A LITERATURE ANALYSIS COMPARING THE PHYSICAL CHARACTERISTICS, INFECTION

RATE, AND COST OF ALLOGRAFTS VERSUS AUTOGRAFTS IN ANTERIOR

CRUCIATE LIGAMENT RECONSTRUCTION.

Submitted by: Sham Persaud

Saint Leo University Undergraduate Student

(Biology Major, Chemistry Minor, and Honors Student)

INTRODUCTION

Major Intra-articular Ligament And The Most Commonly Injured Ligament Of The Knee

Is Needed For Support And Strength Of The Knee

Also Used For Preventing Extreme Translation Of The Tibia Relative To The Femur

100,000 – 250,000 ACL Disruptions Per Year 50,000 Require ACL Reconstruction

HOW ACL TEARS OCCUR

AUTOGRAFTS

ALLOGRAFTS

SURGERY SUMMARY

www.youtube.com/watch?v=q96M0jRqn7k

METHODS

IKDC

IKDC Score = (Some of Items/Maximum Possible Score) X 100

1. Effusion 2. Passive Motion Deficit 3. Ligament Examination 4. Compartment Findings 5. Harvest Site Pathology 6. X-ray Findings 7. Functional Test

LYSHOLM SCORE

Limp (5 points) Pain (25 points) Support (5 points) Locking (15 points) Swelling (10 points) Instability (30 points) Stair Climbing (10 points) Squatting (5 points)

TEGNER SCORE

Activity Scale

Scores Range From 0-10

KT-1000

The KT-1000 knee arthrometer is an objective instrument to measure anterior

tibial motion relative to the femur for anterior

cruciate ligament (ACL) reconstruction.

PHYSICAL DATA COMPARISONTable 1Clinical Outcome Studies of Allograft Versus Autograft Knee Anterior Cruciate Ligament Reconstruction

Study Allograft Type

Autograft Type

Number of Allograft Patients

Number of Autograft Patients

IKDC(Allo/Auto)

Lysholm Score

(Allo/Auto)

Tegner Score (Allo/Auto)

Kt-1000 (Allo/Auto)

Schepsis et al.2003

Quadrupled Hamstring Construct

Quadrupled Hamstring Construct

41 Patients 29 Patients 84.90/86.90 91.8/90.8 6.71/7.00 1.45mm/1.4mm

Rihn et al. 2006 BPTB BPTB 39 Patients 63 Patients 90.70/82.70 N/A N/A 1.3mm/2.2mm

Poehling et al. 2005

Achilles BPTB 41 Patients 118 Patients 89.00/50.00 N/A N/A 3.0mm/2.8mm

Barret et al. 2005

BPTB BPTB 38 Patients 25 Patients 87.00/96.00 N/A N/A 1.46mm/1.04mm

Kuskos et al. 2004

BPTB BPTB 53 Patients 26 Patients *No Difference

84.10/89.90 N/A *Allograft is slightly greater than

Autograft

Chang et al. 2003

BPTB BPTB 46 Patients 33 Patients N/A 90.70/97.00 N/A 1.2mm/1.1mm

Peterson et al. 2001

BPTB BPTB 30 Patients 30 Patients N/A 90.00/88.60 N/A *73%/67% <3mm

Kleipso et al. 1998

BPTB BPTB 36 Patients 26 Patients 85.00/69.00 N/A N/A *75%/69% <3mm

Stringham et al. 1996

BPTB BPTB 31 Patients 47 Patients N/A 90.20/90.60 *0.51/0.53 *70%/80% <3mm

Harner et al. 1996

BPTB BPTB 63 Patients 26 Patients 48.00/39.00 N/A N/A 1.8mm/1.9mm

Sun et al.2009

BPTB BPTB 80 Patients 76 Patients 75.00/72.00 91.00/90.00 7.60/7.80 2.5mm/2.4mm

*Indicates that the data was not considered for the final results.

COST COMPARISONTable 2Cost Comparison: Allograft Versus Autograft Anterior Cruciate Ligament Reconstruction

Data Topic Allograft Autograft

Number of Allografts in Analysis 37 Patients 86 Patients

Total Cost of Procedure $4,622.00 $5,684.00

Hospital Day Price $26.00 $314.00

OR Time/Surgical Center $617.00 $912.00

Pharmacy $677.00 $1,139.00

Anesthesia $588.00 $917.00

Anesthesia Supplies $99.00 $121.00

Radiology $36.00 $123.00

OR Supplies $1,818.00 $1,534

PACU $410.00 $254.00

Laboratory $36.00 $18.00

Central Supplies $11.00 $16.00

Respiratory Care $14.00 $15.00

Cast Room $244.00 $252.00

Other $76.00 $79.00

RATE OF BACTERIAL INFECTION

Table 3Rate of Bacterial Infection: Allograft Versus Autograft Anterior Cruciate Ligament Reconstruction

Data Topic Allograft Autograft

Number of Patients 628 Patients 170 Patients

Number of Patients with Bacterial Infection

4 Patients (.62%) 4 Patients (2.4%)

CONCLUSION

No Significant Difference In Physical Characteristics

Significant Difference In Cost (Pro-Allograft)

No Significant Difference In Bacterial Infection (Favored Allograft)

Allograft Use Was Shown To Be A Viable And Successful ACL Reconstruction Technique.