Download PDF
J Knee Surg 2013; 26(02): 109-116
DOI: 10.1055/s-0032-1319778
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Allograft Versus Autograft in Posterior Cruciate Ligament Reconstruction: An Evidence-Based Systematic Review

Joshua L. Hudgens
1   Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
,
Blake P. Gillette
1   Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
,
Aaron J. Krych
1   Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
,
Michael J. Stuart
1   Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
,
Jedediah H. May
1   Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
,
Bruce A. Levy
1   Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
› Author Affiliations
Further Information

Publication History

04 August 2011

08 April 2012

Publication Date:
28 June 2012 (online)

    Permissions and Reprints

Abstract

Controversy exists as to the superior graft source for posterior cruciate ligament (PCL) reconstruction. Allogeneic and autogeneic tissue have unique advantages and disadvantages, but little is known about the performance of one versus the other. This study is an evidence-based, systematic literature review comparing clinical and functional outcomes of allograft and autograft PCL reconstruction. A search was conducted via the Cochrane and MEDLINE databases for all relevant studies meeting the following inclusion criteria: (1) English language, (2) human subjects, (3) between the years 1980 and 2011, (4) minimum 24-month follow-up, (5) measures of clinical and functional outcomes, and (6) patients with isolated grade II/III PCL injuries who had failed nonoperative management and were deemed clinically and functionally unstable. Excluded studies were (1) technique articles, (2) case reports, and (3) patients with additional ligamentous or bony injuries. A total of 19 relevant studies were identified (2 direct comparison, 5 allograft, and 12 autograft). No appreciable differences between allograft and autograft PCL reconstruction were identified. A paucity of data exists comparing allogeneic and autogeneic PCL reconstruction, but satisfactory clinical and functional results have been obtained with both graft sources.

