Miltenberg Benjamin, Kreulen Randall Timothy, Davis Gaston, Johns William L, Muchintala Rahul, Berg Jonathan, Tjoumakaris Fotios P, Freedman Kevin B
The Rothman Institute at Thomas Jefferson, Bryn Mawr, Pennsylvania, USA.
Orthop J Sports Med. 2025 Jun 19;13(6):23259671251345676. doi: 10.1177/23259671251345676. eCollection 2025 Jun.
Graft choice in anterior cruciate ligament reconstruction (ACLR) is determined by surgeon preference, patient factors, and graft characteristics. An allograft is a viable option with benefits such as decreased operative times and no donor site morbidities, and it can be the preferred graft choice in certain patient populations. Despite this, there is no established standard for allograft processing.
To determine whether allograft processing techniques influence the risk of graft failure, patient-reported outcomes, and revision surgery in patients undergoing ACLR.
Cohort study; Level of evidence, 3.
Consecutive patients from 3 fellowship-trained sports medicine surgeons undergoing ACLR with patellar tendon allografts from January 1, 2016, to January 1, 2022, were identified. Descriptive data, mechanism of injury, graft processing technique, revision history, and patient-reported outcome scores were collected. The primary endpoint was aseptic failure as defined by graft rupture on magnetic resonance imaging. Statistical analysis was performed with the χ test or the Fisher exact test as indicated for categorical variables and with the test and analysis of variance as indicated for continuous variables. The significance level for statistical tests was set at 5%.
A total of 189 patients who underwent ACLR and met the inclusion/exclusion criteria were identified, with 103 Musculoskeletal Transplant Foundation (MTF), 55 Allowash XG, and 31 BioCleanse allografts. The mean age of patients was 43.4 ± 10.5 years, and 60.9% were women. No significant difference was observed between the groups with regard to sex and body mass index ( = .25 and = .64, respectively). However, age at the time of surgery was significantly different between groups ( = .03). The mean patient follow-up time was 4.65 ± 1.40 years. Four patients experienced graft failure (MTF 1% [1/103]; Allowash XG 5.5% [3/55]; BioCleanse 0% [0/31]), with no significant difference in graft failure between groups ( = .20). There were no reported infections. Postoperative International Knee Documentation Committee (IKDC) scores (MTF, 82.6; Allowash XG, 81.7; BioCleanse, 80.2) were not different between groups ( = .60).
Bone-patellar tendon-bone allografts processed using BioCleanse, Allowash XG, and the MTF protocol had similar rates of graft failure and postoperative IKDC scores. Although underpowered, the data suggest that each of these techniques can be used safely with low failure rates and good functional outcomes.
前交叉韧带重建术（ACLR）中移植物的选择取决于外科医生的偏好、患者因素和移植物特征。同种异体移植物是一种可行的选择，具有手术时间缩短和无供区并发症等优点，在某些患者群体中可能是首选的移植物。尽管如此，同种异体移植物的处理尚无既定标准。
确定同种异体移植物处理技术是否会影响接受ACLR的患者发生移植物失败的风险、患者报告的结局以及翻修手术情况。
队列研究；证据等级为3级。
确定了2016年1月1日至2022年1月1日期间3位接受过专科培训的运动医学外科医生连续收治的接受髌腱同种异体移植物ACLR的患者。收集描述性数据、损伤机制、移植物处理技术、翻修史和患者报告的结局评分。主要终点是磁共振成像显示移植物破裂定义的无菌性失败。分类变量按指示采用χ检验或Fisher精确检验进行统计分析，连续变量按指示采用t检验和方差分析进行统计分析。统计检验的显著性水平设定为5%。
共确定了189例接受ACLR且符合纳入/排除标准的患者，其中103例使用肌肉骨骼移植基金会（MTF）的移植物，55例使用Allowash XG移植物，31例使用BioCleanse移植物。患者的平均年龄为43.4±10.5岁，60.9%为女性。各组之间在性别和体重指数方面未观察到显著差异（分别为P = 0.25和P = 0.64）。然而，手术时的年龄在各组之间存在显著差异（P = 0.03）。患者的平均随访时间为4.65±1.40年。4例患者发生移植物失败（MTF为1%[1/103]；Allowash XG为5.5%[3/55]；BioCleanse为0%[0/31]），各组之间的移植物失败无显著差异（P = 0.二十）。未报告感染情况。术后国际膝关节文献委员会（IKDC）评分（MTF为82.6；Allowash XG为81.7；BioCleanse为80.2）在各组之间无差异（P = 0.60）。
使用BioCleanse、Allowash XG和MTF方案处理的骨-髌腱-骨同种异体移植物具有相似的移植物失败率和术后IKDC评分。尽管样本量不足，但数据表明这些技术中的每一种都可以安全使用，失败率低且功能结局良好。
