Chalk Up Another Vote for Using Your Own Tendons in ACL RepairMost studies agree that using the patient's own tissue to repair an anterior cruciate ligament (ACL) tear is the way to go. When the tendon is taken from patellar tendon in front of the knee, many in the medical world consider it the "gold standard."
Despite the good results with this method, there are problems. Muscle weakness, pain, tendonitis, and kneecap fracture are just a few of the possible problems. Researchers are looking for a better way to repair the ACL with fewer complications. This study of ACL repair compares the use of two sources of tendon material in combination with a special way of adding stability to the knee, called iliotibial band tenodesis.
An autograft is tissue taken from the patient. Allograft is the term for tissue donated by someone else. A tenodesis is the use of a tendon from a muscle by moving one of its ends to a different place. In the case of iliotibial band tenodesis, the doctors use a portion of the iliotibial tract, a broad, fibrous band of tissue along the outside of the thigh. One end of the iliotibial band is cut and moved from the outside of the lower leg bone (tibia) to the outside of the thighbone (femur). The goal is to make the knee joint more stable. Moving the iliotibial tract above the joint helps keep the tibia from sliding or shifting forward.
Results were measured by asking patients questions about:
There were no differences between the two groups in terms of pain levels and satisfaction. The allograft patients (those receiving donated tissue) had less motion and strength in knee flexion. The researchers think this may be because the allograft group was older and didn't follow the rehab program fully. There were three tendon ruptures in the allograft group and none in the autograft group.
The authors conclude that the autograft method of repairing a torn ACL is still the best method. However, they think using an allograft along with an iliotibial band tenodesis is another useful operation.
Spencer K. Y. Chang, MD, et al. Anterior Cruciate Ligament Reconstruction: Allograft Versus Autograft. In Arthroscopy. May/June 2003. Vol. 19. No. 5. Pp. 453-462.
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