scholarly journals Allograft Augmentation of Hamstring Anterior Cruciate Ligament Grafts is Associated with Increased Graft Failure

2018 ◽  
Vol 6 (7_suppl4) ◽  
pp. 2325967118S0014
Author(s):  
Crystal Perkins ◽  
Michael T. Busch ◽  
Melissa A. Christino ◽  
S. Clifton Willimon
Keyword(s):  
Soft Tissue ◽  
Acl Reconstruction ◽  
Graft Failure ◽  
Activity Level ◽  
Population Characteristics ◽  
Hamstring Autograft ◽  
Inclusion Criteria ◽  
Graft Rupture ◽  
Graft Diameter

Objectives: ACL reconstruction in adolescents is commonly performed with hamstring autografts. In the adolescent population with very high activity levels, graft rupture is the most feared complication of ACL reconstruction. Young age, higher activity level, allografts, and small graft diameter have been shown to be predictors of graft failure. The applicability of this data to pediatric ACL reconstructions is limited due to heterogeneity of ages, graft constructs, and tunnel techniques. The purpose of this study is to evaluate the association of soft tissue graft constructs and graft rupture following pediatric transphyseal ACL reconstruction. Our hypothesis is that allograft-augmentation of grafts is associated with an increased risk of graft rupture. Methods: A single-institution retrospective review was performed of consecutive patients. Inclusion criteria were age less than 20 years and transphyseal ACL reconstruction with hamstring autograft, with or without allograft augmentation. Graft constructs included 4-strand doubled semitendinosus and gracilis (4-STG), 5-strand tripled semitendinosus and doubled gracilis (5-STG), 6-strand doubled gracilis and semitendinosus plus allograft (6-STGAllo), and 7-strand tripled semitendinosus and doubled gracilis plus allograft (7-STGAllo). Exclusion criteria included multiligament reconstruction and less than 6 months follow-up. The primary outcome was graft rupture. Results: Three hundred fifty-five patients (157 males, 198 females) with an average age of 15.3 years were identified to meet inclusion criteria. Graft constructs included 4-STG (198), 5-STG (91), 6-STGAllo (65), and 7-STGAllo (1). Average graft diameter was 8.3 mm 4-STG, 8.9 mm 5-STG, and 9.2 mm 6-STGAllo. Age and graft sizes were significantly different across groups with older patients (p <0.001) and larger graft sizes (p <0.001) being found in patients with allograft-augmented grafts. Mean duration of follow-up was 26 months (range 6-56 months). There were 51 graft ruptures (14.3%). The failure rate of each construct was 13.6% 4-STG, 11.9% 5-STG, and 19.7% 6-STGAllo. Time to graft failure was 16 months (range 2-40 months), with 49% of failures occurring before 12 months and 24% after 24 months. Twenty-four patients (6.7%) had a contralateral ACL tear during the follow-up period. Table 1 provides population characteristics by graft rupture status. This data suggests that patients who sustain a graft rupture may be slightly younger (p=0.07) and have lower BMI (p=0.07) than those patients without graft rupture. Odds ratios for graft failure by graft construct, controlling for age and graft size were calculated. Patients with 6-STGAllo grafts had an odds ratio of 2.6 (95% CI: 1.02, 6.50) of graft rupture as compared to 4-STG. Conclusion: ACL reconstruction with hamstring autograft combined with soft tissue allograft have a 2.6 times risk of graft rupture as compared to hamstring autograft without augmentation. In situations where the surgeon harvests an inadequately sized 4-strand autograft, we recommend tripling the semitendinosus to produce a larger graft diameter rather than augment with an allograft.

scholarly journals Graft Choice for Adolescent Athletes Returning to High-Risk Sports: A Matched Cohort Analysis of Patellar Tendon and Hamstring Autografts

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0050
Author(s):  
Michael Busch ◽  
Asahi Murata ◽  
Crystal Perkins ◽  
S. Clifton Willimon
Keyword(s):  
High Risk ◽  
Acl Reconstruction ◽  
Patellar Tendon ◽  
Graft Failure ◽  
Activity Level ◽  
Inclusion Criteria ◽  
Graft Rupture ◽  
Graft Choice ◽  
The Mean

