Summary

MCL reconstruction with allograft compared to autograft provides superior improvement in valgus stress measured on radiograph, but patient reported outcomes, graft failures, and post operative complications are similar in both treatments.

Abstract

Introduction

Medial collateral ligament (MCL) reconstruction is performed after failed non-operative treatment or high grade MCL injuries with associated valgus instability. The purpose of this study was to evaluate clinical outcomes following MCL reconstruction with autograft versus allograft.

Methods

A systematic review was performed according to PRISMA guidelines. Several databases were searched (PubMed, CINAHL, EMBASE, and Cochrane Database) to identify studies comparing outcomes of MCL reconstruction with autograft versus allograft. Studies were included if they evaluated clinical outcomes following MCL reconstruction using autograft and/or allograft. Studies with concomitant knee ligament injury other than the anterior collateral ligament were excluded. A quality assessment was performed using the modified Coleman Methodology Score, and risk-of-bias assessment was performed using the Risk of Bias In Non-randomized Studies–of Interventions and the Cochrane Collaboration tools.

Results

The initial search identified a total of 524 studies, 22 of which met inclusion criteria and were included in the study. There were 332 patients (60% male, 40% female), 159 (47.4%) underwent MCL reconstruction with autograft and 173 (52.5%) with allograft. 31.2% of patients undergoing MCL reconstruction with allograft had concomitant anterior cruciate ligament (ACL) reconstruction, as compared to 0 patients undergoing MCL reconstruction with autograft and ACL reconstruction. The most common autografts used were semitendinosus (82, 96.4%) and bone-patellar tendon-bone (3, 3.5%). The most common allografts were the achilles tendon (124, 48.4%), semitendinosus (29.4%), and tibialis anterior (22.1%). Patient reported outcomes such as pain and functionality show strong improvement after MCL reconstruction and indicate greater long-term success compared to MCL repair, regardless of the use of autograft or allograft. Pain (measured by Lysholm scores) improved on average from 54.4 to 89.6 and post-operative functionality (measured by International Knee Documentation Committee (IKDC) scores) improved on average from 53.1 to 88.3 in patients with MCL reconstruction. There was no significant difference in post-operative Lysholm and IKDC scores between MCL reconstruction with autograft or allograft. Two of the 22 studies included data on 63 MCL repair patients, all of which experienced statistically significant lower Lysholm and IKDC scores than their reconstruction counterparts. Radiographic analysis demonstrated that 16 (10.1%) patients who underwent MCL reconstructions using autograft had post-operative valgus instability, whereas about 5 (2.8%)_patients who underwent MCL reconstructions using allograft led to the same outcomes. Graft survivorship was slightly higher in MCL reconstruction using allograft when compared to autograft, but this was not statistically significant. Additionally, compared to MCL-only reconstruction, 82 patients underwent MCL reconstruction and primary or revision ACL reconstruction. 36 (43.9%) of these patients presented with knee extension deficits and failure of valgus stress tests, most of them undergoing MCL reconstruction and revision ACL reconstruction.

Conclusions

MCL reconstruction with either autograft or allograft leads to similar clinical outcomes. Graft failure and post-operative functional limitations occurred more frequently in patients who underwent MCL reconstruction with autograft. MCL reconstruction combined with primary or revision ACL reconstruction results in a higher rate of valgus stress and flexion deficits. Allograft may be the preferred option for MCL reconstruction owing to lower failure rate.