Summary

Systematic Review comparing the use of allograft vs autograft in MCL reconstructionBackground High grade injuries of the medial collateral ligament (MCL) often require surgical management whether in isolation or in multi-ligamentous injured unstable knee. There are several different surgical techniques described along with options of auto- or allograft choices. However, there is paucity of literat

Abstract

Background

High grade injuries of the medial collateral ligament (MCL) often require surgical management in the unstable knee. There are several different surgical techniques along with options of auto- or allograft choices. However, there is paucity of literature to support the use of one graft over the other. The aim of this review is to assess the outcomes of different grafts in MCL reconstruction.

Methods

A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed/Medline and SCOPUS databases were searched. All studies which reported clinical outcomes of MCL reconstruction using allograft, autograft or artificial grafts were included and screened for eligibility. Data collected included patient demographics, sample size, type of graft used, complication and PROMs. A descriptive analysis of the data was conducted. Comparative analysis was not performed due to heterogeneity of data and confounding variables.

Results

11 studies met the criteria with 274 patients. The mean age of patients was 32.7 (range 18 to 61) with the mean follow-up of 30 months (range 12 to 49.7). Four studies described Achilles allografts and seven studies described hamstring autografts (4 semitendinosus, 2 gracilis, 1 semitendionsus and gracilis). 6 were retrospective case series, 2 were RCTs and 2 prospective case series.
77 patients had TA allograft. In the hamstring autograft group, semitendinosus was reported in 88 patients, gracilis was reported in 75 patients, and 34 patients had a combination of semitendinosus and gracilis.
In both allograft and autograft groups, the most prominent indication for MCL reconstruction was multiligament knee injury (87%). The allograft group only had 1 patient with isolated MCL reconstruction while the autograft group only had 9 patients with isolated MCL reconstruction.
The commonest PROM was IKDC score. In the TA allograft group, IKDC improved from 45.3 – 63 preop to 67.9 to 93. Two studies reported statistically significant improvements. In the hamstring autograft group, IKDC improved overall from 46.8-58 preop to 71.7-85 postop (46.8-53 preop to 71.7-85 postop in the semitendinosus group, 73.6 to 80.3 in the gracilis group, and 58 to 78.2 in the semitendinosus and gracilis group). Three studies reported statistically significant improvement. Furthermore, the Lysholm score showed an improvement from 27-67 preop to 70.1-90 in the hamstring autograft group. 4 studies reported statistically significant changes.
The overall complication rate was 13% in the TA allograft group compared to 19.2% in the autograft group. The most common complications in the allograft group were laxity (3.9%) and infection (3.9%). The most common complications in the autograft group was laxity and instability (16.8%) followed by stiffness (1.5%). Laxity and instability in the autograft group was only reported in the semitendinosus group.

Conclusions

Our study shows improvements in PROMs for both autograft and allografts however there is a higher rate of complications with autograft. Furthermore, within this, the rate of laxity and instability is much higher in patients who have had semitendinosus autograft. Further studies are required to assess complication rates and patient outcomes.