Objectives: Graft selection for skeletally mature adolescents undergoing anterior cruciate ligament (ACL) reconstruction is guided by surgeon and patient preference. In young patients returning to high-risk cutting and pivoting sports, graft rupture is the most feared complication of ACL reconstruction. Some studies have demonstrated slightly lower rates of graft failure and decreased laxity in the short term associated with patellar tendon (BTB) autografts as compared to hamstring (HS) autografts, but these studies are limited by their heterogeneity of ages and activity level. The purpose of this study is to compare the rates of graft failure between BTB and HS ACL reconstruction cohorts matched by age, sex, and sport. Methods: A single-institution retrospective review was performed of consecutive patients less than 19 years of age treated with ACL reconstructions using either patellar tendon (BTB) or hamstring (HS) autograft performed by a single surgeon. Skeletally mature or nearly mature patients in “high-risk” ACL injury sports (basketball, football, soccer, lacrosse, and gymnastics) were initially treated with hamstring autografts but the graft preference transitioned to BTB autografts as the preferred graft choice during the study period. This transition in graft preference for adolescents participating in “high risk” sports allows for a comparison of outcomes based on graft types. Inclusion criteria were ages 13 – 18 years, participation in a “high risk” sport, and minimum 24-month follow-up. The two cohorts of patients were matched by age, gender, and sport. The primary outcome measure was graft rupture. Results: One hundred twenty-six patients with an average age of 15.8 years (range 13 – 18 years) met inclusion criteria. There were 60 BTB reconstructions and 66 HS reconstructions. There were 55 females and 71 males. There was no difference in age, sex, BMI, or laterality between groups. There were more patients who played soccer in the BTB cohort (44%) vs HS cohort (22%) and fewer who played basketball in the BTB cohort (24%) vs HS cohort (38%), p = 0.005. There were no differences between the BTB and HS cohorts in terms of meniscus tears (60% v 68%, p = 0.34), meniscus repair (20% v 30%, p = 0.19), or partial meniscectomy (33% v 39%, p = 0.48). Mean duration of follow-up was 41 months (range 24-78 months). There was a difference in follow-up between cohorts (BTB 36 months and HS 50 months, p < 0.05). There were 16 graft ruptures (12.6%). There was no difference in the rate of graft rupture between cohorts (BTB 10.0% vs HS 15.2%, p = 0.45). Mean time to graft rupture was 21 months (range 8 – 35 months) and Kaplan-Meier survival curves demonstrated no difference between cohorts. The mean age of graft failures within the BTB cohort was 15.5 years as compared to 16.1 years for those that did not have a graft failure (p=0.268). The mean age of graft failures within the HS cohort was 14.9 years as compared to 15.9 years for those that did not have a graft failure (p<0.05). Conclusion: ACL reconstruction in adolescents returning to high-risk sports can be performed utilizing BTB or HS autografts with similar rates of graft rupture. Patients under the age of 15 years have a greater risk of failure associated with HS autograft as compared to patients 16 years of age and older with the same graft. In contrast, BTB grafts have similar failure rates regardless of age. There is a trend toward lower rates of graft rupture associated with BTB autografts, but additional patients will be necessary to determine if this trend will become a statistically significant difference.

scholarly journals GRAFT CHOICE FOR ADOLESCENT ATHLETES RETURNING TO HIGH-RISK SPORTS: A MATCHED COHORT ANALYSIS OF PATELLAR TENDON AND HAMSTRING AUTOGRAFTS

2019 ◽  
Vol 7 (3_suppl) ◽  
pp. 2325967119S0007
Author(s):  
Crystal Perkins ◽  
Michael Busch ◽  
Melissa Christino ◽  
Belinda Schaafsma ◽  
S. Clifton Willimon
Keyword(s):  
Anterior Cruciate Ligament ◽  
High Risk ◽  
Acl Reconstruction ◽  
Patellar Tendon ◽  
Graft Failure ◽  
Cruciate Ligament ◽  
Graft Rupture ◽  
Graft Choice ◽  
Anterior Cruciate

