months (2 months-10 years). The Lysholm knee score, Tegner activity score, and instability test results were satisfactory compared with the preoperative values, and no significant difference was determined between the two groups (p> 0.05). Conclusions: There was no difference between ACL reconstructions with fresh-frozen allograft and autograft in terms of the studied parameters.

Anahtar Kelimeler

• Anterior cruciat ligament
• allograft
• autograft
• arthroscopy

Kaynakça

1. 1. Wu J, Kator JL, Zarro M, Leong NL. Rehabilitation Principles to Consider for Anterior Cruciate Ligament Repair. Sports Health. 2022;14(3):424-32.
2. 2. Sanders TL, Maradit Kremers H, Bryan AJ, Larson DR, Dahm DL, Levy BA, et al. Incidence of anterior ligament tears and reconstruction: A 21- year population-based study. Am J Sports Med. 2016;44(6):1502-7.
3. 3. Maniar N, Cole MH, Bryant AL, Opar DA. Muscle Force Contributions to Anterior Cruciate Ligament Loading. Sports Med. 2022;52(8):1737-50.
4. 4. Petersen W, Guenther D, Imhoff AB, Herbort M, Stein T, Schoepp C, et al. Management after acute rupture of the anterior cruciate ligament (ACL). Part 1: ACL reconstruction has a protective effect on secondary meniscus and cartilage lesions. Knee Surg Sports Traumatol Arthrosc. 2023;31(5):1665-74.
5. 5. Dhammi IK, Rehan-Ul-Haq, Kumar S. Graft choices for anterior cruciate ligament reconstruction. Indian J Orthop. 2015;49(2):127-8.
6. 6. Lara PHS, Novaretti JV, Nunes GRDS, Cohen M, Ramos LA. New Graft Choices for ACL Reconstruction: Update Article. Rev Bras Ortop. 2024;59(5):e642-9.
7. 7. Chechik O, Amar E, Khashan M, Lador R, Eyal G, Gold A. An international survey on anterior cruciate ligament reconstruction practices. Int Orthop. 2013;37:201-6.
8. 8. Buerba RA, Boden SA, Lesniak B. Graft selection in contemporary anterior cruciate ligament reconstruction. J Am Acad Orthop Surg Glob Res Rev. 2021;5(10):e21.00230.

