Abstract
The purpose of this systematic review is to ascertain the risk profile of allografts
in primary anterior cruciate ligament reconstruction (ACLR) of skeletally immature
patients. Three databases (PubMed, EMBASE, and MEDLINE) were searched for articles
addressing primary ACLR in skeletally immature patients (i.e., open femoral and tibial
physes). Inclusion criteria encompassed the use of allograft tissue with available
postoperative outcomes data. The methodological index for non-randomized studies (MINORS)
was used to assess all studies. Descriptive statistics such as means, 95% confidence
intervals and standard deviations are presented where applicable. A total of 3,852
studies were screened, with 9 studies of a total of 406 skeletally immature patients
(mean age 14.9 ± 1.2 years) satisfying inclusion criteria. The majority (98%) of included
patients underwent complete transphyseal ACLR. Where specified, allograft options
included Achilles tendon (AT) (66.5%), tibialis anterior tendon (7.6%), bone–patellar
tendon (2.5%), and fascia lata (1.0%). The use of a bone block for the AT was reported
in one patient (0.2%). Postoperatively, and where specified, patients achieved full
range of motion (12.1%), had good Lysholm scores of 94 to 100 (8.1%), and a return
to preinjury level athletic participation of 82.9% (8.4%). Complications (13.3%) included
graft failures (7.9%), nonrevision reoperation (4.7%), and a combined leg length discrepancy
and angular (valgus and extension) deformity (0.2%). There were no reported incidences
of disease transmission. Although failure rates of primary allograft ACL reconstruction
are acceptable compared with other studies of mainly autograft use in this young,
high-risk population, there was a very low rate of clinically significant physeal
damage. However, the relatively low quality of the included studies limits the ability
to recommend routine use of allograft for ACLR in the skeletally immature patient.
More robust studies with long-term follow-up data are necessary to better ascertain
the influence of allograft choice on postoperative outcomes for these young patients.
This is a Level IV study, systematic review of Levels III and IV studies.
Keywords
allograft - pediatric - anterior cruciate ligament - knee - skeletally immature
