ACL graft selection: state of the art

2018 ◽  
Vol 3 (3) ◽  
pp. 177-184 ◽  
Author(s):  
Hideyuki Koga ◽  
Stefano Zaffagnini ◽  
Alan M Getgood ◽  
Takeshi Muneta
Keyword(s):  
Cruciate Ligament ◽  
Quadriceps Tendon ◽  
Hamstring Tendon ◽  
Activity Level ◽  
Factors Affecting ◽  
Acl Graft ◽  
Advantages And Disadvantages ◽  
Recent Developments ◽  
Anterior Cruciate ◽  
Graft Selection

Despite recent developments in anterior cruciate ligament (ACL) reconstruction techniques, there are still several intraoperative factors affecting clinical outcomes that remain widely debated. Among such factors, graft selection might be the most critical yet controversial question for surgeons. As the primary factor influencing a patient’s choice for the ACL graft is surgeon recommendation, surgeons have to consider several factors to select the best graft for each patient. Graft options currently include autograft, allograft or synthetic grafts. In terms of autograft, there are three main options: hamstring tendon, bone-patellar tendon-bone (BPTB) and quadriceps tendon, the two most commonly used being hamstring tendon and BPTB. Limited evidence is available to select the one best graft for every individual patient. Graft selection should be based on the reported rate of graft failure/revision and be individualised according to multiple factors such as gender, age, activity level and type of activity, complications and other patient needs and demands. Furthermore, surgeons should be familiar with a variety of grafts, their specific associated surgical procedures and the advantages and disadvantages of each, with the aim of offering the best graft selection for each individual patient.

Anterior Cruciate Ligament Reconstructions With Quadriceps Tendon Autograft Result in Lower Graft Rupture Rates but Similar Patient-Reported Outcomes as Compared With Hamstring Tendon Autograft: A Comparison of 875 Patients

2020 ◽  
Vol 48 (9) ◽  
pp. 2195-2204 ◽  
Author(s):  
Armin Runer ◽  
Robert Csapo ◽  
Caroline Hepperger ◽  
Mirco Herbort ◽  
Christian Hoser ◽  
...  
Keyword(s):  
Revision Surgery ◽  
Cruciate Ligament ◽  
Quadriceps Tendon ◽  
Hamstring Tendon ◽  
Activity Level ◽  
Activity Levels ◽  
Acl Injuries ◽  
Graft Rupture ◽  
Patient Reported ◽  
Anterior Cruciate

Background: Graft rupture is a devastating outcome after anterior cruciate ligament (ACL) reconstruction (ACLR). Little is known about graft rupture rates as well as clinical and functional outcomes after ACLR with quadriceps tendon (QT) autografts. Purpose: To compare QT with hamstring tendon (HT) autografts in terms of the rates of graft and contralateral ACL rupture as well as patient-reported outcome measures. Study Design: Cohort study; Level of evidence, 3. Methods: All primary ACLRs performed between 2010 and 2016 were followed prospectively for 24 months through the recording of graft ruptures and contralateral ACL injuries as well as patient-administered questionnaires. Results: A total of 875 patients were included in the study. Three factors—graft type, age group, and activity level—had a significant value in predicting the need for revision surgery. The odds of revision surgery were 5.5 times greater in children younger than 15 years than in adults older than 45 years, 3.6 times greater in patients with high activity levels than low activity levels, and 2.7 times greater in patients receiving an HT autograft as compared with a QT autograft. A significantly higher rate of ipsilateral graft ruptures versus contralateral ACL injuries was observed in the HT group (4.9% vs 2.3%; odds ratio, 2.1; P = .01) but not in the QT group (2.8% vs 2.3%). The difference in the ratios of graft and contralateral ACL ruptures was even more pronounced in highly active patients treated with HT autografts (11.1% vs 4.2%; odds ratio, 2.6; P = .01) as compared with QT autografts (5.0% vs 2.8%; P = .48). Two-year measures of Lysholm scores (mean ± SD: QT, 86.0 ± 22.3; HT, 89.4 ± 16.4) and Tegner activity scores (QT, 6.1 ± 2.0; HT, 5.7 ± 1.9) as well as visual analog scale pain (QT, 0.8 ± 1.3; HT, 0.7 ± 1.1) did not differ between grafts. Conclusion: Graft choice does not influence clinical and functional outcomes 2 years after ACLR. However, 3 factors—graft type, age group, and activity level—have a significant value in predicting the need for revision surgery. Patients treated with HT autografts have a significantly higher, activity-dependent risk of revision surgery and experience more ipsilateral graft ruptures than subsequent contralateral ACL injuries when compared with patients treated with QT autografts. Young age and high activity level are significant predictors for ACL revision surgery.

