Department of Orthopaedics and Traumatology, Sakarya Training and Research Hospital, Sakarya, Turkey.
Department of Physical Medicine and Rehabilitation, Gaziosmanpasa Training and Research Hospital, University of Health Sciences, Istanbul, Turkey.
Clin Orthop Surg. 2021 Mar;13(1):47-52. doi: 10.4055/cios20008. Epub 2021 Feb 15.
A small autograft diameter negatively affects functional outcomes, knee stability, and the risk of rerupture after anterior cruciate ligament (ACL) reconstruction, whereas the strength of allograft decreases over time. Therefore, it is not clear whether the use of smaller autografts or the use of larger allografts in ACL yields better results. The aim of this study was to compare the outcome of smaller autografts and larger allografts for ACL reconstruction.
Fifty-one patients who underwent ACL reconstruction with hamstring tendon autografts (size ≤ 8 mm) and 21 patients who underwent ACL reconstruction with allografts (size ≥ 10 mm) were included in our study. All patients underwent the same aggressive early postoperative rehabilitation program. There were no significant differences between the autograft and allograft groups regarding the preoperative patient age, sex, time from injury to surgery, and average follow-up time.
The mean diameter of the 4-stranded hamstring tendon grafts used as autografts was 7.48 ± 0.33 mm and the mean diameter of the allografts was 10.76 ± 0.67 mm. According to specific tests for the ACL (anterior drawer, Lachman, and pivot shift) and clinical evaluation tests (Lysholm knee scoring scale and International Knee Documentation Committee questionnaire), the final follow-up results were significantly better than the preoperative status in both autograft and allograft ACL reconstruction groups. Therefore, there were no significant differences between the autograft and allograft groups preoperatively and at the final follow-up.
The large size of the graft in ACL reconstruction has been reported to affect results positively. However, in our study, we could not find any significant differences between the smaller size autografts and larger size allografts in terms of inadequacy, rerupture, and final follow-up functional results. Although allografts were significantly larger than autografts, we did not have the positive effect of larger size grafts. Smaller size autografts were as effective as the larger size allografts.
较小的移植物直径会对功能结果、膝关节稳定性和前交叉韧带（ACL）重建后再次撕裂的风险产生负面影响，而移植物的强度会随时间而降低。因此，尚不清楚在 ACL 重建中使用较小的自体移植物还是较大的同种异体移植物会产生更好的结果。本研究旨在比较较小的自体移植物和较大的同种异体移植物用于 ACL 重建的结果。
我们纳入了 51 例接受 ACL 重建的患者，他们使用的是自体腘绳肌腱移植物（大小≤8mm），21 例接受 ACL 重建的患者使用的是同种异体移植物（大小≥10mm）。所有患者均接受相同的积极术后早期康复方案。自体和同种异体组之间在术前患者年龄、性别、受伤至手术的时间以及平均随访时间方面无显著差异。
自体 4 股腘绳肌腱移植物的平均直径为 7.48±0.33mm，同种异体移植物的平均直径为 10.76±0.67mm。根据 ACL 的特定测试（前抽屉、lachman 和枢轴转移）和临床评估测试（Lysholm 膝关节评分量表和国际膝关节文献委员会问卷），自体和同种异体 ACL 重建组的最终随访结果均明显优于术前。因此，自体和同种异体组在术前和最终随访时均无显著差异。
已有研究报道，ACL 重建中移植物较大的尺寸会对结果产生积极影响。然而，在我们的研究中，我们无法发现较小尺寸的自体移植物和较大尺寸的同种异体移植物在不充分、再次撕裂和最终随访功能结果方面有任何显著差异。尽管同种异体移植物明显大于自体移植物，但我们并未获得较大尺寸移植物的积极效果。较小尺寸的自体移植物与较大尺寸的同种异体移植物同样有效。