Background: Graft selection for skeletally mature adolescents undergoing anterior cruciate ligament (ACL) reconstruction is guided by surgeon and patient preference. In young patients returning to high-risk cutting and pivoting sports, graft rupture is the most feared complication of ACL reconstruction. Some studies have demonstrated slightly lower rates of graft failure and decreased laxity in the short term associated with patellar tendon (BTB) autografts as compared to hamstring (HS) autografts, but these studies are limited by their heterogeneity of ages and activity level1-3. The purpose of this study is to compare the rates of graft failure between BTB and HS ACL reconstruction cohorts matched by age, sex, and sport. Methods: A single-institution retrospective review was performed of consecutive patients less than 19 years of age treated with ACL reconstructions using either patellar tendon (BTB) or hamstring (HS) autograft performed by a single surgeon. Skeletally mature or nearly mature patients in “high-risk” ACL injury sports (basketball, football, soccer, lacrosse, and gymnastics) were initially treated with hamstring autografts but the graft preference transitioned to BTB autografts as the preferred graft choice during the study period. This transition in graft preference for adolescents participating in “high risk” sports allows for a comparison of outcomes based on graft types. Inclusion criteria were ages 13 – 18 years, participation in a “high risk” sport, and minimum 6-month follow-up. The two cohorts of patients were matched by age, gender, and sport. The primary outcome measure was graft rupture. Results: One hundred fifty-two patients with an average age of 16 years (range 13 – 18 years) underwent ACL reconstruction during the study period. There were 71 BTB reconstructions and 81 HS reconstructions. There were 64 females and 88 males. There was no difference in age, sex, BMI, or laterality between groups. There were more patients who played soccer in the BTB cohort (44%) vs HS cohort (20%) and fewer who played basketball in the BTB cohort (24%) vs HS cohort (41%), p = 0.005. There were no differences between the BTB and HS cohorts in terms of meniscus tears (61% v 72%, p = 0.15), meniscus repair (21% v 32%, p = 0.13), or partial meniscectomy (32% v 33%, p = 0.90). Mean duration of follow-up was 28 months (range 7-57 months). There was no difference in follow-up between cohorts (BTB 28 months and HS 29 months, p = 0.19). There were a total of 16 graft ruptures (10.5%). There was no difference in the rate of graft rupture between cohorts (BTB 8.5% vs HS 12.3%, p = 0.60). Mean time to graft rupture was 21 months (range 8 – 35 months) and Kaplan-Meier survival curves demonstrated no difference between cohorts. Conclusions: ACL reconstruction in adolescents returning to high-risk sports can be performed utilizing BTB or HS autografts with similar rates of graft rupture. There is a trend toward lower rates of graft rupture associated with BTB autografts, but additional patients will be necessary to determine if this trend will become a statistically significant difference. Beynnon BD, Johnson RJ, Fleming BC, et al. Anterior cruciate ligament replacement: comparison of bone-patellar tendon bone grafts with two-strand hamstring grafts. A prospective, randomized study. J Bone Joint Surg Am 2002;84(9):1503-1513. Ho B, Edmonds EW, Chambers HG et al. Risk factors for early ACL reconstruction failure in pediatric and adolescent patients: a review of 561 cases. J Pediatr Orthop 2016. Samuelsen BT, Webster KE, Johnson NR, et al. Hamstring autograft versus patellar tendon autograft for ACL reconstruction: is there a difference in graft failure rate? A meta-analysis of 47,613 patients. Clin Orthop Relat Res 2017;475(10):2459-2468.

Revision Risk of Soft Tissue Allograft Versus Hybrid Graft After Anterior Cruciate Ligament Reconstruction

2020 ◽  
Vol 48 (4) ◽  
pp. 799-805 ◽  
Author(s):  
Raffy Mirzayan ◽  
Heather A. Prentice ◽  
Anthony Essilfie ◽  
William E. Burfeind ◽  
David Y. Ding ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Hamstring Autograft ◽  
Tissue Allograft ◽  
Aseptic Revision ◽  
Revision Risk ◽  
Anterior Cruciate ◽  
Graft Diameter

Background: When a harvested hamstring autograft is deemed by the surgeon to be of inadequate diameter, the options include using the small graft, using another autograft from a different site, augmenting with an allograft (hybrid graft), using a different configuration of the graft (eg, 5- or 6-stranded), or abandoning the autograft and using allograft alone. A small graft diameter is associated with a higher revision risk, and using another autograft site includes added harvest-site morbidity; therefore, use of a hybrid graft or an allograft alone may be appealing alternative options. Revision risk for hybrid graft compared with soft tissue allograft is not known. Purpose: To evaluate the risk for aseptic revision surgery after primary anterior cruciate ligament reconstruction (ACLR) using a soft tissue allograft compared with ACLR using a hybrid graft in patients 25 years and younger. Study Design: Cohort study; Level of evidence, 3. Methods: Data from a health care system’s ACLR registry were used to identify primary isolated unilateral ACLRs between 2009 and 2016 using either a hybrid graft (hamstring autograft with soft tissue allograft) or a soft tissue allograft alone. Multivariable Cox proportional hazards regression was used to evaluate risk for aseptic revision after ACLR according to graft used after adjustment for age, allograft processing, tunnel drilling technique, and region where the primary ACLR was performed. Results: The cohort included 2080 ACLR procedures; a hybrid graft was used for 479 (23.0%) ACLRs. Median follow-up time was 3.4 years (interquartile range, 1.8-5.1 years). The crude 2-year aseptic revision probability was 5.4% (95% CI, 4.3%-6.7%) for soft tissue allograft ACLR and 3.8% (95% CI, 2.3%-6.4%) for hybrid graft ACLR. After adjustment for covariates, soft tissue allograft ACLR had a higher risk of aseptic revision during follow-up compared with hybrid graft ACLR (hazard ratio, 2.00; 95% CI, 1.21-3.31; P = .007). Conclusion: Soft tissue allografts had a 2-fold higher risk of aseptic revision compared with hybrid graft after ACLR. Future studies evaluating the indications for using hybrid grafts and the optimal hybrid graft diameter is needed.

