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Knee Surgery, Sports Traumatology,... Oct 2023To compare graft dimensions, functional outcomes, and failure rates following anterior cruciate ligament reconstruction (ACLR) with either five-strand or four-strand... (Meta-Analysis)
Meta-Analysis Review
Though five-strand hamstring autografts demonstrate greater graft diameter, postoperative outcomes are equivocal to four-strand hamstring autograft preparations: a systematic review and meta-analysis of level I and II studies.
PURPOSE
To compare graft dimensions, functional outcomes, and failure rates following anterior cruciate ligament reconstruction (ACLR) with either five-strand or four-strand hamstring autograft options.
METHODS
Three databases (MEDLINE, PubMed, and EMBASE) were searched from inception to 22 April 2023 for level I and II studies comparing five- and four-strand hamstring autografts in ACLR. The authors adhered to the PRISMA and R-AMSTAR guidelines as well as the Cochrane Handbook for Systematic Reviews of Interventions. Data on demographics, surgical details and rehabilitation, graft diameter, patient-reported outcome measures (PROMs), and rates of positive Lachman test, positive pivot shift test, and graft rupture were extracted. PROMs included Knee Osteoarthritis and Outcome Score (KOOS) subscales, Lysholm, and International Knee Documentation Committee (IKDC).
RESULTS
One randomized controlled trial (RCT) and four prospective cohort studies with 572 patients were included. Graft diameters were larger in the five-strand group with a mean difference of 0.93 mm (95% CI 0.61 to 1.25, p < 0.001, I = 66%). The five-strand group reported statistically higher KOOS ADL subscale and Lysholm scores with a mean difference of 4.85 (95% CI 0.14 to 9.56, p = 0.04, I = 19%) and 3.01 (95% CI 0.48 to 5.53, p = 0.02, I = 0%), respectively. There were no differences in KOOS symptoms, pain, quality of life, or sports subscales, or IKDC scores. There were no differences in rates of positive Lachman test, positive pivot shift test, or graft rupture with pooled odds ratios of 0.62 (95% CI 0.13 to 2.91, n.s., I = 80%), 0.94 (95% CI 0.51 to 1.75, n.s., I = 31%), and 2.13 (95% CI 0.38 to 12.06, n.s., I = 0%), respectively.
CONCLUSIONS
Although five-stranded hamstring autografts had significantly larger graft diameters compared to four-stranded grafts with a mean difference of 0.93 mm, similar graft rupture rates and clinical laxity assessments were identified following ACLR. While some PROMs were statistically superior in the five-stranded hamstring groups, the threshold for the minimal clinical important difference was not reached indicating similar clinical outcomes overall.
LEVEL OF EVIDENCE
Level II.
Topics: Humans; Autografts; Hamstring Tendons; Knee Joint; Transplantation, Autologous; Osteoarthritis, Knee; Anterior Cruciate Ligament Injuries; Randomized Controlled Trials as Topic
PubMed: 37477649
DOI: 10.1007/s00167-023-07515-8 -
Journal of Investigative Surgery : the... Dec 2016Purpose/Aim of the study: The purpose of this analysis was to compare the clinical outcomes of vertebral fusion with allograft versus autograft bone. (Comparative Study)
Comparative Study Review
UNLABELLED
Purpose/Aim of the study: The purpose of this analysis was to compare the clinical outcomes of vertebral fusion with allograft versus autograft bone.
MATERIALS AND METHODS
Medline, PubMed, Cochrane, EMBASE, and Google Scholar databases were searched until July 27, 2015 using the keywords: lumbar vertebrae, surgery, spondylolisthesis, bone transplantation, allograft, autograft. Inclusion criteria were randomized controlled trials (RCTs), two-arm prospective studies, retrospective studies, and cohort studies comparing the results of autograft and allograft in patients receiving lumbar spinal fusion. The outcomes were changes of Oswestry Disability Index (ODI) and visual analogue scale (VAS) pain scores from baseline at 1, 2, and 3 years after surgery and fusion rates.
