Open AccessXenograft for anterior cruciate ligament reconstruction was associated with high graft processing infection
Author(s) -
Van Der Merwe Willem,
Lind Martin,
Faunø Peter,
Van Egmond Kees,
Zaffagnini Stefano,
Marcacci Maurilio,
Cugat Ramon,
Verdonk Rene,
Ibañez Enrique,
Guillen Pedro,
Marcheggiani Muccioli Giulio Maria
Publication year - 2020
Publication title -
journal of experimental orthopaedics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.597
H-Index - 18
ISSN - 2197-1153
DOI - 10.1186/s40634-020-00292-0
Subject(s) - medicine , anterior cruciate ligament , anterior cruciate ligament reconstruction , surgery , orthopedic surgery , tendon , patellar tendon , urology
Purpose To evaluate clinical ad radiological outcomes of anterior cruciate ligament (ACL) reconstruction with an immunochemically modified porcine patellar tendon xenograft controlled against human Achilles tendon allograft at 24‐month minimum follow‐up. Methods 66 patients undergoing arthroscopic ACL reconstruction were randomized into 2 groups: 34 allografts and 32 xenografts treated to attenuate the host immune response. Follow‐up was 24‐month minimum. Anterior knee stability was measured as KT − 1000 side‐to‐side laxity difference (respect to the contralateral healthy knee). Functional performance was assessed by one‐legged hop test. Objective manual pivot‐shift test and subjective (IKDC, Tegner and SF‐36) outcomes were collected. MRI and standard X‐Ray were performed. Results 61 subjects (32 allograft, 29 xenograft) were evaluated at 12 and 24 months. Six of the subjects in xenograft group (20.6%) got an infection attributed to a water‐based pathogen graft contamination in processing. Intention‐to‐treat analysis (using the last observation carried forward imputation method) revealed higher KT − 1000 laxity in xenograft group at 24‐month follow‐up ( P = .042). Also pivot‐shift was higher in xenograft group at 12‐month ( P = .015) and 24‐month follow‐up ( P = .038). Per‐protocol analysis (missing/contaminated subjects excluded) did not revealed clinical differences between groups. Tibial tunnel widening in the allograft group was low, whereas xenograft tunnel widening was within the expected range of 20–35% as reported in the literature. No immunological reactivity was associated to xenograft group. Conclusions High infection rate (20.6%) was reported in xenograft group. Both groups of patients achieved comparable clinical outcomes if missing/contaminated subjects are excluded. Improved harvesting/processing treatments in future studies using xenografts for ACL reconstruction are needed to reduce infection rate, otherwise xenograft should not be used in ACL reconstruction. Level of evidence Multicenter and double‐blinded Randomized Controlled Clinical Trial, Level I.