scholarly journals ACL Reconstruction In High School and College-aged Athletes: Does Autograft Choice Affect Recurrent ACL Revision Rates?

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0028
Author(s):  
Christopher C. Kaeding ◽  
Kurt P. Spindler ◽  
Laura J. Huston ◽  
Alex Zajichek ◽  
Keyword(s):  
Acl Reconstruction ◽  
Graft Failure ◽  
Knee Laxity ◽  
Hamstring Graft ◽  
Hamstring Autograft ◽  
Acl Graft ◽  
Percentage Points ◽  
Competition Level ◽  
Risk Patients

Objectives: Physicians’ and patients’ decision-making process between bone-patellar tendon-bone (BTB) versus hamstring autografts for ACL reconstruction (ACLR) may be influenced by a patient’s gender, laxity level, sport played, and/or competition level in the young, active athlete. The purpose of this study was to determine the incidence of subsequent ligament disruption for high school and college-aged athletes between autograft BTB versus hamstring grafts for ACLRs. Our hypothesis is there would be no recurrent ligament failure differences between autograft types at 6-year follow-up. Methods: Our inclusion criteria were patients aged 14-22 who were injured in sport (basketball, football, soccer, other), had a contralateral normal knee, and were due to have a unilateral primary ACLR with either a BTB or hamstring autograft. All patients were prospectively followed at two and six years and contacted by phone and/or email to determine whether any subsequent surgery had occurred to either knee since their initial ACLR. If so, operative reports were obtained, whenever possible, in order to document pathology and treatment. Multivariable regression modeling controlled for age, gender, ethnicity/race, body mass index, sport and competition level, activity level, knee laxity, and graft type. The six-year outcomes of interest were the incidence of subsequent ACL reconstruction to either knee. Results: Eight hundred thirty-nine (839) patients were eligible, of which 770 (92%) had 6-year follow-up for subsequent surgery outcomes. The median age was 17, with 48% females, and the distribution of BTB to hamstring was 492 (64%) and 278 (36%) respectively. Thirty-three percent (33%) of the cohort was classified as having “high grade” knee laxity preoperatively. The overall ACL revision rate was 9.2% in the ipsilateral knee, 11.2% in the contralateral normal ACL, and 19.7% had one or the other within 6 years of the index ACLR surgery. High-grade laxity (OR: 2.4; 95% CI: 1.4, 3.9; p=0.001), autograft type (OR: 2.1; 95% CI: 1.3, 3.5; p=0.004), and age (OR: 0.8; 95% CI: 0.7, 0.96; p=0.009) were the 3 most influential predictors of a recurrent ACL graft revision on the ipsilateral knee, respectively, whereas the sport of the index injury (OR: 0.3; 95% CI: 0.2, 0.7; p=0.002) was the most influential predictor of a subsequent primary ACL reconstruction on the contralateral knee. The odds of a recurrent ACL graft revision on the ipsilateral knee for patients receiving a hamstring autograft were 2.1 times the odds of a patient receiving a BTB autograft (95% CI: 1.3, 3.5). For low-risk patients (5% incidence of graft failure), a hamstring graft can increase the risk of recurrent ACL graft revision by 5 percentage points, from 5% to 10%. For high-risk patients (35% incidence of graft failure), a hamstring graft can increase the risk of recurrent ACL graft revision by 15 percentage points, from 35% to ˜ 50%. An individual prediction risk calculator for a subsequent ACL graft revision can be determined by the nomogram in Figure 1. Conclusion: There is a high rate of subsequent ACL tears in both the ipsilateral and contralateral knees in this young athletic cohort, with evidence suggesting that incidence of ACL graft revisions at 6 years following index surgery is significantly higher in hamstring autograft compared to BTB autograft. [Figure: see text]

Anterolateral Ligament Reconstruction Is Associated With Significantly Reduced ACL Graft Rupture Rates at a Minimum Follow-up of 2 Years: A Prospective Comparative Study of 502 Patients From the SANTI Study Group