RESULTS
Of 154 studies identified in the database searches, five were included in the quantitative analysis (one RCT, one prospective, and three retrospective studies). The mean patient age ranged from approximately 40 to 65 years, and approximately half of the patients were males. The total number of patients who received allografts was 333 and the total that received autografts was 175. The analysis revealed the change of ODI and VAS pain score at 1, 2 and 3 years was similar between the allograft and autograft groups (all, p > .05), as were the fusion rates (p > .05).
CONCLUSIONS
Both allograft and autograft provide acceptable outcomes for spinal fusion.
Topics: Allografts; Autografts; Humans; Ilium; Lumbar Vertebrae; Pain Measurement; Spinal Fusion; Treatment Outcome
PubMed: 27064603
DOI: 10.3109/08941939.2016.1166534 -
The American Journal of Sports Medicine Nov 2011Surgical anterior cruciate ligament reconstruction using tendon grafts has become the standard to treat the functionally unstable anterior cruciate ligament-deficient... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Surgical anterior cruciate ligament reconstruction using tendon grafts has become the standard to treat the functionally unstable anterior cruciate ligament-deficient knee. Although tendons clearly differ biologically from ligaments, multiple animal studies have shown that the implanted tendons indeed seem to remodel into a ligamentous "anterior cruciate ligament-like" structure.
PURPOSE
The goal of this study was to systematically review the current literature on the "ligamentization" process in human anterior cruciate ligament reconstruction.
STUDY DESIGN
Systematic review.
METHODS
A computerized search using relevant search terms was performed in the PubMed, MEDLINE, EMBASE, and Cochrane Library databases, as well as a manual search of reference lists. Searches were limited to studies examining the healing of the intra-articular portion of the tendon graft based on biopsies of this graft obtained from a living human.
RESULTS
Four studies were determined to be appropriate for systematic review, none of them reaching a level of evidence higher than 3. All reports considered autografts. Biopsy specimens were evaluated by light or electron microscopy and analyzed for vascularization, cellular aspects, and appearance of extracellular matrix. All authors universally agreed that the tendon grafts survive in the intra-articular environment. Based on changes observed in the healing grafts with regard to vascularization, cellular aspects, and properties of the extracellular matrix, different chronologic stages in the ligamentization process were discerned.
CONCLUSION
The key finding of this systematic review is that a free tendon graft replacing a ruptured human anterior cruciate ligament undergoes a series of biologic processes termed "ligamentization." The graft seems to remain viable at any time during this course. Histologically, the mature grafts may resemble the normal human anterior cruciate ligament, but ultrastructural differences regarding collagen fibril distribution do persist. Different stages of the ligamentization process are described, but no agreement exists on their time frame. Problematic direct transmission of animal data to the human situation, the limited number of reports considering the ligamentization process in humans, and the potential biopsy sampling error attributable to superficial graft biopsies necessitate further human studies on anterior cruciate ligament graft ligamentization.
Topics: Anterior Cruciate Ligament Reconstruction; Female; Humans; Male; Tendons; Treatment Outcome
PubMed: 21515806
DOI: 10.1177/0363546511402662 -
Orthopaedic Journal of Sports Medicine Dec 2023Anterior cruciate ligament reconstruction (ACLR) surgery with quadriceps tendon (QT) grafts, both with and without a patellar bone plug, have gained popularity in recent... (Review)
Review
BACKGROUND
Anterior cruciate ligament reconstruction (ACLR) surgery with quadriceps tendon (QT) grafts, both with and without a patellar bone plug, have gained popularity in recent years in the primary and revision settings. Postoperative complications occur with the use of QT autografts.
PURPOSE
To systematically review the incidence of postoperative complications after primary ACLR QT autograft and compare complication rates in patients undergoing all-soft tissue QT grafts versus QT grafts with a patellar bone plug (QTPB).
STUDY DESIGN
Systematic review; Level of evidence, 4.
METHODS
A literature search using the 2020 PRISMA guidelines was performed by querying PubMed, Embase, and Scopus databases from database inception through August 2022. Included were evidence level 1 to 4 human clinical studies in English that reported complications after primary ACLR with QT autograft. The incidence of complications within the included studies was extracted. Differences in the incidence of postoperative complications between ACLR with QT with and without a patellar bone plug were calculated.
