Prospective cohort study observes reduced early pain and faster functional recovery with allografts in ACL reconstruction, indicating donor tissue provides viable long-term stability.
Key Points
To prospectively compare long-term 5-year subjective and objective clinical outcomes between Achilles tendon allograft with soft-tissue fixation and bone-patellar tendon-bone autograft with interference screw fixation in primary ACL reconstruction.
Prospective comparative cohort study following 41 patients treated with Achilles tendon allograft and 118 patients treated with bone-patellar tendon-bone autograft (N=159 total).
Follow-up evaluations occurred preoperatively, at 1 to 2 weeks, 6 weeks, 3 months, 6 months, and annually for 5 years.
Outcomes were assessed objectively via KT-1000 arthrometer measurements, range of motion, and IKDC scores, alongside five subjective pain, functional status, and quality-of-life questionnaires analyzed using mixed-effects ANOVA.
Autograft patients reported significantly greater bodily pain on the RAND-36 at 1 week (P = .0006), 6 weeks (P = .0007), and 3 months (P = .0270), as well as higher McGill VAS pain scores at 1 to 2 weeks (P < .0001) and 6 weeks (P = .0147).
Normal or near-normal knee function was reported by 33% of allograft patients versus 14% of autograft patients at 3 months (P = .0558), with allograft patients reporting significantly fewer activity limitations at 6 weeks (P = .0501), 3 months (P = .0431), and 6 months (P = .0014).
The allograft group exhibited significantly greater joint laxity on KT-1000 measurements across all time points (P = .0520), though laxity decreased significantly over time in both cohorts (P < .0001) to produce comparable 5-year functional outcomes.