Document Title: Gorschewsky-AJSM-Aug05.shtml
Article Title: Clinical Comparison of the Tutoplast Allograft and Autologous Patellar Tendon (Bone–Patellar Tendon–Bone) for the Reconstruction of the Anterior Cruciate Ligament: 2- and 6-Year Results
Authors: Ottmar Gorschewsky, MD, Andreas Klakow, MD, Kathrin Riechert, MD, Martin Pitzl, MD and Roland Becker, MD
Publication: American Journal of Sports Medicine, Baltimore, Maryland
Date: August 2005
Volume 33, pages 1202-1209
Keywords: ACL reconstruction, autograft, allograft, anterior cruciate ligament rupture, surgical maintenance, bone–patellar–tendon–bone (BPTB).

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Comments: The authors conclude that allografts are not the best choice for ACL reconstructions, especially for active people, given the comparatively high proclivity of allografts towards gradual stretching-out and subsequent failure (in comparison to autografts). They do note, however, that allografts are still a viable option for people with multiple, complex knee-ligament injuries. So, the graft of choice is still the patellar-tendon autograft.

ABSTRACT

Background: The use of an allograft as a suitable transplant is still open to debate, in terms of donor morbidity, implantation reaction, and long-term results, as well as the risk of disease transmission.

Hypothesis: The clinical results 2 and 6 years after implantation of a bone–patellar tendon–bone allograft (Tutoplast) and bone–patellar tendon–bone autograft show no significant difference in relation to stability, function, and rate of rupture.

Study Design: Cohort study; Level of evidence, 2.

Method: Between 1995 and 1998, 268 patients with anterior cruciate ligament ruptures were surgically treated: 132 patients received a bone–patellar tendon–bone allograft implantation and 136 patients a bone–patellar tendon–bone autograft. The results were evaluated using the International Knee Documentation Committee, Noyes, and Lysholm scores.

Results: There were 201 patients assessable after 2 years and 186 patients after 6 years. Ruptures of the implants in the allograft group occurred in 20 patients (20.6%) within 2 years and in 38 patients (44.7%) after 6 years. In the autograft group, transplants ruptured in 5 patients (4.8%) after 2 years and in 6 patients (5.9%) after 6 years.

Conclusion: This study shows that Based on the data, it would appear that the regular use of bone–patellar tendon–bone allografts, particularly for physically active patients, is unsuitable. n the case of reoperations or multiple, complex ligamentous injuries.

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