RESULTS
A total of 20 studies from 2004 to 2022, comprised of 2381 patients (2389 knees; 68.3% male) with a mean age of 27 years (range, 12-58 years), were identified. The mean follow-up was 28.5 months (range, 6-47 months). The total incidence of complications was 10.3%, with persistent postoperative knee pain being the most common (10.8%). Patients who underwent ACLR with all-soft tissue QT grafts had a 2.7-times increased incidence of anterior knee pain (23.3% vs 8.6%) and reoperations (5.9% vs 3.2%) when compared with QTPB grafts ( < .01 for both). There was no appreciable difference in total complications, graft failures, ACLR revisions, cyclops lesions, or range of motion deficit ( > .05 for all). Patellar fractures occurred exclusively after QTPB (2.2%).
CONCLUSION
Complications after primary ACLR using QT autograft were recorded in 10.5% of knees, with anterior knee pain being the most common. No difference was reported in the overall incidence of complications with the use of the QT versus QTPB grafts; however, anterior knee pain was 2.7 times greater with use of a soft tissue quadriceps graft.
PubMed: 38145223
DOI: 10.1177/23259671231199728 -
Knee Surgery, Sports Traumatology,... Dec 2023Research regarding revision anterior cruciate ligament reconstruction (RACLR) with quadriceps tendon (QT) autografts is lacking. The purpose of this study was to perform... (Meta-Analysis)
Meta-Analysis
Quadriceps tendon autograft has similar clinical outcomes when compared to hamstring tendon and bone-patellar tendon-bone autografts for revision ACL reconstruction: a systematic review and meta-analysis.
PURPOSE
Research regarding revision anterior cruciate ligament reconstruction (RACLR) with quadriceps tendon (QT) autografts is lacking. The purpose of this study was to perform a systematic review and meta-analysis of RACLR with QT and compare its patient outcomes to RACLR with hamstring tendon (HT) and bone-patellar tendon-bone (BTB) autografts.
METHODS
Adhering to PRISMA guidelines, a search for studies using QT in RACLR was performed within PubMed, Scopus, and CINAHL from database date of inception through December 26, 2022. Primary outcomes sought included: failure rate, Lysholm scores, International Knee Documentation Committee (IKDC) scores, IKDC grades, arthrometric knee side-to-side differences (STSD), pivot shift grade, donor site morbidity, return to sport, visual analog scale (VAS) pain scores.
RESULTS
Nine studies were included consisting of 606 RACLR: 349 QT, 169 HT, and 88 BTB. Overall failure rates were 7.6% QT, 13.3% HT, and 8.7% BTB. Mean weighted Lysholm scores were 85.8 ± 3.8 QT, 82.5 ± 3.8 HT and 86.6 ± 4.5 BTB. IKDC average scores were 82.3 ± 1.6 QT, 80.1 ± 1.7 HT, and 81.7 ± 5.5BTB. Combined rates of IKDC A/B grades were 88.4% and 80.0% for QT and HT, respectively. VAS average scores were 0.9 ± 1.1 QT, 1.4 ± 0.2 HT, and 0.7 ± 0.8 for BTB. Side-to-side difference was reported for QT and HT with average values of 1.7 ± 0.6 mm and 2.1 ± 0.5 mm, respectively. Grade 0 or 1 pivot shifts were reported in 96.2% of QT patients and 91.3% of HT. Donor site morbidity, only reported for QT and HT, was 14.6 ± 9.7% and 23.6 ± 14.1%, respectively. QT resulted in a mean Tegner score of 5.9 ± 1.5 versus HT 5.7 ± 1.5. Rate of return to pivoting sports was 38.0% QT, 48.6% HT, and 76.9% BTB. Across all outcomes, there was no significant difference when comparing QT to HT, QT to BTB, and QT compared to HT and BTB combined.
CONCLUSIONS
RACLR with QT yields satisfactory patient reported outcomes, satisfactory improvement in knee laxity, expected return to sport rates, and has an overall 7.6% failure rate. Outcomes are comparative to those of HT and BTB making it an acceptable graft choice for RACLR. Surgeons should consider using QT autograft for RACLR, especially when other autografts are unavailable.
LEVEL OF EVIDENCE
IV.
