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

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

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.

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Author information

Authors and Affiliations

  1. U.O. Chirurgia Articolare e Traumatologia dello Sport, Istituto Clinico Villa Aprica, Como, Italy

    Corrado Bait

  2. Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy

    Pietro Randelli

  3. 1° Clinica Ortopedica, ASST Centro specialistico ortopedico traumatologico Gaetano Pini, CTO, Milan, Italy

    Pietro Randelli & Riccardo Compagnoni

  4. ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini, CTO, Milan, Italy

    Paolo Ferrua & Massimo Berruto

  5. Dipartimento di Ortopedia e Traumatologia, Università Campus biomedico, Rome, Italy

    Rocco Papalia & Andrea Tecame

  6. Casa di Cura Villa del Sole, Catanzaro, Italy

    Filippo Familiari

  7. U.O. Ortopedia, Clinica “Città di Parma”, Parma, Italy

    Paolo Adravanti

  8. Sport Clinique, Clinica Mater Dei, Rome, Italy

    Ezio Adriani

  9. Centro di Chirurgia del Ginocchio, Istituto clinico Humanitas, Rozzano, MI, Italy

    Enrico Arnaldi

  10. Clinica Ortopedica dell’Università degli studi di Pavia, Fondazione policlinico San Matteo, Pavia, Italy

    Franco Benazzo & Giacomo Zanon

  11. U.O. Ortopedia e Traumatologia 2, Istituto clinico sant’Anna, Brescia, Italy

    Giovanni Bonaspetti

  12. Centro di Traumatologia dello Sport, Ospedale Koelliker, Turin, Italy

    Gian Luigi Canata

  13. Centro di Artroscopia e Chirurgia del Ginocchio, Clinica “Sol et Salus”, Rimini, Italy

    Pier Paolo Canè & Marco Fravisini

  14. Clinica Ortopedica Università di Udine, Udine, Italy

    Araldo Causero

  15. Casa di Cura San Camillo, Forte dei Marmi, Lucca, Italy

    Giancarlo Coari

  16. Clinica Ars Medica, Lugano, Switzerland

    Matteo Denti

  17. Banca del tessuto muscolo scheletrico, ASST Centro specialistico Ortopedico Traumatologico Gaetano Pini, CTO, Milan, Italy

    Maristella Farè

  18. Ospedale Universitario Sant’Andrea, Rome, Italy

    Andrea Ferretti

  19. S.O. Ortopedia e Traumatologia, AOU Careggi, Firenze, Italy

    Francesco Giron

  20. Oasi Bioresearch Foundation Gobbi NPO, Milan, Italy

    Alberto Gobbi

  21. Ospedale Sacro Cuore di Negrar, Verona, Italy

    Vincenzo Madonna & Claudio Zorzi

  22. Dipartimento di Ortopedia dell’Università degli Studi di Sassari, Sassari, Italy

    Andrea Manunta

  23. Casa di cura villa Stuart, Rome, Italy

    Pier Paolo Mariani

  24. S.C. Ortopedia Articolare, Ospedali Galliera, Genoa, Italy

    Claudio Mazzola

  25. Dipartimento di Ortopedia dell’Università Cattolica di Roma, Rome, Italy

    Giuseppe Milano

  26. Nuovo ospedale di Sassuolo, Modena, Italy

    Luigi Pederzini

  27. Centro Sp.Or.T.S., Clinica Fornaca, Turin, Italy

    Flavio Quaglia

  28. Dipartimento di medicina e scienza della salute (V. Tiberio), Università degli studi del Molise, Campobasso, Italy

    Mario Ronga

  29. Centro di Traumatologia dello Sport, Istituto Ortopedico Galeazzi, Milan, Italy

    Herbert Schönhuber

  30. Centro di Chirurgia del ginocchio, Istituto Clinico “Città di Brescia” Brescia, Brescia, Italy

    Giacomo Stefani

  31. Centro di Traumatologia dello Sport, Istituto clinico Humanitas, Rozzano, MI, Italy

    Piero Volpi

  32. Villa Maria Cecilia Hospital, Cotignola, Ravenna, Italy

    Raul Zini

  33. Clinica Ortopedica e Traumatologica II Istituti Ortopedici Rizzoli Bologna, Bologna, Italy

    Stefano Zaffagnini

Authors
  1. Corrado Bait
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  2. Pietro Randelli
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  3. Riccardo Compagnoni
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  4. Paolo Ferrua
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  5. Rocco Papalia
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  6. Filippo Familiari
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  7. Andrea Tecame
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  8. Paolo Adravanti
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  9. Ezio Adriani
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  11. Franco Benazzo
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  14. Gian Luigi Canata
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  22. Francesco Giron
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  23. Alberto Gobbi
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  24. Vincenzo Madonna
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  28. Giuseppe Milano
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  31. Mario Ronga
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  32. Herbert Schönhuber
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  33. Giacomo Stefani
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  34. Piero Volpi
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  35. Giacomo Zanon
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  36. Raul Zini
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  37. Claudio Zorzi
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  38. Stefano Zaffagnini
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Corresponding author

Correspondence to Riccardo Compagnoni.

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Conflict of interest

All authors declared that they have no conflict of interest regarding the object of the study. Ezio Adriani is consultant for Depuy Shyntes. Giacomo Stefani is consultant for Smith Nephew and Depuy. Pietro Randelli is consultant for Depuy and Arthrex. Andrea Ferretti is consultant for Arthrex. 

Ethical approval

This study reports results of a consensus among orthopedic surgeons and did not involved humans or patients. Ethical committee approval is not required in this kind of scientific works.

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Bait, C., Randelli, P., Compagnoni, R. et al. Italian consensus statement for the use of allografts in ACL reconstructive surgery. Knee Surg Sports Traumatol Arthrosc 27, 1873–1881 (2019). https://doi.org/10.1007/s00167-018-5003-6

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