Keywords

posterior cruciate ligament - reconstruction - allograft - autograft
 

  • References

  • 1 Cosgarea AJ, Jay PR. Posterior cruciate ligament injuries: evaluation and management. J Am Acad Orthop Surg 2001; 9 (5) 297-307
    PubMedGoogle Scholar
  • 2 Díaz-de-Rada P, Barriga A, Barroso JL, García-Barrecheguren E, Alfonso M, Valentí JR. Positive culture in allograft ACL-reconstruction: what to do?. Knee Surg Sports Traumatol Arthrosc 2003; 11 (4) 219-222
    CrossrefPubMedGoogle Scholar
  • 3 Kainer MA, Linden JV, Whaley DN , et al. Clostridium infections associated with musculoskeletal-tissue allografts. N Engl J Med 2004; 350 (25) 2564-2571
    CrossrefPubMedGoogle Scholar
  • 4 Nemzek JA, Arnoczky SP, Swenson CL. Retroviral transmission by the transplantation of connective-tissue allografts. An experimental study. J Bone Joint Surg Am 1994; 76 (7) 1036-1041
    PubMedGoogle Scholar
  • 5 Arnoczky SP, Warren RF, Ashlock MA. Replacement of the anterior cruciate ligament using a patellar tendon allograft. An experimental study. J Bone Joint Surg Am 1986; 68 (3) 376-385
    PubMedGoogle Scholar
  • 6 Pinkowski JL, Reiman PR, Chen SL. Human lymphocyte reaction to freeze-dried allograft and xenograft ligamentous tissue. Am J Sports Med 1989; 17 (5) 595-600
    CrossrefPubMedGoogle Scholar
  • 7 Tom JA, Rodeo SA. Soft tissue allografts for knee reconstruction in sports medicine. Clin Orthop Relat Res 2002; 402 (402) 135-156
    CrossrefPubMedGoogle Scholar
  • 8 Krych AJ, Jackson JD, Hoskin TL, Dahm DL. A meta-analysis of patellar tendon autograft versus patellar tendon allograft in anterior cruciate ligament reconstruction. Arthroscopy 2008; 24 (3) 292-298
    CrossrefPubMedGoogle Scholar
  • 9 McAllister DR, Joyce MJ, Mann BJ, Vangsness Jr CT. Allograft update: the current status of tissue regulation, procurement, processing, and sterilization. Am J Sports Med 2007; 35 (12) 2148-2158
    CrossrefPubMedGoogle Scholar
  • 10 Rihn JA, Irrgang JJ, Chhabra A, Fu FH, Harner CD. Does irradiation affect the clinical outcome of patellar tendon allograft ACL reconstruction?. Knee Surg Sports Traumatol Arthrosc 2006; 14 (9) 885-896
    CrossrefPubMedGoogle Scholar
  • 11 Kartus J, Movin T, Karlsson J. Donor-site morbidity and anterior knee problems after anterior cruciate ligament reconstruction using autografts. Arthroscopy 2001; 17 (9) 971-980
    CrossrefPubMedGoogle Scholar
  • 12 Wright RW, Brand RA, Dunn W, Spindler KP. How to write a systematic review. Clin Orthop Relat Res 2007; 455: 23-29
    CrossrefPubMedGoogle Scholar
  • 13 Kim SJ, Kim TE, Jo SB, Kung YP. Comparison of the clinical results of three posterior cruciate ligament reconstruction techniques. J Bone Joint Surg Am 2009; 91 (11) 2543-2549
    CrossrefPubMedGoogle Scholar
  • 14 Nyland J, Hester P, Caborn DN. Double-bundle posterior cruciate ligament reconstruction with allograft tissue: 2-year postoperative outcomes. Knee Surg Sports Traumatol Arthrosc 2002; 10 (5) 274-279
    CrossrefPubMedGoogle Scholar
  • 15 Sekiya JK, West RV, Ong BC, Irrgang JJ, Fu FH, Harner CD. Clinical outcomes after isolated arthroscopic single-bundle posterior cruciate ligament reconstruction. Arthroscopy 2005; 21 (9) 1042-1050
    CrossrefPubMedGoogle Scholar
  • 16 Shon OJ, Lee DC, Park CH, Kim WH, Jung KA. A comparison of arthroscopically assisted single and double bundle tibial inlay reconstruction for isolated posterior cruciate ligament injury. Clin Orthop Surg 2010; 2 (2) 76-84
    CrossrefPubMedGoogle Scholar
  • 17 Yoon KH, Bae DK, Song SJ, Cho HJ, Lee JH. A prospective randomized study comparing arthroscopic single-bundle and double-bundle posterior cruciate ligament reconstructions preserving remnant fibers. Am J Sports Med 2011; 39 (3) 474-480
    CrossrefPubMedGoogle Scholar
  • 18 Adachi N, Ochi M, Uchio Y, Iwasa J, Ishikawa M, Shinomiya R. Temporal change of joint position sense after posterior cruciate ligament reconstruction using multi-stranded hamstring tendons. Knee Surg Sports Traumatol Arthrosc 2007; 15 (1) 2-8
    CrossrefPubMedGoogle Scholar
  • 19 Chan YS, Yang SC, Chang CH , et al. Arthroscopic reconstruction of the posterior cruciate ligament with use of a quadruple hamstring tendon graft with 3- to 5-year follow-up. Arthroscopy 2006; 22 (7) 762-770
    CrossrefPubMedGoogle Scholar
  • 20 Chen B, Gao S. Double-bundle posterior cruciate ligament reconstruction using a non-hardware suspension fixation technique and 8 strands of autogenous hamstring tendons. Arthroscopy 2009; 25 (7) 777-782
    CrossrefPubMedGoogle Scholar
  • 21 Chen CH, Chen WJ, Shih CH. Arthroscopic reconstruction of the posterior cruciate ligament: a comparison of quadriceps tendon autograft and quadruple hamstring tendon graft. Arthroscopy 2002; 18 (6) 603-612
    CrossrefPubMedGoogle Scholar