Topics: Humans; Hamstring Tendons; Autografts; Patellar Ligament; Anterior Cruciate Ligament Injuries; Tendons; Transplantation, Autologous; Bone-Patellar Tendon-Bone Grafting
PubMed: 37804345
DOI: 10.1007/s00167-023-07592-9 -
Journal of Clinical Medicine Jul 2022Anterior cruciate ligament (ACL) reconstruction is widely used to restore knee stability after injury, but the risk of revision surgery increases when the autograft size... (Review)
Review
Anterior cruciate ligament (ACL) reconstruction is widely used to restore knee stability after injury, but the risk of revision surgery increases when the autograft size is inadequate. Ultrasound (US) measurements of preoperative target tendons have been applied to predict the intraoperative autograft size, with various outcomes across different studies. This systematic review and meta-analysis aimed to summarize the evidence and investigate the usefulness of US in predicting autograft size. Electronic databases were searched for relevant studies from inception to 19 January 2022. The primary outcome was the correlation between the preoperative US measurements of donor tendons and intraoperative autograft size. The secondary outcomes encompassed the predictive performance of US for autograft size and the comparison between US and magnetic resonance imaging (MRI) for preoperative tendon measurements. Nine studies, comprising 249 patients, were enrolled. The preoperative US measurements of the donor tendons demonstrated a significant positive correlation with their intraoperative autograft diameter, with a pooled correlation coefficient of 0.443 (95% confidence interval [CI], 0.266−0.591, p < 0.001) for the gracilis and semitendinosus autograft, 0.525 (95% CI, 0.114−0.783, p = 0.015) for the semitendinosus autograft, and 0.475 (95% CI, 0.187−0.687, p = 0.002) for the gracilis autograft. The pooled sensitivity and specificity of US imaging in predicting the autograft diameter were 0.83 (95% CI 0.57−0.95) and 0.70 (95% CI, 0.36−0.91), respectively. Moreover, no significant differences were observed between US and MRI measurements in predicting the sizes of the gracilis and semitendinosus autografts. Preoperative US measurements of the target tendons were moderately correlated with the intraoperative autograft size. US imaging has a discriminative performance similar to that of MRI in predicting the autograft size. A standardized US scanning protocol is needed for future studies to minimize the variations in tendon measurements across different investigators and increase the comparability of US imaging with intraoperative findings.
PubMed: 35807157
DOI: 10.3390/jcm11133876 -
International Ophthalmology Nov 2019Currently, regenerative medicine has attracted much attention among researchers investigating new methods to treat ocular surface diseases. Based on this new concept,... (Meta-Analysis)
Meta-Analysis
PURPOSE
Currently, regenerative medicine has attracted much attention among researchers investigating new methods to treat ocular surface diseases. Based on this new concept, cultivated limbal epithelial transplantation (CLET), whether in the form of autograft or allograft, has emerged as a promising surgical procedure for treating limbal stem cell deficiency (LSCD). Given that there is no updated comparison between autograft and allograft CLETs, the present review and meta-analysis aims to compare and determine the efficacy of two different CLET techniques, autologous versus allogeneic, based on a literature review of relevant studies.
METHODS
A comprehensive search of electronic databases, including PubMed, Web of Science, Cochrane Library, Embase and Scopus, for related articles was performed in March 2018 to obtain relevant articles and to conduct a meta-analysis investigating the success rate of ocular surface regeneration and two-line improvement in best-corrected visual acuity (BCVA) using autograft versus allograft transplantations.
RESULTS
A total of 30 studies, including 1306 eyes from 1288 patients with LSCD, with a sample size ranging from 6 to 200 and follow-up period of 0.6-156 months, were reviewed. Of 1306 eyes, 982 (75.2%) underwent autograft and 324 (24.8%) received allografts from living or deceased donors. Meta-analysis revealed that there was no significant difference between autograft and allograft CLETs in terms of success rate and two-line BCVA improvement. The prospective studies showed a zero difference between the two groups; only two retrospective studies included in the analysis pulled the autografts up to 1.82 and 1.2 times more than allografts in terms of success rate and two-line BCVA improvement, respectively [pooled OR 1.82 (95% CI 0.80-4.11); pooled OR 1.2 (95% CI 0.54-2.65)]. There was no statistically significant evidence of bias in the meta-analysis in terms of success rates and two-line BCVA improvement.
