Anterior cruciate ligament reconstruction with bone-patellar tendon-bone graft: comparison of autograft, fresh-frozen allograft, and γ-irradiated allograft.

ABSTRACT

PURPOSE: To compare clinical follow-up results of anterior cruciate ligament (ACL) reconstruction using (1) autologous, (2) fresh-frozen allogeneic, and (3) γ-irradiated allogeneic bone-patellar tendon-bone (BPTB). METHODS: From February 2002 to January 2006, 187 patients received BPTB ACL reconstruction at our center. One hundred forty-two consecutive patients who had received single-bundle BPTB ACL reconstruction were included in this study. Of these patients, 41 had autografts, 33 had fresh-frozen allografts, and 68 had γ-irradiated allografts. Clinical results were evaluated with the KT-1000 maximum displacement test (MEDmetric, San Diego, CA), Lachman test, and Lysholm, Irrgang, and Larson activity scales. RESULTS: The mean duration of follow-up was 6.7 ± 1.5 years (range, 4.2 to 8.2 years). There were 3 cases of acute synovitis due to immunologic rejection (fresh-frozen allografts) and 6 cases of failure (γ-irradiated allografts). KT-1000 examination showed more anterior laxity in the γ-irradiated allograft group compared with the autograft and fresh-frozen allograft groups (P < .05). The Lysholm, Irrgang, and Larson activity scales showed no difference among the 3 groups (P > .05). CONCLUSIONS: The study showed a statistically poorer KT-1000 result and higher failure rate in the γ-irradiated allograft group compared with the autograft and fresh-frozen allograft groups. This may suggest that γ-irradiated allograft is not a good candidate graft for ACL reconstruction. Power analysis showed that the study was underpowered, so further research and longer follow-up study are needed to make this point clearer. LEVEL OF EVIDENCE Level III, retrospective comparative study.