ReconstrucciÓn primaria de ligamento cruzado anterior con autoinjerto vs. aloinjerto

Abstract

Although the autograft has traditionally been the gold standard for the reconstruction of the anterior cruciate ligament (RLCA), the use of allograft has increased in recent years. Although numerous studies have shown that irradiated allografts are associated with increased failure rates, some authors claim excellent results after RLCA with non-irradiated allografts. The objective of this study is to compare the clinical results measured in terms of functional and activity scales, and the differences in anteroposterior and rotational stability between patients who underwent primary plasty of the Anterior Cruciate Ligament (ACL) with autograft versus allograft in our center. Material and Method: between 2012 and 2014, 50 primary L.C.A reconstructions were performed. Achilles allograft (ALO) was used in 25 cases and semitendinosusgracilis autograft (AUTO) in 25 cases. The Lysholm-Tegner functional scales and the IKDC (International Knee Documentation Committee) scale were performed. In addition, anteroposterior displacement was clinically evaluated with an arthrometer (KT1000) and the presence of pivot shift was verified in search of rotational instability. Postoperative range of motion was measured at 1, 2 and 6 months.
Results: The average follow-up was 2 years for both groups. There were no significant differences regarding the functional scales, or the instability tests (KT1000 and pivot shift). There were 2 complications (8%) for the ALO group, which was a deep infection (septic arthritis) and new tissue rupture that required revision of the graft, and in the AUTO group there were also 2 complications (8%), one case of hypoesthesia in the medial zone and another of discomfort when kneeling or performing deep squats. Conclusion: The use of allograft, in accordance with the literature, constitutes a therapeutic option when choosing the graft in patients older than 45 years of age who do not have a high demand or in multiligamentary knee injuries. Due to the major complications presented in the allograft group, this technique is not recommended as a choice in primary ACL plasty.