Summary

Individuals who underwent ACLR with hamstring tendon autograft or fresh-frozen allograft had similar long-term core muscle endurance, proprioception, and surgical satisfaction, but individuals who underwent ACLR with hamstring tendon autograft had lower proprioception than healthy controls.

Abstract

Objective

New studies are conducted daily to determine the best graft among various graft types in anterior cruciate ligament reconstruction (ACLR). Frequently preferred hamstring tendon autografts or fresh-frozen allografts have been compared, particularly using subjective tests and functional jump tests [1,2]. Comparing the two graft types in terms of parameters that are directly related to the functional performance of the individual, such as core endurance and knee proprioception may help to understand the differences in terms of the results of graft types. Thus, it may guide clinicians in understanding the functional parameters that should be considered for graft types after surgery and in creating specific rehabilitation plans. The study aimed to compare core muscle endurance, proprioception, and surgery satisfaction among individuals who underwent ACLR with either hamstring tendon autograft or fresh-frozen allografts and healthy individuals.

Methods

A total of 52 individuals undergoing ACLR and 30 healthy individuals were assessed. Individuals who underwent ACLR with hamstring tendon autograft (Group 1) or fresh-frozen allograft (Group 2) and a health control group (HC) with similar activity levels were included in this study. The surgical groups were evaluated 12-60 months after surgery. The proprioception was assessed with a dual inclinometer in closed kinetic chain positions. Surgical satisfaction was assessed using a Visual Analog Scale (VAS). In addition, the core muscle endurance was assessed by the trunk flexor endurance test, side bridge test, trunk extensor test, and prone bridge test. Statistical analysis was performed using Statistical Package for Service Solutions (SPSS) version 23.0 (SPSS, Chicago, IL).

Results

There were 23 individuals (mean age 31.13±8.85 years) in Group 1, 29 individuals (mean age 33.07±5.49 years) in Group 2, and 30 individuals (mean age 33.77±7.09 years) in HC. There was no difference between the surgical groups in terms of core muscle endurance, proprioception, and surgery satisfaction (p>0.05). Additionally, there was no difference in Group 2 between HC. However, there were significant differences between Group 1 with the HC in terms of proprioception of the injured side (p<0.031).

Conclusions

This study showed that no graft type was superior to another in terms of core muscle endurance, proprioception, and surgery satisfaction after ACLR. However, the proprioception was still found to be lower in individuals who underwent surgery with autograft compared to healthy controls. This should be taken into consideration when returning to the level of physical activity after surgery.
Keywords: Allografts, autografts, anterior cruciate ligament reconstruction, proprioception, core muscle endurance.
References
1- Wang S, Zhang C, Cai Y, et al. Autograft or Allograft? Irradiated or Not? A contrast between autograft and allograft in anterior cruciate ligament reconstruction: a meta-analysis. Arthroscopy. 2018;34(12):3258-3265.
2- Issın A, Öner A, Sofu H, et al. Comparison of freeze-dried tibialis anterior allograft and four-strand hamstring autograft in anterior cruciate ligament reconstruction. Acta Orthop Traumatol Turc. 2019;53(1):45-49.