CONCLUSIONS
The present analysis revealed no significant differences in success rates or visual improvement between autograft and allograft surgical techniques.
Topics: Allografts; Autografts; Cells, Cultured; Corneal Diseases; Corneal Transplantation; Epithelium, Corneal; Humans; Limbus Corneae; Stem Cell Transplantation; Stem Cells; Visual Acuity
PubMed: 30826943
DOI: 10.1007/s10792-019-01092-x -
International Journal of Surgery... Jan 2018Irradiated allografts and autografts are commonly used for anterior cruciate ligament (ACL) reconstruction. The outcomes between these two grafts are controversial. This... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Irradiated allografts and autografts are commonly used for anterior cruciate ligament (ACL) reconstruction. The outcomes between these two grafts are controversial. This meta-analysis and systematic review of prospective comparative studies was performed to compare the clinical outcomes, including knee functionality, stability, subjective evaluation, complications, and failure, of irradiated allografts and autografts in primary ACL reconstruction.
MATERIALS AND METHODS
PubMed, Embase, and the Cochrane Library were searched from database inception to 12 August 2017 to identify prospective studies that compared irradiated allografts with autografts for primary ACL reconstruction. Randomized controlled trials were included in the meta-analysis. Prospective cohort studies were included in the systematic reviews. Two reviewers independently assessed the study quality and extracted relevant data. Statistical heterogeneity among the trials was evaluated by the chi-square and I-square tests.
RESULTS
Four randomized controlled trials and two prospective cohort studies involving 18,835 patients met the inclusion criteria. In the meta-analysis, significant differences were observed in knee stability and subjective evaluation with respect to the KT-2000 score (p < .0001), pivot shift test (p = .001), anterior drawer test (p = .0001), Lachman test (p = .0002), subjective International Knee Documentation Committee (IKDC) score (p < .0001), Cincinnati knee score (p = .04), Lysholm score (p = .01), and Tegner score (p = .03). However, the differences in functional assessment in terms of the overall IKDC score (p = .21), range of motion (p = .94), Harner's vertical jump test (p = .09), Daniel's one-leg hop test (p = .50), and complication rate (p = .34) were not significant between the two groups. Failure was reported in two prospective cohort studies in 302 of 14,829 (2%) patients in the autograft group and 157 of 3941 (4%) patients in the irradiated allograft group.
CONCLUSION
Irradiated allografts are inferior to autografts for patients undergoing primary ACL reconstruction with respect to knee stability and subjective evaluation. However, no significant differences were found between the two groups in terms of function and complication. The robustness of the findings might need to be further validated because of the limited number of randomized controlled trials. More randomized controlled trials with longer follow-ups are required to further evaluate the failure rate in the two groups.
Topics: Adult; Allografts; Anterior Cruciate Ligament Reconstruction; Autografts; Female; Humans; Knee Joint; Male; Prospective Studies; Range of Motion, Articular; Transplantation, Autologous; Transplantation, Homologous; Treatment Outcome
PubMed: 29247811
DOI: 10.1016/j.ijsu.2017.12.007 -
The American Journal of Sports Medicine Oct 2022It is unclear whether the results of osteochondral transplant using autografts or allografts for talar osteochondral defect are equivalent. (Meta-Analysis)
Meta-Analysis
BACKGROUND
It is unclear whether the results of osteochondral transplant using autografts or allografts for talar osteochondral defect are equivalent.
PURPOSE
A systematic review of the literature was conducted to compare allografts and autografts in terms of patient-reported outcome measures (PROMs), MRI findings, and complications.
STUDY DESIGN
Systematic review; Level of evidence, 4.
METHODS
This study was conducted according to the PRISMA guidelines. The literature search was conducted in February 2021. All studies investigating the outcomes of allograft and/or autograft osteochondral transplant as management for osteochondral defects of the talus were accessed. The outcomes of interest were visual analog scale (VAS) score for pain, American Orthopaedic Foot and Ankle Society (AOFAS) score, and Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score. Data concerning the rates of failure and revision surgery were also collected. Continuous data were analyzed using the mean difference (MD), whereas binary data were evaluated with the odds ratio (OR) effect measure.
