Abstract | April 20, 2023

Medial Collateral Ligament Reconstruction with Autograft vs Allograft

Jack Blitz, MS

Nigel Blackwood, BA, Medical Student, 3rd Year, Tulane University School of Medicine, New Orleans, LA; Jack A. Blitz, MS, Medical Student, 2rd Year, Tulane University School of Medicine, New Orleans, LA; Bryan Vopat, MD, Orthopaedic Surgery, Associate Professor, University of Kansas Medical Center, Kansas City, KS; Victoria K. Ierulli, MS, Medical Student, 1st Year, Tulane University School of Medicine, New Orleans, LA; Mary K. Mulcahey, MD, Orthopaedic Surgery, Associate Professor, Tulane University School of Medicine, New Orleans, LA.

Learning Objectives

  1. The reader should understand the similarities and differences of the outcomes of MCL reconstruction with autograft and allograft.
  2. The reader should understand the variability and confounding factors that complicate the analysis of graft choice

Background/Knowledge Gap: Medial collateral ligament (MCL) reconstruction is performed for high grade MCL injuries with valgus instability or after failed nonoperative treatment. The purpose of this study was to evaluate clinical outcomes following MCL reconstruction with autograft versus allograft.

Methods/Design: A systematic review was performed according to PRISMA guidelines. Databases including PubMed, CINAHL, EMBASE, and Cochrane Database were searched to identify studies comparing outcomes of MCL reconstruction with autograft versus allograft. Studies were excluded if they included a concomitant knee ligament injury other than the anterior collateral ligament. A quality assessment was performed using the modified Coleman Methodology Score. Results/Findings: The initial search identified 524 studies, 22 of which met inclusion criteria. Overall, there were 332 patients (60% male, 40% female), 159 (47.4%) underwent MCL reconstruction with autograft and 173 (52.5%) with allograft. 31.2% of patients who underwent MCL reconstruction with allograft had concomitant anterior cruciate ligament (ACL) reconstruction, as compared to 0 patients who underwent MCL reconstruction with autograft. Pain (measured by Lysholm scores) improved on average from 54.4 to 89.6, and post-operative functionality (measured by International Knee Documentation Committee (IKDC) scores) improved on average from 53.1 to 88.3 in patients with MCL reconstruction. There was no significant difference in post-operative Lysholm and IKDC scores between MCL reconstruction with autograft or allograft. Radiographic analysis demonstrated that 16 (10.1%) patients who underwent MCL reconstructions using autograft had post-operative valgus instability, and 5 (2.8%) patients who underwent MCL reconstructions using allograft had the same outcome. 82 patients underwent MCL reconstruction and primary or revision ACL reconstruction, and 36 (43.9%) of these patients presented with knee extension deficits and failure of valgus stress tests.

Conclusion/Implications: MCL reconstruction with either autograft or allograft leads to similar clinical outcomes such as Lysholm and Tegner scores. Valgus stress on radiograph improved more significantly in patients who underwent MCL reconstruction with allograft compared to autograft. MCL reconstruction combined with primary or revision ACL reconstruction results in a higher rate of valgus stress and flexion deficits.



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