A meta-analysis of anterior cruciate ligament reconstruction with autograft compared with nonirradiated allograft

Abstract

Background: To compare autograft with non-irradiated allograft for reconstruction of anterior cruciate ligament.

Methods: MEDLINE, EMBASE, and Cochrane Library databases, as well as unpublished and ongoing studies were searched through up to 20 July 2013 to identify studies meeting the pre-stated inclusion criteria.

Results: A total of 12 studies (n=1167, including 597 patients in the autograft group and 570 patients in the allograft group) were included. The methodological scores for randomized controlled trials ranged from two to four (total score: seven), and for non-randomized prospective studies and cohort studies ranged from four to seven (total score: 12). Except for the Lysholm score (WMD, -1.46; P<0.05) showing a statistically significant difference but a small and clinically irrelevant difference, there was no significant difference between autograft and non-irradiated allograft with respect to the overall IKDC (International Knee Documentation Committee) level, subjective IKDC score, Tegner score, complication, ROM (range of motion), Pivot-shift test, Anterior drawer test, Lachman test, Daniel's one-leg hop test, Harner's vertical jump test, and Instrumented knee laxity test. The results were consistent across a series of sensitivity analyses and subgroup analyses.

Conclusions: Patients with autograft exhibited little clinical advantage over non-irradiated allograft with respect to knee stability, function and side effects. The robustness of the findings might need to be further validated due to the relatively small number of randomized controlled trials.

Level of evidence: Level II, meta-analysis of prospective studies.

Keywords: Allograft; Anterior cruciate ligament; Autograft; Meta-analysis.