2017 ◽  
Vol 45 (7) ◽  
pp. 1547-1557 ◽  
Author(s):  
Bertrand Sonnery-Cottet ◽  
Adnan Saithna ◽  
Maxime Cavalier ◽  
Charles Kajetanek ◽  
Eduardo Frois Temponi ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Graft Failure ◽  
Ligament Reconstruction ◽  
Return To Sport ◽  
Hamstring Tendon ◽  
Anterolateral Ligament ◽  
Study Group ◽  
Graft Rupture ◽  
The Mean

Background: Graft failure and low rates of return to sport are major concerns after anterior cruciate ligament (ACL) reconstruction, particularly in a population at risk. Purpose: To evaluate the association between reconstruction techniques and subsequent graft rupture and return-to-sport rates in patients aged 16 to 30 years participating in pivoting sports. Study Design: Cohort study; Level of evidence, 2. Methods: A prospective study of patients undergoing primary ACL reconstruction with a bone–patellar tendon–bone (B-PT-B) graft, quadrupled hamstring tendon (4HT) graft, or hamstring tendon graft combined with anterolateral ligament reconstruction (HT+ALL) was conducted by the Scientific ACL NeTwork International (SANTI) Study Group. Survivorship data from Kaplan-Meier analysis were analyzed in multivariate Cox regression models to identify the prognosticators of graft ruptures and return to sport. Results: Five hundred two patients (mean age, 22.4 ± 4.0 years) with a mean follow-up of 38.4 ± 8.5 months (range, 24-54 months) were included. There were 105 B-PT-B, 176 4HT, and 221 HT+ALL grafts. The mean postoperative scores at latest follow-up were the following: Lysholm: 92.4 ± 8.6, Tegner: 7.4 ± 2.1, and subjective International Knee Documentation Committee (IKDC): 86.8 ± 10.5 for B-PT-B grafts; Lysholm: 91.3 ± 9.9, Tegner: 6.6 ± 1.8, and subjective IKDC: 85.4 ± 10.4 for 4HT grafts; and Lysholm: 91.9 ± 10.2, Tegner: 7.0 ± 2.0, and subjective IKDC: 81.8 ± 13.1 for HT+ALL grafts. The mean side-to-side laxity was 0.6 ± 0.9 mm for B-PT-B grafts, 0.6 ± 1.0 mm for 4HT grafts, and 0.5 ± 0.8 mm for HT+ALL grafts. At a mean follow-up of 38.4 months, the graft rupture rates were 10.77% (range, 6.60%-17.32%) for 4HT grafts, 16.77% (range, 9.99%-27.40%) for B-PT-B grafts, and 4.13% (range, 2.17%-7.80%) for HT+ALL grafts. The rate of graft failure with HT+ALL grafts was 2.5 times less than with B-PT-B grafts (hazard ratio [HR], 0.393; 95% CI, 0.153-0.953) and 3.1 times less than with 4HT grafts (HR, 0.327; 95% CI, 0.130-0.758). There was no significant difference in the graft failure rate between 4HT and B-PT-B grafts (HR, 1.204; 95% CI, 0.555-2.663). Other prognosticators of graft failure included age ≤25 years ( P = .012) and a preoperative side-to-side laxity >7 mm ( P = .018). The HT+ALL graft was associated with higher odds of returning to preinjury levels of sport than the 4HT graft (odds ratio [OR], 1.938; 95% CI, 1.174-3.224) but not compared with the B-PT-B graft (OR, 1.460; 95% CI, 0.813-2.613). Conclusion: In a high-risk population of young patients participating in pivoting sports, the rate of graft failure with HT+ALL grafts was 2.5 times less than with B-PT-B grafts and 3.1 times less than with 4HT grafts. The HT+ALL graft is also associated with greater odds of returning to preinjury levels of sport when compared with the 4HT graft.

Allograft Augmentation of Hamstring Anterior Cruciate Ligament Autografts Is Associated With Increased Graft Failure in Children and Adolescents

2019 ◽  
Vol 47 (7) ◽  
pp. 1576-1582 ◽  
Author(s):  
Crystal A. Perkins ◽  
Michael T. Busch ◽  
Melissa Christino ◽  
Mackenzie M. Herzog ◽  
S. Clifton Willimon
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Graft Failure ◽  
Cruciate Ligament ◽  
Hamstring Tendon ◽  
Hamstring Graft ◽  
Tissue Allograft ◽  
Graft Rupture ◽  
Anterior Cruciate ◽  
Graft Diameter

