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Analysis of Outcomes of Anterior Cruciate Ligament Repair With 5-Year Follow-up: Allograft Versus Autograft

2005; Elsevier BV; Volume: 21; Issue: 7 Linguagem: Inglês

10.1016/j.arthro.2005.04.112

1526-3231

Gary G. Poehling, Walton W. Curl, Cassandra A. Lee, T. Adam Ginn, Julia T. Rushing, Michelle J. Naughton, Martha B. Holden, David Martin, Beth Paterson Smith,

Sports injuries and prevention

Purpose: To prospectively compare outcomes of primary anterior cruciate ligament (ACL) reconstruction with either Achilles tendon allograft with soft-tissue fixation or standard bone-patellar tendon-bone autograft with interference screw fixation. Type of Study: Prospective comparative case series. Methods: A group of 41 patients who underwent soft-tissue allograft reconstruction and a group of 118 patients who underwent autograft bone-patellar tendon-bone reconstruction were included in the final results. Patients were evaluated preoperatively and postoperatively at 1 to 2 weeks, 6 weeks, 3 months, 6 months, and then annually for 5 years. Objective measures of outcome included KT-1000 measurements, range of motion, ligamentous integrity, thigh atrophy, and International Knee Documentation Committee score. Subjective evaluations included patient completion of 5 questionnaires documenting functional status, pain, and health-related quality of life: (1) the short-form McGill Pain Questionnaire, (2) a patient subjective assessment of knee function and symptoms, (3) a patient subjective assessment follow-up, (4) a knee pain scale, and (5) the RAND 36-Item Health Survey. Mixed models analysis of variance was used to compare the outcomes of the treatment groups using baseline values of the study variables as a covariate. Results: Autograft patients reported significantly more pain on the bodily pain subscale of the RAND-36 than the allograft group at 1 week ( P = .0006), 6 weeks ( P = .0007), and 3 months ( P = .0270). Autograft patients reported more pain than allograft patients on the McGill Pain Scale visual analog scale at 1 to 2 weeks ( P < .0001) and 6 weeks ( P = .0147). Patient assessment of function and symptoms showed that a higher proportion of patients reported normal or nearly normal knee function in the allograft group than in the autograft group at 3 months (33% v 14%, P = .0558, respectively). Fewer activity limitations were reported by allograft patients than autograft patients at 6 weeks ( P = .0501), 3 months ( P = .0431), and 6 months ( P = .0014). After reconstruction, the allograft group displayed significantly more laxity in KT-1000 measurements at all time points than the autograft group ( P = .0520). These measurements decreased over time for both groups ( P < .0001). Conclusions: Five-year follow-up of patients undergoing ACL reconstruction with allograft versus autograft were compared objectively and subjectively. Both groups of patients achieved similar long-term outcomes. Overall, the allograft patients reported less pain at 1 and 6 weeks after surgery, better function at 1 week, 3 months, and 1 year, and fewer activity limitations throughout the follow-up period. Level of Evidence: Level II, prospective cohort study.