scholarly journals 20-Year Outcomes of Anterior Cruciate Ligament Reconstruction With Hamstring Tendon Autograft: The Catastrophic Effect of Age and Posterior Tibial Slope

2017 ◽  
Vol 46 (3) ◽  
pp. 531-543 ◽  
Author(s):  
Lucy J. Salmon ◽  
Emma Heath ◽  
Hawar Akrawi ◽  
Justin P. Roe ◽  
James Linklater ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Degenerative Change ◽  
Acl Injury ◽  
Hamstring Tendon ◽  
Activity Level ◽  
Acl Graft ◽  
Hamstring Tendon Autograft ◽  
Graft Rupture ◽  
Tendon Autograft

Background: No well-controlled studies have compared the long-term outcome of anterior cruciate ligament (ACL) reconstruction with hamstring tendon autograft between adolescents and adults. Increased posterior tibial slopes (PTSs) have been reported in the ACL-injured versus controls, but the effect of PTS on the outcome after reconstruction is relatively unexplored. Purpose: To compare the prospective longitudinal outcome of “isolated” ACL ruptures treated with anatomic endoscopic ACL reconstruction using hamstring tendon autograft over 20 years in adolescent and adult cohorts and to examine factors for repeat ACL injury. Study Design: Case-control study; Level of evidence, 3. Methods: A single-surgeon series of 200 consecutive patients undergoing isolated primary ACL reconstruction with hamstring tendon autograft were prospectively studied. Subjects were assessed preoperatively and at 2, 7, 15, and 20 years postoperatively. Outcomes included International Knee Documentation Committee (IKDC) Knee Evaluation, IKDC subjective scores, KT-1000 instrumented laxity testing, and radiological evaluation of degenerative change and medial tibial slope. Twenty-year outcomes were compared between those who underwent surgery at the age of 18 years or younger (adolescent group, n = 39) and those who underwent surgery when older than 18 years (adult group, n = 161). Results: At 20 years, 179 of 200 subjects were reviewed (89.5%). ACL graft rupture occurred in 37 subjects and contralateral ACL injury in 22 subjects. Of those with intact ACL grafts at 20 years, outcomes were not statistically different between adolescents and adults for the variables of IKDC subjective score ( P = .29), return to preinjury activity level ( P = .84), current activity level ( P = .69), or degree of radiological degenerative change at 20 years ( P = .51). The adolescent group had a higher proportion of grade 1 ligamentous laxity testing compared with the adult group ( P = .003). Overall, ACL graft survival at 20 years was 86% for adults and 61% for adolescents (hazard ration, 3.3; P = .001). The hazard for ACL graft rupture was increased by 4.8 in adolescent males and 2.5 in adolescent females compared with adults. At 20 years, the ACL survival for adolescents with a PTS of ≥12° was 22%. The hazard for ACL graft rupture was increased by 11 in adolescents with a PTS of ≥12° ( P = .001) compared with adults with a PTS <12°. Conclusion: Repeat ACL injury after isolated ACL reconstruction is common, occurring in 1 in 3 over 20 years. In the absence of further injury, isolated ACL reconstruction using this technique was associated with good long-term outcomes with respect to patient-reported outcomes and return to sports, regardless of age. However, mild ligament laxity and ACL graft rupture after ACL reconstruction are significantly more common in adolescents, especially adolescent males, compared with adults. PTS of 12° or more is the strongest predictor of repeat ACL injury, and its negative effect is most pronounced in adolescents.

scholarly journals Anterior Cruciate Ligament Reconstruction in High School and College-Aged Athletes: Does Autograft Choice Influence Anterior Cruciate Ligament Revision Rates?