9. 9. Huang Z, Cui J, Zhong M, Deng Z, Chen K, Zhu W. Risk factors of cartilage lesion after anterior cruciate ligament reconstruction. Front Cell Dev Biol. 2022;10:935795.
10. 10. Brinlee AW, Dickenson SB, Hunter-Giordano A, Snyder-Mackler L. ACL Reconstruction Rehabilitation: Clinical Data, Biologic Healing, and Criterion-Based Milestones to Inform a Return-to-Sport Guideline. Sports Health. 2022;14(5):770-9.
11. 11. Mehl J, Otto A, Baldino JB, Achtnich A, Akoto R, Imhoff AB, et al. The ACL-deficient knee and the prevalence of meniscus and cartilage lesions: a systematic review and meta-analysis (CRD42017076897). Arch Orthop Trauma Surg. 2019;139(6):819-41.
12. 12. Goetz G, de Villiers C, Sadoghi P, Geiger-Gritsch S. Allograft for Anterior Cruciate Ligament Reconstruction (ACLR): A Systematic Review and Meta-Analysis of Long-Term Comparative Effectiveness and Safety. Results of a Health Technology Assessment. Arthrosc Sports Med Rehabil. 2020;2(6):e873-91.
13. 13. DeFroda S, Fice M, Tepper S, Bach BR Jr. Our Preferred Technique for Bone-Patellar Tendon-Bone Allograft Preparation. Arthrosc Tech. 2021;10(11):e2591-96.
14. 14. Brown MJ, Carter T. ACL allograft: advantages and When to Use. Sports Med Arthrosc Rev 2018;26:75-8.
15. 15. Saliba I, Hardy A. Four-Stranded Semitendinosus Tendon Anterior Cruciate Ligament Reconstruction With Mini-invasive Anterolateral Ligament Reconstruction. Arthrosc Tech. 2024;13(7):102988.
16. 16. Darnley JE, Léger-St-Jean B, Pedroza AD, Flanigan DC, Kaeding CC, Magnussen RA. Anterior Cruciate Ligament Reconstruction Using a Combination of Autograft and Allograft Tendon: A MOON Cohort Study. Orthop J Sports Med. 2016;4(7):2325967116662249.
17. 17. Fan L, Zhang L, Tang J, Xu Z, Fu W. Comparison of clinical outcomes between hamstring tendon autografts and hybrid grafts in ACL reconstruction: a systematic review and meta-analysis. J Orthop Surg Res. 2024;19(1):809.
18. 18. Alomar AZ, Nasser ASB, Kumar A, Kumar M, Das S, Mittal S. Hamstring graft diameter above 7 mm has a lower risk of failure following anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2022;30(1):288-97.
19. 19. D'Ambrosi R, Giorgino R, Corona K, Jaykumar T, Mariani I, Ursino N, et al. Hamstring tendon autografts and allografts show comparable clinical outcomes and knee stability after anterior cruciate ligament reconstruction in patients over fifty years old with no signs of osteoarthritis progression. Int Orthop. 2022;46(9):2029-39.
20. 20. Williams RJ, Hyman J, Petrigliano F, Rozental T, Wickiewicz TL. Anterior Cruciate Ligament Reconstruction with a Four-Strand Hamstring Tendon Autograft. J Bone Jt Surg. 2005;87(1):51-66.
21. 21. Smith CK, Howell SM, Hull ML. Anterior Laxity, Slippage, and Recovery of Function in the First Year After Tibialis Allograft Anterior Cruciate Ligament Reconstruction. Am J Sports Med. 2011;39(1):78-88.
22. 22. Lee JH, Bae DK, Song SJ, Cho SM, Yoon KH. Comparison of Clinical Results and Second-Look Arthroscopy Findings After Arthroscopic Anterior Cruciate Ligament Reconstruction Using 3 Different Types of Grafts. Arthrosc J Arthrosc Relat Surg. 2010;26(1):41-9.
23. 23. Dhillon J, Kraeutler MJ, Belk JW, McCarty EC, McCulloch PC, Scillia AJ. Autograft and nonirradiated allograft for anterior cruciate ligament reconstruction demonstrate similar clinical outcomes and graft failure rates: an updated systematic review. Arthroscopy, Sports Medicine, and Rehabilitation. 2022,4(4), e1513-21.
24. 24. Cusumano A, Capitani P, Messina C, Girolamo L, Vigano M, Ravasio G, et al. Different timing in allograft and autograft maturation after primary anterior cruciate ligament reconstruction does not influence the clinical outcome at mid-long-term follow-up. Knee Surg Sports Traumatol Arthrosc. 2022;30(7):2281-90.
25. 25. Jung SH, Choi CH, Kim SH, Chung K, Moon HS, Sim W, et al. Sequential Comparison of Knee Muscle Strength after Anterior Cruciate Ligament Reconstruction between Hamstring Autograft and Tibialis Anterior Allograft: Propensity Score Matched Pair Analysis. Diagnostics (Basel). 2024;14(14):1478.
26. 26. D'Ambrosi R, Meena A, Arora ES, Attri M, Schäfer L, Migliorini F. Reconstruction of the anterior cruciate ligament: a historical view. Ann Transl Med. 2023;11(10):364.
27. 27. Setiawan CR, Aryana IGNW. Graft Selection Between Tendon Autograft and Allograft in Anterior Cruciate Ligament Reconstruction Based on the Histological Perspective: A Meta-Analysis. Rev Bras Ortop (Sao Paulo). 2023;58(3):388-96.
28. 28. Atik OŞ. Autografts or allografts for anterior cruciate ligament reconstruction?. Jt Dis Relat Surg. 2013;24(3):125-25.