Tarık ALTUNKILIÇ, Bünyamin ARI, Ercan ŞAHİN, İsmail GÜZEL, Feyza İNCEOĞLU

Allogreft ve Otogreft Kullanılarak Ön Çapraz Bağ Rekonstrüksiyonu Yapılan Hastaların Klinik Karşılaştırması

Amaç: Bu çalışmanın amacı, ön çapraz bağın (ÖÇB) otogreft veya allogreft onarımı yapılmış olan bireylerin klinik sonuçlarının incelenmesidir. Gereç ve Yöntemler: 2014 ve 2020 yılları arasında semitendinosus-gracilis tendon otogreftleri (semitendinosus-gracilis tendon autografts, SGT-A) ve tibialis anterior tendon allogreftleri (tibialis anterior tendon allografts, TAT-A) kullanılmak suretiyle ÖÇB rekonstrüksiyonu yapılmış olan hastaların dosyaları üzerinde geriye dönük olarak analiz yapıldı. Bu çalışmaya her iki grupta da 30 hastanın verileri dahil edildi. Hastaların sonuçlarının karşılaştırılması amacıyla diz laksite testleri, Lysholm diz skorlama sistemi, Tegner aktivite skoru ve Uluslararası Diz Dokümantasyon Komitesi (International Knee Documentation Committee, IKDC) skoru kullanıldı. Bulgular: Preoperatif ölçüm ile son ölçüm arasında Tegner aktivite skoru bakımından anlamlı bir fark yokken (p=0,241), IKDC skorları ve Lysholm diz skorlamaları, bu çalışmadaki her iki grup için de preoperatif ölçüm ve son kontrol ziyareti arasında istatistiksel olarak anlamlı bir şekilde değişti (sırasıyla, p=0,020 ve p=0,038). SGT-A grubu Lysholm diz skorunun preoperatif değeri %60,97 ve son kontrol değeri ise %90,48 idi. TAT-A grubu için preoperatif Lysholm diz skoru değeri %61,31 ve son kontrol değeri ise %95,03 idi. Ön çekmece ve Lachman test bulguları, hem otogreft hem de allogreft gruplarında gruplar arası (otogreft ve allogreft) istatistiksel olarak anlamlı şekilde değişiklikler gösterdi (her iki p<0,001). Sonuç: Bu çalışmada diz fonksiyonu ve laksite açısından, otogreft grubuna kıyasla allogreft grubunda daha iyi klinik sonuç elde edilmiştir.

Anahtar Kelimeler:

Ön çapraz bağ, allogreft, artroskopi

Clinical Comparison of Patients Undergoing Anterior Cruciate Ligament Reconstruction Using an Allograft or Autograft

Aim: The purpose of this study was to examine the clinical results of individuals who underwent an autograft or allograft repair of the anterior cruciate ligament (ACL). Material and Methods: Retrospective analysis was done on the patient files of patients who underwent ACL reconstruction between 2014 and 2020 using semitendinosus-gracilis tendon autografts (SGT-A) and tibialis anterior tendon allografts (TAT-A). In this study, the data of 30 patients in each group were included. Knee laxity tests, the Lysholm knee grading system, the Tegner activity score, and the International Knee Documentation Committee (IKDC) score were used to compare patient results. Results: While there was no significant difference in the Tegner activity score between the preoperative and the final measurement (p=0.241), the IKDC scores and the Lysholm knee ratings changed statistically significantly between the preoperative measurement and the last control visit (p=0.020, and p=0.038, respectively) for both groups in this study. The SGT-A group’s Lysholm knee score had a preoperative value of 60.97% and a final control value of 90.48%. The preoperative Lysholm knee score for the TAT-A group was 61.31%, and the final control value was 95.03%. The anterior drawer and Lachman test findings showed statistically significant intergroup (autograft and allograft) alterations in both the autograft and allograft groups (both p<0.001). Conclusion: In terms of knee function and laxity, this study achieved a better clinical outcome in the allograft group compared to the autograft group.

Keywords:

