- Discussion:
- general
discussion of allograft tissue:
- as pointed out by Harner et al. 1996, subjective knee scores were slightly better for knees having ACL - bone patellar bone allograft (as compared to BPB autograft patients)
- objective ratings included normal (or nearly normal) results in 48% of allograft patients vs. 38% of autograft patients;
- in contrast, the study by Stringham et al 1996, several interesting findings were noted:
- Lysholm scores greater than 90 were found in 69% of autograft patients vs 67% of allograft patients;
- side to side laxitiy measurements of less than 3 mm were found in 80% of autograft patients vs 70% allograft patients;
- patellofemoral symptoms were slightly more common in allograft patients than in autograft patients;
- 4 out of 31 allograft patients sustained traumatic ruptures within one year of surgery;
- Complications:
-
tibial tunnel syndrome:
- postoperative widening of the tibial tunnel of more than 2.8 mm may occur in 46% of patients who receive an allograft;
- consider tying the graft over a tibial post;
-
graft rejection:
- note that fresh frozen and freeze dried allografts do not seem to cause graft rejection;
-
allograft ruptures:
- may occur as a result of using allografts from older donors (age older than 30-35 is a risk factor);
Use of allografts after failed treatment of rupture of the anterior cruciate ligament [see comments].
The effects of in situ freezing on the anterior cruciate ligament. An experimental study in goats.
The biomechanics of anterior cruciate ligament rehabilitation and reconstruction.
Arms SW, Pope MH, Johnson RJ, Fischer RA, Arvidsson I, Eriksson E. Am J Sports Med 1984; 12:8-18.
Intraarticular reaction associated with the use of freeze-dried, ethylene oxide-sterilized bone-patella tendon-bone allografts in the reconstruction of the anterior cruciate ligament.
Am J Sports Med 1990;18:1. Jackson DW, Windler GE, Simon TM:
Anterior cruciate ligament reconstruction using freeze dried ethylene oxide sterilized bone-patella tendon-bone allografts: 2 years of results in 35 patients.
Am J Sports Med 1991;19:35-41. Roberts TS, Drez D, McCarthy W, et al:
The effect of a ligament-augmentation device on allograft reconstructions for chronic ruptures of the anterior cruciate ligament.
Use of Allografts after Failed Treatment of Rupture of the Anterior Cruciate Ligament.
Comparison of anterior cruciate ligament reconstructions using patellar tendon autograft or allograft. DR Stringham MD et al. Arthroscopy Vol 12 No 4. Aug. 1996. p 414-421.
Failure of Primary Anterior Cruciate Ligament Surgery Using Anterior Tibialis Allograft.
Do Anterior Cruciate Ligament Allograft Culture Results Correlate With Clinical Infections?
