Alternative graft sourcesAllograft

Quadriceps tendon

John F. Meyers M.D.

Allograft advantages

• No donor morbidity

• Readily available

• Can use any size

• Shorter operative time

• Better cosmesis

Allograft disadvantages

• Slower incorporation

• ? Ultimate strength

• Disease transmission

• Cost

Basic ScienceArnoczky-canine

• Avascular necrosis followed by revascularization and cellular proliferation

• At one year the gross and histologic appearance of the allograft resembled that of a normal ACL

Basic ScienceJackson- goat

• At 6 months allografts had smaller cross sectional area and persistence of large diameter collagen fibers.

• Autografts were stronger than allografts at the 6 month period

• Force to failure 2 times greater in autograft.

Basic ScienceShino- canine

• Vascular pattern of allograft similar to ACL at 52 weeks.

• Mean energy to failure 57% of control at 52 weeks

Basic ScienceFisher- humans

• Tunnel widening with achilles tendon allografts

• Clinical results excellent

ClinicalIndelicato

• Fresh-frozen slightly better than freeze-dried.

• Clinical results good.

• No autograft controls.

ClinicalShino

• Good results at average 5 year followup.

• No autograft controls.

ClinicalNoyes

• No difference between BTB and fascia lata allografts.

ClinicalCollette

• Compared BTB autogtaft and allograft.

• Results similar.

ClinicalHarner

• Compared autograft and allograft.

• Evaluated by objective and subjective data

• No statistically significant difference in any area.

Disease TransmissionHIV and Hepatitis

• 1:1.6 million chance of disease transmission using AATB screening and antibody testing.

• Now using antibody, antigen and recumbent DNA testing.

There has never been a case of disease transmission

using freeze-dried tissue !

VIDEO

Quadriceps tendon- advantages

• Larger and stronger graft possible.

• Can be harvested by assistant while surgeon doing notchplasty.

• Not an allograft!

Quadriceps tendon- disadvantages

• Postoperative quadriceps weakness.

• No track record to date.

Basic ScienceStaubli

• Patellar ligamen stiffer than Quadriceps tendon.

Basic ScienceHarris

• Load to failure 1.36 times Patellar tendon

ClinicalBlouth

• Described use of quad tendon for ACL reconstruction in 1984

ClinicalFulkerson

• 130 Quad tendon reconstructions with only four failures since 1994.

VideoFulkerson Technique