Background: Anterior cruciate ligament (ACL) reconstruction in adolescents is commonly performed with hamstring tendon autografts. Small graft diameter is one risk factor for graft failure and options to upsize the autologous hamstring graft include allograft augmentation and tripling one or both of the hamstring tendons. Purpose: To evaluate the association of upsized hamstring graft constructs and graft rupture after ACL reconstruction. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective review was performed of patients 19 years of age and younger who underwent hamstring autograft ACL reconstruction with or without soft tissue allograft augmentation from 2012 to 2016. All patients were skeletally mature or had less than 2 years of growth remaining. Graft constructs included 4-strand doubled semitendinosus and gracilis autograft (4-STG), 5-strand tripled semitendinosus and doubled gracilis autograft (5-STG), and 6-strand doubled gracilis and semitendinosus autograft augmented with a soft tissue allograft (6-STGAllo). The primary outcome measure was graft rupture. Results: A total of 354 patients with a mean age of 15.3 years (range, 10-19 years) were included. Graft constructs included 4-STG (198 knees), 5-STG (91 knees), and 6-STGAllo (65 knees). The average diameter of the graft constructs was 8.3 mm for 4-STG, 8.9 mm for 5-STG, and 9.2 mm for 6-STGAllo ( P < .001). The mean follow-up was 26 months (range, 6-56 months). There were 50 (14%) graft ruptures and 24 (7%) contralateral ACL tears. The graft failure rates were 14% for 4-STG, 12% for 5-STG, and 20% for 6-STGAllo ( P = .51). The average time to graft failure was 16 months (range, 2-40 months). After adjusting for age and graft size, patients who had allograft-augmented grafts (6-STGAllo) had 2.6 (95% CI, 1.02, 6.50) times the odds of graft rupture compared with 4-STG. There was no significant difference in failure rate between patients who had 5-STG grafts compared with 4-STG (OR, 1.2; 95% CI, 0.5, 2.7). Conclusion: ACL reconstruction with hamstring tendon autografts augmented with allografts has a significantly increased risk of graft rupture compared with comparably sized hamstring tendon autografts. In situations where the surgeon harvests an inadequately sized 4-strand autograft, we recommend obtaining a larger graft diameter by tripling the semitendinosus rather than augmenting with an allograft.

scholarly journals “RELATIVE” RISK OF ACL RE-INJURY

2019 ◽  
Vol 7 (3_suppl) ◽  
pp. 2325967119S0009
Author(s):  
Joshua T. Bram ◽  
Nakul S. Talathi ◽  
Christopher J. DeFrancesco ◽  
Neeraj M. Patel ◽  
Theodore J. Ganley
Keyword(s):  
Acl Reconstruction ◽  
Graft Failure ◽  
Acl Injury ◽  
Degree Relative ◽  
Acl Tear ◽  
Graft Rupture ◽  
Meniscus Tears ◽  
History Of ◽  
Primary Acl Reconstruction

Background Several studies have examined ACL injury history among relatives of patients undergoing ACL reconstruction, but they have primarily analyzed adult populations with variable results. Additionally, few studies have examined concomitant injuries or post-operative outcomes among pediatric patients with a family history of ACL tear. Therefore, the purpose of this study was to identify the proportion of pediatric ACL patients with a first degree relative who had suffered an ACL tear while also examining concomitant meniscal or ligamentous injuries and subsequent complication rates. Methods 1009 patients who underwent ACL reconstruction at an urban tertiary care children’s hospital between January 2009 and May 2016 were contacted via email and/or telephone and asked to complete a follow-up survey. Data collected included subsequent complications – including graft rupture, contralateral ACL injury, and meniscus tears – along with information regarding any relatives who had suffered an ACL tear. Patient medical records were reviewed to determine the age of the patient at the time of surgery as well as concomitant meniscus and ligamentous injuries at the time of injury. Results 425 patients who underwent primary ACL reconstruction completed the survey. The mean age at surgery was 15.0? 2.4 years with a mean follow-up time of 4.6? 2.1 years. Patients were stratified into three groups by the number of first degree relatives (parent or sibling) who had an ACL tear history: no relatives, one relative, or more than one relative. 101 respondents (23.8%) reported at least one first degree relative who had previously torn an ACL. 15 (3.5%) had more than one first degree relative with an ACL tear. There were no differences in the age at time of surgery or the number of concomitant meniscus and ligamentous injuries suffered across the three stratified groups. While children with zero or one affected first degree relative had similar rates of graft failure (11.4% and 9.3%, respectively), those with two or more affected first-degree relatives had a significantly higher graft failure rate (40.0%, p=0.003). There were no differences in the number of post-operative contralateral ACL tears (p=0.438) or meniscus tears (p=0.477) across the groups. When these complications were analyzed together as one outcome, patients with more than one affected first-degree relative suffered more combined graft ruptures, contralateral ACL tears, and meniscal tears (53.3%) than patients with zero (21.9%) or only one affected first degree relative (22.1%, p=0.02). This group of patients also suffered more total complications that required surgical intervention (66.7%) than patients with zero (21.0%) or only one affected first degree family member (22.1%, p<0.001). Conclusion/Significance Patients undergoing primary ACL reconstruction who have a strong family history of ACL tear appear more likely to suffer a post-operative graft rupture and suffer a complication requiring surgery.

