Autografts May Extend Life of ACL Reconstructions

SEATTLE—The type of material used to create a new anterior cruciate ligament (ACL) may determine the length of time an athlete can stay in the game, according to a study presented at the 2014 Annual Meeting of the American Orthopaedic Society of Sports Medicine. “Our study results highlight that in a young athletic population, allografts fail more frequently than using autografts,” said Craig R. Bottoni, MD, lead author from Tripler Army Medical Center in Honolulu, Hawaii, and his team of researchers.

In their study, which lasted from June 2002 to August 2003, researchers randomized 99 patients with a symptomatic ACL-deficient knee (87 male; 95 active-duty military) to either hamstring autograft or tibialis posterior allograft for their ACL construction. All allografts were from a single tissue bank, aseptically processed and fresh frozen without terminal irradiation. Graft fixation was identical in all knees and all patients followed the same post-operative rehabilitation protocol, blinded to the therapists.

Preoperative and postoperative assessments were performed via examination and/or telephone and internet-based questionnaire to ascertain functional and subjective status using established knee metrics. The primary outcome measures were graft integrity, subjective knee stability, and functional status.

Overall, both groups were similar in demographics and preoperative activity level. The mean and median age of both groups was similar (29 and 26). Concomitant meniscal and chondral pathology, microfracture, and meniscal repairs performed at the time of reconstruction were similar in both groups.

At a minimum 10 years (range: 120-134 months) from surgery, 96 patients (97 knees) were contacted (2 patients were deceased and 1 was lost to follow-up). There were four (8.3%) autograft and 13 (26.5%) allograft failures, which required revision reconstruction. In the remaining patients whose graft was intact, there was no difference in the mean SANE, Tegner, or IKDC scores.

“After following the patients for 10 years, more than 80% of all grafts were intact and had maintained stability. However, those patients who had an allograft failed at a rate more than three times higher than those reconstructed with an autograft. This study was also of only one type of allograft—tibialis posterior. Therefore, we can make a strong statement about that type and not necessarily extrapolate to other types of allografts, most notably those with bone,” said Dr. Bottoni. “By better understanding why and how grafts fail in ACL reconstructions, we can increase the life span of these procedures and minimize future surgeries where feasible,” he said.

SEATTLE—The type of material used to create a new anterior cruciate ligament (ACL) may determine the length of time an athlete can stay in the game, according to a study presented at the 2014 Annual Meeting of the American Orthopaedic Society of Sports Medicine. “Our study results highlight that in a young athletic population, allografts fail more frequently than using autografts,” said Craig R. Bottoni, MD, lead author from Tripler Army Medical Center in Honolulu, Hawaii, and his team of researchers.

In their study, which lasted from June 2002 to August 2003, researchers randomized 99 patients with a symptomatic ACL-deficient knee (87 male; 95 active-duty military) to either hamstring autograft or tibialis posterior allograft for their ACL construction. All allografts were from a single tissue bank, aseptically processed and fresh frozen without terminal irradiation. Graft fixation was identical in all knees and all patients followed the same post-operative rehabilitation protocol, blinded to the therapists.

Preoperative and postoperative assessments were performed via examination and/or telephone and internet-based questionnaire to ascertain functional and subjective status using established knee metrics. The primary outcome measures were graft integrity, subjective knee stability, and functional status.

Overall, both groups were similar in demographics and preoperative activity level. The mean and median age of both groups was similar (29 and 26). Concomitant meniscal and chondral pathology, microfracture, and meniscal repairs performed at the time of reconstruction were similar in both groups.

At a minimum 10 years (range: 120-134 months) from surgery, 96 patients (97 knees) were contacted (2 patients were deceased and 1 was lost to follow-up). There were four (8.3%) autograft and 13 (26.5%) allograft failures, which required revision reconstruction. In the remaining patients whose graft was intact, there was no difference in the mean SANE, Tegner, or IKDC scores.

“After following the patients for 10 years, more than 80% of all grafts were intact and had maintained stability. However, those patients who had an allograft failed at a rate more than three times higher than those reconstructed with an autograft. This study was also of only one type of allograft—tibialis posterior. Therefore, we can make a strong statement about that type and not necessarily extrapolate to other types of allografts, most notably those with bone,” said Dr. Bottoni. “By better understanding why and how grafts fail in ACL reconstructions, we can increase the life span of these procedures and minimize future surgeries where feasible,” he said.

SEATTLE—The type of material used to create a new anterior cruciate ligament (ACL) may determine the length of time an athlete can stay in the game, according to a study presented at the 2014 Annual Meeting of the American Orthopaedic Society of Sports Medicine. “Our study results highlight that in a young athletic population, allografts fail more frequently than using autografts,” said Craig R. Bottoni, MD, lead author from Tripler Army Medical Center in Honolulu, Hawaii, and his team of researchers.

In their study, which lasted from June 2002 to August 2003, researchers randomized 99 patients with a symptomatic ACL-deficient knee (87 male; 95 active-duty military) to either hamstring autograft or tibialis posterior allograft for their ACL construction. All allografts were from a single tissue bank, aseptically processed and fresh frozen without terminal irradiation. Graft fixation was identical in all knees and all patients followed the same post-operative rehabilitation protocol, blinded to the therapists.

Preoperative and postoperative assessments were performed via examination and/or telephone and internet-based questionnaire to ascertain functional and subjective status using established knee metrics. The primary outcome measures were graft integrity, subjective knee stability, and functional status.

Overall, both groups were similar in demographics and preoperative activity level. The mean and median age of both groups was similar (29 and 26). Concomitant meniscal and chondral pathology, microfracture, and meniscal repairs performed at the time of reconstruction were similar in both groups.

At a minimum 10 years (range: 120-134 months) from surgery, 96 patients (97 knees) were contacted (2 patients were deceased and 1 was lost to follow-up). There were four (8.3%) autograft and 13 (26.5%) allograft failures, which required revision reconstruction. In the remaining patients whose graft was intact, there was no difference in the mean SANE, Tegner, or IKDC scores.

“After following the patients for 10 years, more than 80% of all grafts were intact and had maintained stability. However, those patients who had an allograft failed at a rate more than three times higher than those reconstructed with an autograft. This study was also of only one type of allograft—tibialis posterior. Therefore, we can make a strong statement about that type and not necessarily extrapolate to other types of allografts, most notably those with bone,” said Dr. Bottoni. “By better understanding why and how grafts fail in ACL reconstructions, we can increase the life span of these procedures and minimize future surgeries where feasible,” he said.