2020 ◽  
Vol 48 (2) ◽  
pp. 298-309 ◽  
Author(s):  
◽  
Kurt P. Spindler ◽  
Laura J. Huston ◽  
Alexander Zajichek ◽  
Emily K. Reinke ◽  
...  
Keyword(s):  
High School ◽  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Knee Laxity ◽  
Activity Level ◽  
Hamstring Autograft ◽  
Acl Graft ◽  
Normal Knee ◽  
Baseline Activity ◽  
Anterior Cruciate

Background: Physicians’ and patients’ decision-making process between bone–patellar tendon–bone (BTB) and hamstring tendon autografts for anterior cruciate ligament (ACL) reconstruction (ACLR) may be influenced by a variety of factors in the young, active athlete. Purpose: To determine the incidence of both ACL graft revisions and contralateral ACL tears resulting in subsequent ACLR in a cohort of high school– and college-aged athletes who initially underwent primary ACLR with either a BTB or a hamstring autograft. Study Design: Cohort study; Level of evidence, 2. Methods: Study inclusion criteria were patients aged 14 to 22 years who were injured in sports, had a contralateral normal knee, and were scheduled to undergo unilateral primary ACLR with either a BTB or a hamstring autograft. All patients were prospectively followed for 6 years to determine whether any subsequent ACLR was performed in either knee after their initial ACLR. Multivariable regression modeling controlled for age, sex, ethnicity/race, body mass index, sport and competition level, baseline activity level, knee laxity, and graft type. The 6-year outcomes were the incidence of subsequent ACLR in either knee. Results: A total of 839 patients were eligible, of which 770 (92%) had 6-year follow-up for the primary outcome measure of the incidence of subsequent ACLR. The median age was 17 years, with 48% female, and the distribution of BTB and hamstring grafts was 492 (64%) and 278 (36%), respectively. The incidence of subsequent ACLR at 6 years was 9.2% in the ipsilateral knee, 11.2% in the contralateral normal knee, and 19.7% for either knee. High-grade preoperative knee laxity (odds ratio [OR], 2.4 [95% confidence interval [CI], 1.4-3.9]; P = .001), autograft type (OR, 2.1 [95% CI, 1.3-3.5]; P = .004), and age (OR, 0.8 [95% CI, 0.7-1.0]; P = .009) were the 3 most influential predictors of ACL graft revision in the ipsilateral knee. The odds of ACL graft revision were 2.1 times higher for patients receiving a hamstring autograft than patients receiving a BTB autograft (95% CI, 1.3-3.5; P = .004). No significant differences were found between autograft choices when looking at the incidence of subsequent ACLR in the contralateral knee. Conclusion: There was a high incidence of both ACL graft revisions and contralateral normal ACL tears resulting in subsequent ACLR in this young athletic cohort. The incidence of ACL graft revision at 6 years after index surgery was 2.1 times higher with a hamstring autograft compared with a BTB autograft.

Anterior Closing Wedge Proximal Tibial Osteotomy and Revision Anterior Cruciate Ligament Reconstruction With Quadriceps Tendon Autograft

2021 ◽  
Vol 1 (5) ◽  
pp. 263502542110227
Author(s):  
Katie Geers ◽  
Benjamin Ormseth ◽  
Andrew Garrone ◽  
Robert Siston ◽  
Robert A. Duerr
Keyword(s):  
Anterior Cruciate Ligament ◽  
Risk Factor ◽  
Graft Failure ◽  
Cruciate Ligament ◽  
Quadriceps Tendon ◽  
Acl Injuries ◽  
Acl Graft ◽  
Closing Wedge ◽  
Anterior Cruciate ◽  
Tendon Autograft

