The use of allograft tissue in posterior cruciate, collateral and multi-ligament knee reconstruction
Por:
Strauss, MJ, Varatojo, R, Boutefnouchet, T, Condello, V, Samuelsson, K, Gelber, PE, Adravanti, P, Laver, L, Dimmen, S, Eriksson, K, Verdonk, P, Spalding, T
Publicada:
1 jun 2019
Resumen:
Purpose Currently both autograft and allograft tissues are available for reconstruction of posterior cruciate, collateral and multi-ligament knee injuries. Decision-making is based on a complex interplay between anatomical structures, functional bundles and varying biomechanical requirements. Despite theoretically better biological healing and reduced risk of disease transmission autografts are associated with donor site morbidity as well as being limited by size and quantity. The use of allografts eliminates donor-site morbidity but raises cost and issues of clinical effectiveness. The purpose of this paper is to review current concepts and evidence for the use of allografts in primary posterior cruciate, collateral and multi-ligament reconstructions.
Methods A narrative review of the relevant literature was conducted for PCL, collateral ligament and multi-ligament knee reconstruction. Studies were identified using a targeted and systematic search with focus on recent comparative studies and all clinical systematic reviews and meta-analyses. The rationale and principles of management underpinning the role of allograft tissue were identified and the clinical and functional outcomes were analysed. Finally, the position of postoperative physiotherapy and rehabilitation was identified.
Results The review demonstrated paucity in high quality and up-to-date results addressing the issue especially on collaterals and multi-ligament reconstructions. There was no significant evidence of superiority of a graft type over another for PCL reconstruction. Contemporary principles in the management of posterolateral corner, MCL and multi-ligament injuries support the use of allograft tissue.
Conclusion The present review demonstrates equivalent clinical results with the use of autografts or allografts. It remains, however, difficult to generate a conclusive evidence-based approach due to the paucity of high-level research. When confronted by the need for combined reconstructions with multiple grafts, preservation of synergistic muscles, and adapted postoperative rehabilitation; the current evidence does offer support for the use of allograft tissue.
Filiaciones:
Strauss, MJ:
Steadman Philippon Res Inst, Vail, CO USA
Oslo Univ Hosp, Orthopaed Div, Oslo, Norway
Univ Oslo, Oslo, Norway
Norwegian Sch Sports Sci, OSTRC, Oslo, Norway
Varatojo, R:
Hosp Cuf Descobertas, Rua Mario Botas, Lisbon, Portugal
Boutefnouchet, T:
Univ Hosp Coventry & Warwickshire NHS Trust, Clifford Bridge Rd, Coventry, W Midlands, England
Condello, V:
Clin Humanitas Castelli, Dept Orthopaed, Via Mazzini,11, Bergamo, Italy
Samuelsson, K:
Sahlgrens Univ Hosp, Molndal, Sweden
Univ Gothenburg, Sahlgrenska Acad, Inst Clin Sci, Gothenburg, Sweden
Gelber, PE:
Univ Autonoma Barcelona, Hosp Santa Creu Sant Pau, Barcelona, Spain
Univ Autonoma Barcelona, ICATME Hosp Univ Dexeus, Barcelona, Spain
Adravanti, P:
Citta Parma Clin, Dept Orthopaed, Piazzale Athos Maestri 5, Parma, Italy
Dimmen, S:
Lovisenberg Diaconal Hosp, Oslo, Norway
Eriksson, K:
Stockholm South Hosp, Karolinska Inst, Stockholm, Sweden
Verdonk, P:
Monica Hosp, Antwerp Orthoped Ctr, Antwerp, Belgium
Spalding, T:
Univ Hosp Coventry & Warwickshire NHS Trust, Clifford Bridge Rd, Coventry, W Midlands, England
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