S. SCHEFFLER - Berlin, Allemagne
Autologous tissue remains the primary graft option in ACL surgery. However, with increasing activity efforts in higher age groups and the demand of today's patients to continue strenuous activities even after primary ACL reconstruction, an increase in revision surgery has been observed. Also, multiligamentous injuries of the knee joint are increasingly approached with anatomic reconstruction of each injured structure. This had led to a substantial increase in the demand for allograft tissue.
Allografts offer certain advantages, such as avoidance of graft site morbidity and impairment of flexor and extensor muscle strength of the knee joint, improved cosmesis and the possibility to adapt graft sizes and configurations, especially in revision surgery. However, concerns remain about disease transmission, allograft availability and increased costs. Also, it has been suggested that increased knee laxity can be found during long-term healing of soft-tissue allografts in high activity patients .
In this presentation, indications for allograft ACL surgery will be discussed. Different allograft choices, such as the patellar, hamstring, quadriceps, achilles or tibialis anterior tendons as well as their differences in mechanical and biological healing properties will be presented .
New legal guidelines have been proposed by the European Union that will render the use of non-sterilized soft-tissue allografts virtually impossible. Therefore current graft processing and sterilization techniques will be explained and an outlook provided on future developments to ensure safe usage of soft-tissue allografts .
A summary of the most recent clinical outcome studies will be discussed. Agreement exists that ACL reconstruction with allograft tissue provides acceptable results . However, it is matter of debate whether there is increased knee laxity and rerupture rates of allograft ACL reconstruction compared to autologous ACL reconstruction during long-term healing . Findings of basic science studies that examined the differences between autologous, non-sterilized and sterilized graft remodelling and incorporation will be related to the results of clinical studies.
Finally, an outlook about future developments in allograft ACL surgery will be given.
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