scholarly journals Effect of Graft Choice on the 6 Year Outcome of Revision Anterior Cruciate Ligament Reconstruction in the Multicenter ACL Revision Study (MARS) Cohort

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0028
Author(s):  
Mars Group ◽  
Rick W. Wright
Keyword(s):  
Acl Reconstruction ◽  
Graft Failure ◽  
Cruciate Ligament ◽  
Patient Reported Outcome ◽  
Activity Level ◽  
Graft Choice ◽  
Patient Reported ◽  
Revision Reconstruction ◽  
Anterior Cruciate

Objectives: Most surgeons believe that graft choice for anterior cruciate ligament (ACL) reconstruction is an important factor related to outcome. The purpose of this study was to determine if revision ACL graft choice predicts outcomes related to sports function, activity level, OA symptoms, graft re-rupture, and reoperation at six years following revision reconstruction. We hypothesized that autograft use would result in increased sports function, increased activity level, and decreased OA symptoms (as measured by validated patient reported outcome instruments). Additionally, we hypothesized that autograft use would result in decreased graft failure and reoperation rate 6 years following revision ACL reconstruction. Methods: Revision ACL reconstruction patients were identified and prospectively enrolled by 83 surgeons over 52 sites. Data collected included baseline demographics, surgical technique and pathology, and a series of validated patient reported outcome instruments (IKDC, KOOS, WOMAC, and Marx activity rating score). Patients were followed up for 6 years, and asked to complete the identical set of outcome instruments. Incidence of additional surgery and re-operation due to graft failure were also recorded. Multivariate regression models were used to determine the predictors (risk factors) of IKDC, KOOS, WOMAC, Marx scores, graft re-rupture, and re-operation rate at 6 years following revision surgery. Results: 1234 patients were successfully enrolled with 716 (58%) males. Median age was 26. In 87% this was their first revision. 367 (30%) were undergoing revision by the surgeon that had performed the previous reconstruction. 598 (48%) underwent revision reconstruction utilizing an autograft, 599 (49%) allograft, and 37 (3%) both autograft and allograft. Median time since their last ACL reconstruction was 3.4 years. Questionnaire follow-up was obtained on 810 subjects (65%), while phone follow-up was obtained on 949 subjects (76%). The IKDC, KOOS, and WOMAC scores (with the exception of the WOMAC stiffness subscale) all significantly improved at the 6-year follow-up time point (p<0.001). Contrary to the IKDC, KOOS, and WOMAC scores, the 6-year MARX activity scale demonstrated a significant decrease from the initial score at enrollment (p<0.001). Graft choice proved to be a significant predictor of 6-year Marx activity level scores (p=0.005). Specifically, the use of an autograft for revision reconstruction predicted improved activity levels [Odds Ratio (OR) = 1.54; 95% confidence intervals (CI) = 1.14, 2.04]. Graft choice proved to be a significant predictor of 6-year IKDC scores (p=0.018), in that soft tissue grafts predicted higher 6-year IKDC scores [OR = 1.62; 95% confidence intervals (CI) = 1.09, 2.414]. For the KOOS subscales, graft choice did not predict outcome score. Graft re-rupture was reported in 55/949 (5.8%) of patients by their 6-year follow-up: 37 allografts, 16 autografts, and 2 allograft + autograft. Use of an autograft for revision resulted in patients 6.04 times less likely to sustain a subsequent graft rupture than if an allograft was utilized (p=0.009; 95% CI=1.57, 23.2). Conclusion: Improved sports function and patient reported outcome measures are obtained when an autograft is utilized. Additionally, autograft type shows a decreased risk in graft re-rupture at six years follow-up. Surgeon education regarding the findings in this study can result in potentially improved revision ACLR results for our patients.

scholarly journals Anterior Cruciate Ligament Reconstruction with Concomitant Osteochondral Allograft Transplantation versus Anterior Cruciate Ligament Reconstruction: A Comparative Matched-Group Analysis of Return to Sport and Satisfaction

