Italian consensus statement for the use of allografts in ACL reconstructive surgery

Corrado Bait, Pietro Randelli, Riccardo Compagnoni, Paolo Ferrua, Rocco Papalia, Filippo Familiari, Andrea Tecame, Paolo Adravanti, Ezio Adriani, Enrico Arnaldi, Franco Benazzo, Massimo Berruto, Giovanni Bonaspetti, Gian Luigi Canata, Pier Paolo Canè, Araldo Causero, Giancarlo Coari, Matteo Denti, Maristella Farè, Andrea FerrettiMarco Fravisini, Francesco Giron, Alberto Gobbi, Vincenzo Madonna, Andrea Manunta, Pier Paolo Mariani, Claudio Mazzola, Giuseppe Milano, Luigi Pederzini, Flavio Quaglia, Mario Ronga, Herbert Schönhuber, Giacomo Stefani, Piero Volpi, Giacomo Zanon, Raul Zini, Claudio Zorzi, Stefano Zaffagnini

Research output: Contribution to journalArticle

Abstract

PURPOSE: Graft choice for primary anterior cruciate ligament reconstruction (ACL-R) is debated, with considerable controversy and variability among surgeons. Autograft tendons are actually the most used grafts for primary surgery; however, allografts have been used in greater frequency for both primary and revision ACL surgery over the past decade. Given the great debate on the use of allografts in ACL-R, the "Allografts for Anterior Cruciate Ligament Reconstruction" consensus statement was developed among orthopedic surgeons and members of SIGASCOT (Società Italiana del Ginocchio, Artroscopia, Sport, Cartilagine, Tecnologie Ortopediche), with extensive experience in ACL-R, to investigate their habits in the use of allograft in different clinical situations. The results of this consensus statement will serve as benchmark information for future research and will help surgeons to facilitate the clinical decision making.

METHODS: In March 2017, a formal consensus process was developed using a modified Delphi technique method, involving a steering group (9 participants), a rating group (28 participants) and a peer-review group (31 participants). Nine statements were generated and then debated during a SIGASCOT consensus meeting. A manuscript has been then developed to report methodology and results of the consensus process and finally approved by all steering group members.

RESULTS: A different level of consensus has been reached among the topics selected. Strong agreement has been reported in considering harvesting, treatment and conservation methods relevant for clinical results, and in considering biological integration longer in allograft compared to autograft. Relative agreement has been reported in using allograft as the first-line graft for revision ACL-R, in considering biological integration a crucial aspect for rehabilitation protocol set-up, and in recommending a delayed return to sport when using allograft. Relative disagreement has been reported in using allograft as the first-line graft for primary ACL-R in patients over 50, and in not considering clinical results of allograft superior to autograft. Strong disagreement has been reported in using allograft as the first-line graft for primary ACL-R and for skeletally immature patients.

CONCLUSIONS: Results of this consensus do not represent a guideline for surgeons, but could be used as starting point for an international discussion on use of allografts in ACL-R.

LEVEL OF EVIDENCE: IV, consensus of experts.

Original languageEnglish
Pages (from-to)1-9
Number of pages9
JournalKnee Surgery, Sports Traumatology, Arthroscopy
DOIs
Publication statusE-pub ahead of print - Jun 21 2018

Keywords

  • ACL reconstruction
  • ACL revision
  • Allograft
  • Anterior cruciate ligament
  • Autograft
  • Consensus
  • Knee
  • Pediatric

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    Bait, C., Randelli, P., Compagnoni, R., Ferrua, P., Papalia, R., Familiari, F., Tecame, A., Adravanti, P., Adriani, E., Arnaldi, E., Benazzo, F., Berruto, M., Bonaspetti, G., Canata, G. L., Canè, P. P., Causero, A., Coari, G., Denti, M., Farè, M., ... Zaffagnini, S. (2018). Italian consensus statement for the use of allografts in ACL reconstructive surgery. Knee Surgery, Sports Traumatology, Arthroscopy, 1-9. https://doi.org/10.1007/s00167-018-5003-6