RESULTS
Data from 40 studies (1174 procedures) with a mean follow-up of 46.5 ± 25 months were retrieved. There was comparability concerning the length of follow-up, male to female ratio, mean age, body mass index, defect size, VAS score, and AOFAS score ( > .1) between the groups at baseline. At the last follow-up, the MOCART (MD, 10.5; = .04) and AOFAS (MD, 4.8; = .04) scores were better in the autograft group. The VAS score was similar between the 2 groups ( = .4). At the last follow-up, autografts demonstrated lower rate of revision surgery (OR, 7.2; < .0001) and failure (OR, 5.1; < .0001).
CONCLUSION
Based on the main findings of the present systematic review, talar osteochondral transplant using allografts was associated with higher rates of failure and revision compared with autografts at midterm follow-up.
Topics: Allografts; Autografts; Cartilage; Cartilage Diseases; Cartilage, Articular; Female; Humans; Intra-Articular Fractures; Magnetic Resonance Imaging; Male; Retrospective Studies; Talus; Transplantation, Autologous; Treatment Outcome
PubMed: 34554880
DOI: 10.1177/03635465211037349 -
Arthroscopy : the Journal of... May 2023To compare clinical and radiologic outcomes following superior capsular reconstruction (SCR) using dermal allograft versus tensor fascia lata (TFL) autograft for massive... (Review)
Review
Acellular Dermal Allograft and Tensor Fascia Lata Autograft Show Similar Patient Outcome Improvement and High Rates of Complications and Failures at a Minimum 2-Year Follow-Up: A Systematic Review.
PURPOSE
To compare clinical and radiologic outcomes following superior capsular reconstruction (SCR) using dermal allograft versus tensor fascia lata (TFL) autograft for massive rotator cuff tears with a minimum 2-year follow-up.
METHODS
A literature search was performed by querying Scopus, EMBASE, and PubMed computerized databases from database inception through September 2022 in accordance with the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies evaluating clinical and radiologic outcomes, as well as complications following SCR for the treatment of massive rotator cuff tears were included. Study quality was assessed via the Newcastle-Ottawa Scale and the National Institutes of Health Quality Assessment. The mean change from preoperative to postoperative values (delta) was calculated for each outcome.
RESULTS
Seventeen studies, consisting of 519 patients were identified. Mean duration of follow-up ranged from 24 to 60 months. Mean reduction in visual analog scale pain score ranged from 2.9 to 5.9 points following use of dermal allograft, and 3.4 to 7.0 points following TFL autograft reconstruction. Mean improvements in American Shoulder and Elbow Surgeons score were similar between groups (dermal allograft: 28.0-61.6; TFL autograft: 24.7-59.3). The mean increase in forward flexion ranged from 31° to 38° with dermal allograft, versus 19° to 69° with TFL autograft. Average improvement in active external rotation with dermal allograft ranged from -0.4° to 11° and from 2° to 22.4° using TFL autograft. A similar change in acromiohumeral distance following SCR (dermal allograft: 0.9-3.2 mm; TFL autograft: 0.3-3.6 mm) was appreciated. The rate of complications within the dermal allograft group ranged from 4.5% to 38.2% versus 13.3% to 86.4% following TFL autograft. Failure rate ranged from 4.5 to 38.2% following dermal allograft versus 4.5 to 86.4% with TFL autograft.
CONCLUSIONS
Acellular dermal allograft versus TFL autograft for SCR both demonstrate improved VAS and American Shoulder and Elbow Surgeons scores, with increased values in flexion and external rotation, and increased visual analog scale, although with high variability. Both grafts demonstrate high rates of complications and failures at minimum 2-year follow-up.
LEVEL OF EVIDENCE
IV; systematic review of level II-IV studies.
Topics: Humans; Rotator Cuff Injuries; Shoulder Joint; Fascia Lata; Autografts; Range of Motion, Articular; Arthroscopy; Allografts; Treatment Outcome
PubMed: 36657648
DOI: 10.1016/j.arthro.2023.01.003