  • 22 Houe T, Jørgensen U. Arthroscopic posterior cruciate ligament reconstruction: one- vs. two-tunnel technique. Scand J Med Sci Sports 2004; 14 (2) 107-111
    CrossrefPubMedGoogle Scholar
  • 23 Jung YB, Tae SK, Jung HJ, Lee KH. Replacement of the torn posterior cruciate ligament with a mid-third patellar tendon graft with use of a modified tibial inlay method. J Bone Joint Surg Am 2004; 86-A (9) 1878-1883
    PubMedGoogle Scholar
  • 24 Lien OA, Aas EJ, Johansen S, Ludvigsen TC, Figved W, Engebretsen L. Clinical outcome after reconstruction for isolated posterior cruciate ligament injury. Knee Surg Sports Traumatol Arthrosc 2010; 18 (11) 1568-1572
    CrossrefPubMedGoogle Scholar
  • 25 Seon JK, Song EK. Reconstruction of isolated posterior cruciate ligament injuries: a clinical comparison of the transtibial and tibial inlay techniques. Arthroscopy 2006; 22 (1) 27-32
    CrossrefPubMedGoogle Scholar
  • 26 Wong T, Wang CJ, Weng LH , et al. Functional outcomes of arthroscopic posterior cruciate ligament reconstruction: comparison of anteromedial and anterolateral trans-tibia approach. Arch Orthop Trauma Surg 2009; 129 (3) 315-321
    CrossrefPubMedGoogle Scholar
  • 27 Wu CH, Chen AC, Yuan LJ , et al. Arthroscopic reconstruction of the posterior cruciate ligament by using a quadriceps tendon autograft: a minimum 5-year follow-up. Arthroscopy 2007; 23 (4) 420-427
    CrossrefPubMedGoogle Scholar
  • 28 Zhao J, Huangfu X. Arthroscopic single-bundle posterior cruciate ligament reconstruction: Retrospective review of 4- versus 7-strand hamstring tendon graft. Knee 2007; 14 (4) 301-305
    CrossrefPubMedGoogle Scholar
  • 29 Zhao J, Xiaoqiao H, He Y, Yang X, Liu C, Lu Z. Sandwich-style posterior cruciate ligament reconstruction. Arthroscopy 2008; 24 (6) 650-659
    CrossrefPubMedGoogle Scholar
  • 30 Ahn JH, Yoo JC, Wang JH. Posterior cruciate ligament reconstruction: double-loop hamstring tendon autograft versus Achilles tendon allograft—clinical results of a minimum 2-year follow-up. Arthroscopy 2005; 21 (8) 965-969
    CrossrefPubMedGoogle Scholar
  • 31 Wang CJ, Chan YS, Weng LH, Yuan LJ, Chen HS. Comparison of autogenous and allogenous posterior cruciate ligament reconstructions of the knee. Injury 2004; 35 (12) 1279-1285
    CrossrefPubMedGoogle Scholar
  • 32 Jackson DW, Grood ES, Goldstein JD , et al. A comparison of patellar tendon autograft and allograft used for anterior cruciate ligament reconstruction in the goat model. Am J Sports Med 1993; 21 (2) 176-185
    CrossrefPubMedGoogle Scholar
  • 33 Prodromos C, Joyce B, Shi K. A meta-analysis of stability of autografts compared to allografts after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2007; 15 (7) 851-856
    CrossrefPubMedGoogle Scholar
  • 34 Kennedy JC, Hawkins RJ, Willis RB, Danylchuck KD. Tension studies of human knee ligaments. Yield point, ultimate failure, and disruption of the cruciate and tibial collateral ligaments. J Bone Joint Surg Am 1976; 58 (3) 350-355
    CrossrefPubMedGoogle Scholar
  • 35 Race A, Amis AA. The mechanical properties of the two bundles of the human posterior cruciate ligament. J Biomech 1994; 27 (1) 13-24
    CrossrefPubMedGoogle Scholar
  • 36 Bosch U, Decker B, Kasperczyk W, Nerlich A, Oestern HJ, Tscherne H. The relationship of mechanical properties to morphology in patellar tendon autografts after posterior cruciate ligament replacement in sheep. J Biomech 1992; 25 (8) 821-830
    CrossrefPubMedGoogle Scholar
  • 37 Bosch U, Decker B, Möller HD, Kasperczyk WJ, Oestern HJ. Collagen fibril organization in the patellar tendon autograft after posterior cruciate ligament reconstruction. A quantitative evaluation in a sheep model. Am J Sports Med 1995; 23 (2) 196-202
    CrossrefPubMedGoogle Scholar
  • 38 Bosch U, Gässler N, Decker B. Alterations of glycosaminoglycans during patellar tendon autograft healing after posterior cruciate ligament replacement. A biochemical study in a sheep model. Am J Sports Med 1998; 26 (1) 103-108
    PubMedGoogle Scholar
  • 39 Bosch U, Kasperczyk WJ. Healing of the patellar tendon autograft after posterior cruciate ligament reconstruction—a process of ligamentization? An experimental study in a sheep model. Am J Sports Med 1992; 20 (5) 558-566
    CrossrefPubMedGoogle Scholar
  • 40 Kasperczyk WJ, Bosch U, Oestern HJ, Tscherne H. Staging of patellar tendon autograft healing after posterior cruciate ligament reconstruction. A biomechanical and histological study in a sheep model. Clin Orthop Relat Res 1993; 286 (286) 271-282
    PubMedGoogle Scholar
  • 41 Moeller HD, Bosch U, Decker B. Collagen fibril diameter distribution in patellar tendon autografts after posterior cruciate ligament reconstruction in sheep: changes over time. J Anat 1995; 187 (Pt 1) 161-167
    PubMedGoogle Scholar