Anterior cruciate ligament, allograft, arthroscopy,

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Herzog MM, Marshall SW, Lund JL, Pate V, Mack CD, Spang JT. Trends in incidence of ACL reconstruction and concomitant procedures among commercially insured individuals in the United States, 2002-2014. Sports Health. 2018;10(6):523-31.
Nicholls M, Aspelund T, Ingvarsson T, Briem K. Nationwide study highlights a second peak in ACL tears for women in their early forties. Knee Surg Sports Traumatol Arthrosc. 2018;26(2):648-54.
Fodor P, Sólyom A, Ivănescu A, Fodor R, Bățagă T. Prevalence of chondral lesions in knee arthroscopy. J Interdiscip Med. 2018;3(1):21-4.
Nwachukwu BU, Patel BH, Lu Y, Allen AA, Williams RJ 3rd. Anterior cruciate ligament repair outcomes: an updated systematic review of recent literature. Arthroscopy. 2019;35(7):2233-47.
Etzel CM, Nadeem M, Gao B, Boduch AN, Owens BD. Graft choice for anterior cruciate ligament reconstruction in women aged 25 years and younger: a systematic review. Sports Health. 2022;14(6):829-41.
Mahiroğullari M, Kuşkucu M, Kiral A, Pehlivan O, Akmaz I, Tirmik U. Early results of reconstruction of chronic anterior cruciate ligament ruptures using four-strand hamstring tendon autografts. Acta Orthop Traumatol Turc. 2005;39(3):224-30. Turkish.
Arnold MP, Calcei JG, Vogel N, Magnussen RA, Clatworthy M, Spalding T, et al. ACL study group survey reveals the evolution of anterior cruciate ligament reconstruction graft choice over the past three decades. Knee Surg Sports Traumatol Arthrosc. 2021;29(11):3871-6.
Bianchi N, Sacchetti F, Bottai V, Gesi M, Carlisi A, Facchini A, et al. LARS versus hamstring tendon autograft in anterior cruciate ligament reconstruction: a single-centre, single surgeon retrospective study with 8 years of follow-up. Eur J Orthop Surg Traumatol. 2019;29(2):447-53.
Faul F, Erdfelder E, Lang AG. Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses. Behav Res Methods. 2009;41(4):1149-60.
Beck NA, Lawrence JTR, Nordin JD, DeFor TA, Tompkins M. ACL tears in school-aged children and adolescents over 20 years. Pediatrics. 2017;139(3):e20161877.
Widner M, Dunleavy M, Lynch S. Outcomes following ACL reconstruction based on graft type: are all grafts equivalent? Curr Rev Musculoskelet Med. 2019;12(4):460-5.
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.
Arida C, Tsikrikas CG, Mastrokalos DS, Panagopoulos A, Vlamis J, Triantafyllopoulos IK. Comparison of bone-patella tendon-bone and four-strand hamstring tendon grafts for anterior cruciate ligament reconstruction: a prospective study. Cureus. 2021;13(11):19197.
Tisherman R, Wilson K, Horvath A, Byrne K, De Groot J, Musahl V. Allograft for knee ligament surgery: an American perspective. Knee Surg Sports Traumatol Arthrosc. 2019;27(6):1882-90.
Su M, Jia X, Zhang Z, Jin Z, Li Y, Dong Q, et al. Medium-term (least 5 years) comparative outcomes in anterior cruciate ligament reconstruction using 4SHG, allograft, and LARS ligament. Clin J Sport Med. 2021;31(2):e101-10.
Lin KM, Boyle C, Marom N, Marx RG. Graft selection in anterior cruciate ligament reconstruction. Sports Med Arthrosc Rev. 2020;28(2):41-8.
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.
Razi M, Moradi A, Safarcherati A, Askari A, Arasteh P, Ziabari EZ, et al. Allograft or autograft in skeletally immature anterior cruciate ligament reconstruction: a prospective evaluation using both partial and complete transphyseal techniques. J Orthop Surg Res. 2019;14(1):85.
Yang R, Deng H, Hou J, Ouyang Y, Chen Z, Song B, et al. Comparison of knee stability and synovial fluid alterations in anterior cruciate ligament reconstruction with a hamstring autograft or an allograft. Orthopedics. 2017;40(5):e892-7.
Cengiz Ö, Demir N, Dırvar F. Effects of graft selection in arthroscopic anterior cruciate ligament reconstruction: midterm functional results. Sisli Etfal Hastan Tip Bul. 2019;53(4):419-25.
Deng NL, Zhang L, Sun J, Ma J, Zhang S, Liu XH, et al. Tibialis anterior allograft versus hamstring tendon autograft for anterior cruciate ligament reconstruction:long-term clinical outcomes. Zhongguo Gu Shang. 2021;34(3):269-74. Chinese.
Zeng C, Gao SG, Li H, Yang T, Luo W, Li YS, et al. Autograft versus allograft in anterior cruciate ligament reconstruction: a meta-analysis of randomized controlled trials and systematic review of overlapping systematic reviews. Arthroscopy. 2016;32(1):153-63.e18.
Bistolfi A, Capella M, Guidotti C, Sabatini L, Artiaco S, Massè A, et al. Functional results of allograft vs. autograft tendons in anterior cruciate ligament (ACL) reconstruction at 10-year follow-up. Eur J Orthop Surg Traumatol. 2021;31(4):729-35.
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. Arthrosc Sports Med Rehabil. 2022;4(4):e1513-21.
Haffar A, Goh GS, Fillingham YA, Torchia MT, Lonner JH. Treatment of arthrofibrosis and stiffness after total knee arthroplasty: an updated review of the literature. Int Orthop. 2022;46(6):1253-79.
Rucinski K, Stannard JP, Crecelius C, Cook JL. Changes in knee range of motion after large osteochondral allograft transplantations. Knee. 2021;28:207-13.
Cheuy VA, Foran JRH, Paxton RJ, Bade MJ, Zeni JA, Stevens-Lapsley JE. Arthrofibrosis associated with total knee arthroplasty. J Arthroplasty. 2017;32(8):2604-11.
Sheth U, Sniderman J, Whelan DB. Early surgery of multiligament knee injuries may yield better results than delayed surgery: a systematic review. JISAKOS. 2019;4(1):26-32.
Sasaki Y, Fujii M, Araki D, Marshall BD, Linde MA, Smolinski P, et al. Effect of percentage of femoral anterior cruciate ligament insertion site reconstructed with hamstring tendon on knee kinematics and graft force. Am J Sports Med. 2021;49(5):1279-85.
Büyükdoğan K, Laidlaw MS, Fox MA, Kew ME, Miller MD. Effect of tibial tunnel placement using the lateral meniscus as a landmark on clinical outcomes of anatomic single-bundle anterior cruciate ligament reconstruction. Am J Sports Med. 2021;49(6):1451-9.