ACLR: No difference between hamstring autograft and fresh-frozen tibialis allograft .
This report has been verified
by one or more authors of the
original publication.
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2013;1(2):222 Arthroscopy. 2012 Aug;28(8):1079-86. doi: 10.1016/j.arthro.2012.05.010147 patients undergoing anterior cruciate ligament (ACL) reconstruction were randomized to receive surgery with autogenous hamstring tendon or with fresh-frozen allograft anterior tibialis tendon. Over 2 years, there was no difference between the two groups with regard to stability, pivot shift test results, radiographic outcomes, International Knee Documentation Committee (IKDC) subjective and functional scores, and complications.
Was the allocation sequence adequately generated?
Was allocation adequately concealed?
Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?
Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?
Blinding Patients: Was knowledge of the allocated interventions adequately prevented?
Was loss to follow-up (missing outcome data) infrequent?
Are reports of the study free of suggestion of selective outcome reporting?
Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?
Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?
Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?
Sim = 1
Incerto = 0,5
Não relevante = 0
Não = 0
A Avaliação dos Critérios de Relato avalia a transparência com que os autores relatam as caraterísticas metodológicas e do ensaio na publicação. A avaliação está dividida em cinco categorias que são apresentadas de seguida.
4/4
Randomization
3/4
Outcome Measurements
2/4
Inclusion / Exclusion
4/4
Therapy Description
4/4
Statistics
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
O Índice de Fragilidade é uma ferramenta que auxilia na interpretação de achados significativos, fornecendo uma medida de força para um resultado. O Índice de Fragilidade representa o número de eventos consecutivos que precisam de ser adicionados a um resultado dicotómico para que o resultado deixe de ser significativo. Um número pequeno representa um resultado mais fraco e um número grande representa um resultado mais forte.
Porque é que este estudo era necessário agora?
Although research has shown excellent results with regard to the use of autografts in ACL reconstruction, some surgeons prefer to use allografts in order to prevent the occurrence of harvest site morbidity. There is little high quality research investigating the effectiveness of allografts, in that most studies have been retrospective in nature. From this research, it has been determined that rejection and slow recovery are potential problems in patients who receive allografts. This study aimed to compare the use of an autogenous hamstring tendon with a fresh-frozen allograft anterior tibialis tendon in ACL reconstruction in order to determine if there is a difference between the two treatments with regard to stability and functioning.
Qual era a principal questão de investigação?
Is there a difference between the use of autogenous hamstring tendon and fresh-frozen anterior tibialis tendon allograft in ACL reconstruction with regard to clinical outcomes and knee stability assessed over 2 years?
- At 2 years, there was no significant difference between the two groups for the maximum manual KT scores (autograft: 85% with normal stability, allograft: 90% with normal stability; p>0.05)
- The two groups did not differ with respect to mean IKDC subjective scores (91.0, 90.9; p>0.05) and mean functional IKDC scores (85% normal, 90% normal; p>0.05) at 2 years
- There was no significant difference between the two groups at 2 years for the pivot-shift test results (89% with normal findings, 92% with normal findings; p>0.05), the number of patients with effusion (1 in the autograft group and 0 in the allograft group; p>0.05), knee extension (94% with normal extension, 96% with normal extension; p>0.05), thigh circumference (p>0.05), and the single leg hop test results (p>0.05)
- According to radiographs, 93% of the autograft group and 88% of the allograft group had no evidence of medial compartment arthrosis (p>0.05). 96% of the autograft group and 88% of the allograft group demonstrated no evidence of lateral compartment arthrosis.
De que é que me devo lembrar mais?
Results suggest that there is no difference between the use of a hamstring autograft and the use of a fresh-frozen soft-tissue tibialis allograft in ACL reconstruction with regard to clinical outcomes, function, knee stability, and radiographic outcomes at 2 years.
Como é que isto afectará o tratamento dos meus doentes?
Further research with appropriate sample sizes, greater follow up, and patient-centered clinical outcomes is needed to compare the effectiveness of autografts and allografts in ACL reconstruction.
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