Autograft superior to both irradiated and non-irradiated allograft for primary ACL reconstruction: a systematic review
Bibliographic record
Abstract
ImportanceGraft choice in anterior cruciate ligament (ACL) reconstruction is controversial. Recent evidence questions the equivalence of non-irradiated allografts to autografts in primary reconstruction.AimTo compare the clinical outcomes of primary ACL reconstruction using autografts and allografts.Evidence reviewA computerised search of the Pubmed/Medline, Cochrane Central Register of Controlled Trials, and SCOPUS databases was performed. We included comparative studies with level of evidence I to III, minimum 2 year follow-up, a minimum of 20 patients in each treatment arm, and selected outcome measures. Non-irradiated, non-chemically treated allografts and irradiated or chemically treated allografts were compared with autografts. The Cochrane Collaboration tool was used for quality appraisal.FindingsTwenty-two studies were included for the systematic review. These included 1148 autografts, 939 non-irradiated, non-chemically treated allografts, and 308 irradiated or chemically treated allografts. The failure rates for both allograft groups were inferior to that of autograft, with the OR for failure favouring autografts versus non-irradiated, non-chemically treated allografts (OR 0.51, 95% CI 0.30 to 0.88), and irradiated or chemically treated allografts (OR 0.12, 95% CI 0.06 to 0.21). Other outcome measures, including the Lachman test, pivot shift, instrumented laxity testing, and IKDC scores demonstrated no statistically significant differences for autograft and non-irradiated, non-chemically treated allograft reconstructions. Irradiated and chemically treated allograft reconstructions were inferior to autograft reconstructions in almost every examined outcome measure.Conclusions and relevanceIn this level III systematic review, autograft reconstructions have a lower failure rate than both non-irradiated and irradiated allografts, particularly for younger patients. Other clinical outcome measures for autografts and non-irradiated allografts are not significantly different. Based on our results, it appears that irradiated and chemically-treated allografts have clearly inferior results, and surgeons should exercise caution when recommending ACL reconstruction with these allografts.Level of evidenceIII. Graft choice in anterior cruciate ligament (ACL) reconstruction is controversial. Recent evidence questions the equivalence of non-irradiated allografts to autografts in primary reconstruction. To compare the clinical outcomes of primary ACL reconstruction using autografts and allografts. A computerised search of the Pubmed/Medline, Cochrane Central Register of Controlled Trials, and SCOPUS databases was performed. We included comparative studies with level of evidence I to III, minimum 2 year follow-up, a minimum of 20 patients in each treatment arm, and selected outcome measures. Non-irradiated, non-chemically treated allografts and irradiated or chemically treated allografts were compared with autografts. The Cochrane Collaboration tool was used for quality appraisal. Twenty-two studies were included for the systematic review. These included 1148 autografts, 939 non-irradiated, non-chemically treated allografts, and 308 irradiated or chemically treated allografts. The failure rates for both allograft groups were inferior to that of autograft, with the OR for failure favouring autografts versus non-irradiated, non-chemically treated allografts (OR 0.51, 95% CI 0.30 to 0.88), and irradiated or chemically treated allografts (OR 0.12, 95% CI 0.06 to 0.21). Other outcome measures, including the Lachman test, pivot shift, instrumented laxity testing, and IKDC scores demonstrated no statistically significant differences for autograft and non-irradiated, non-chemically treated allograft reconstructions. Irradiated and chemically treated allograft reconstructions were inferior to autograft reconstructions in almost every examined outcome measure. In this level III systematic review, autograft reconstructions have a lower failure rate than both non-irradiated and irradiated allografts, particularly for younger patients. Other clinical outcome measures for autografts and non-irradiated allografts are not significantly different. Based on our results, it appears that irradiated and chemically-treated allografts have clearly inferior results, and surgeons should exercise caution when recommending ACL reconstruction with these allografts.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.019 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.011 | 0.008 |
| Bibliometrics | 0.005 | 0.006 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.006 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".