Background: Anterior cruciate ligament (ACL) ruptures are among the most common injuries in young athletes and active adults. Reconstruction of the ACL most often leads to good functional outcomes and return to full activities. However, a number of patients experience ACL graft failures requiring revision surgery. The reasons for ACL graft failure are often multifactorial, though recent attention has been given to elevated posterior tibial slope (PTS) as a risk factor for recurrent ACL injuries. Indications: In patients with 2 or more ACL reconstruction failures with a PTS ≥12 degrees, anterior closing wedge proximal tibia osteotomy (ACWPTO) may be indicated to reduce the risk of recurrent ACL graft failure and allow return to full activities. Technique Description: This surgical technique video demonstrates the ACWPTO using a case example in a young athlete. Preoperative templating on lateral radiograph is used to determine the amount of correction for the closing wedge. The osteotomy is completed using K-wires and a free hand biplanar cutting technique with the tibial tubercle left in place. This is performed with a concomitant revision ACL reconstruction using quadriceps tendon autograft. Results: There are 2 small cases series published with good clinical outcomes and return to sport activities. No ACL graft failures were reported in either study with short-term follow-up. Discussion: In this surgical technique video, we review the literature indicating elevated PTS as a risk factor in ACL injuries and recurrent ACL graft failures. We highlight important technique pearls and pitfalls to avoid complications during the surgical demonstration. Finally, we review postoperative rehabilitation guidelines and clinical outcomes within the existing literature. In patients with recurrent ACL graft failures, ACWPTO provides a safe and reliable technique to correct an elevated PTS and return patients back to full activities with reduced risk of ACL graft re-tear.

scholarly journals Arthroscopic anterior cruciate ligament reconstruction with central quadriceps tendon bone (CQTB) graft: An outcome study in fifty Indian patients

2017 ◽  
Vol 5 (10) ◽  
pp. 4506
Author(s):  
Saurabh Sharma ◽  
Gururaj Joshi ◽  
Vivek M. Philip ◽  
Nitin Kaushal
Keyword(s):  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Quadriceps Tendon ◽  
Hamstring Tendon ◽  
Functional Improvement ◽  
Anterior Drawer ◽  
Lachman Test ◽  
Number Of Patients ◽  
Anterior Cruciate

Background: Arthroscopic ACL reconstruction using biologic autografts is the current gold standard in the management of symptomatic ACL tears. The commonly used BPTB (Bone-Patellar Tendon-Bone) and quadrupled hamstring tendon grafts have their own disadvantages. This study was conducted to evaluate the efficacy of CQTB (Central Quadriceps Tendon Bearing) graft as an autograft for ACL reconstruction in relieving instability in ACL deficient knees.Methods: 50 patients (45males; 5 females) with symptomatic ACL laxity, who underwent arthroscopic ACL reconstruction using the CQTB graft were followed up for 1 year. The functional improvement was analyzed by comparing the pre-operative Lysholm scores with those at 03 months, 06 months and 12 months post operatively. The objective improvement was analyzed comparing the Anterior Drawer and Lachman test grades pre-operatively and after 1 year follow up. The mean length of the graft and the post-operative morbidity were also noted.Results: The average Lysholm scores improved from a pre-operative value of 44.34 to 78.98,87.86 and 91.58 at 03months,06 months and 1 year respectively. (p<0.05; ANOVA). The number of patients with Grade I, II and III laxities on Anterior Drawer test improved from 01, 36 and 12 respectively to 43, 06 and 01 respectively 1 year after surgery (p<0.05; paired t test). The number of patients with Grade I, II and III laxities on Lachman test reduced from 1, 34 and 15 y to 39, 10 and 01 respectively. The average thickness of graft harvested was 9.21mm.Conclusions: CQTB autograft is a viable option along with other available autografts in its ability to reconstruct native ACL, without any hazards and additional complications.

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