Analysis of outcomes of anterior cruciate ligament repair with 5-year follow-up: allograft versus autograft.
OBJECTIVE
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.


METHODS
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.


METHODS
Level II, prospective cohort study.
Poehling
Gary G
GG
Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27151, USA.
Curl
Walton W
WW
Lee
Cassandra A
CA
Ginn
T Adam
TA
Rushing
Julia T
JT
Naughton
Michelle J
MJ
Holden
Martha B
MB
Martin
David F
DF
Smith
Beth P
BP
D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D001284:Atrophy; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000601:surgery*; D008297:Male; D010149:Postoperative Pain; D010329:Patella / Q000601:surgery*; D011446:Prospective Studies; D016059:Range of Motion, Articular; D019651:Plastic Surgery Procedures / Q000379:methods / Q000534:rehabilitation; D011795:Surveys and Questionnaires; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous; D016896:Treatment Outcome