[Clinico-histologic comparison of allogenic and autologous bone-tendon-bone using one-third of the patellar tendon in reconstruction of the anterior cruciate ligament]

Abstract

Reconstruction of the ruptured anterior cruciate ligament (ACL) using modern techniques achieves successful long-term results in up to 90% of all cases. Yet the discussion continues as to the suitable implant to replace the ACL in terms of donor morbidity, implant reaction, long-term results, and potenzial risk of carrier concerning the allograft. The clinical and histological results from 2 years experience with the BPTB allograft (Tutoplast) and the BPTB autograft for ACL reconstruction are compared with reference to stability, functionality, rerupture rate, and histological reaction of the remodelling process. A BTB patella tendon allograft was implanted into 132 patients and a BPTB autograft into 136 patients. The patients were randomly allocated to the two groups. The results were recorded by an independent researcher and assessed according to the IKDC and Lysholm score. In the allograft group, a total of 20 patients (2.6%) reruptured within an average period of 11.75 months. In the autograft group, the transplant reruptured in five patients (4.8%) after an average of 17 months. Histological reappraisal indicated delayed incorporation and extended reconstruction in the BPTB allograft. There were clearer and more protracted indications of hypercellularity and hypervascularity, and the collagen matrix had not regularly aligned longitudinally even 1 year later. A detailed analysis of the BPTB allograft group indicated that especially in young and very sporty patients there is increased elongation of the implant and a clearly higher rerupture rate. Hence, according to the data we have collected, it would seem that the use of the BPTB allograft (Tutoplast) is not suitable especially in young patients who frequently practice high-level sports involving high knee stress.