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0026
Author(s):  
Grant Hoerig Garcia ◽  
Michael L. Redondo ◽  
Joseph Liu ◽  
David R. Christian ◽  
Adam Blair Yanke ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
Activity Level ◽  
Return To Sports ◽  
Inclusion Criteria ◽  
Pain Scores ◽  
Anterior Cruciate

Objectives: Anterior cruciate ligament (ACL) rupture is commonly associated with articular cartilage injury. Few studies have evaluated the influence of cartilage repair on the outcome of ACL reconstruction. Currently, no known study has examined the return to sport rates of concomitant ACL reconstruction and OCA. The purpose of this study is to evaluate rate and level of return to sports, as well as long-term outcomes, between a matched cohort of isolated ACL reconstruction (ACLR) versus ACL reconstruction with concomitant OCA (ACLR/OCA). Methods: A prospectively collected registry was queried retrospectively for consecutive patients who underwent ACL reconstruction with concomitant OCA. Inclusion criteria were preoperative diagnosis of ACL rupture and more than 2 years of follow-up. After meeting the inclusion criteria, all ACL reconstructions with concomitant OCA were matched to two isolated ACL reconstruction patients via +/- 5 years of age at time of surgery, gender, revision status, and ACL reconstruction graft type. At final follow-up, patients were asked to complete a subjective sports questionnaire, the Marx activity scale, a visual analog scale (VAS), and a satisfaction questionnaire. Results: Seventeen ACL/OCA patients met inclusion criteria. Fourteen eligible 2:1 matched pairs (28 ACLR; 14 ACLR/OCA;), were identified for analysis. The average age at the time of surgery was 33.89 +/- 8.64 and 35.92 +/- 6.22 for the ACLR and ACLR/OCA groups, respectively (P = .44). Average follow-up was 4.09 years and 5.14 years for the ACLR and ACLR/OCA groups, respectively (P = .17). At final follow-up, the average Marx activity scalescores were 6.54 for ACRL patients and 1.57 for ACLR/OCA patients; final scores were significantly different between groups (P < 0.01). The average VAS pain scores at final follow-up were 1.96 in the ACLR and 3.64 in ACLR/OCA groups with the ACLR/OCA patients displaying significantly worse final VAS pain scores (P = .03). 89.3% of ACLR patients (25 of 28) returned to at least 1 sport postoperatively compared with 57.1% of ACLR/OCA patients (8 of 14) (P=0.04). At final follow-up, 14.2% (2 of 14) of the ACLR/OCA group and 32.1% (9 of 28) of the ACLR group reported starting a new sport or activity. Average timing for full return to sports was 9.57 +/- 5.53 months and 9.27 +/- 3.25 months for the ACLR/OCA and ACLR groups, respectively (P = .86). At final follow-up, 33.3% and 57.1% of patients returned to better or same level of sport for the ACLR/OCA and ACLR groups, respectively (P = .06). Significantly more ACLR/OCA patients reported their activity level was hindered by their knee (92.8% ACLR/OCA; 60.7% ACLR). Significantly more ACLR patients reported satisfaction with their surgery compared with ACLR/OCA patients (89% vs 57%) (P < 0.01), however no statistical difference was observed in satisfaction with ability to play sports between groups. Conclusion: Significantly less ACLR/OCA patients (57.1%) were able to return to at least 1 sport when compared to a matched ACLR cohort (89.3%). At final follow-up, a higher percentage of ACLR patients were able to return to pretreatment activity intensity level or better (ACLR/OCA, 33.3%; ACLR, 57.1%). ACLR/OCA patients had significantly more pain and lower Marx activity scores. Despite a lower return to sport rate, there was no statistical difference in reported satisfaction with activity level between the groups, however the ACLR/OCA groups reported significantly lower overall surgical satisfaction.

Graft Rupture Rates After Combined ACL and Anterolateral Ligament Reconstruction Versus Isolated ACL Reconstruction: A Matched-Pair Analysis From the SANTI Study Group

2021 ◽  
pp. 036354652110289
Author(s):  
Bertrand Sonnery-Cottet ◽  
Ibrahim Haidar ◽  
Johnny Rayes ◽  
Thomas Fradin ◽  
Cedric Ngbilo ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Ligament Reconstruction ◽  
Anterolateral Ligament ◽  
Activity Level ◽  
Acl Graft ◽  
Anterolateral Ligament Reconstruction ◽  
Graft Rupture ◽  
The Mean

Background: Clinical studies have demonstrated significant advantages of combined anterior cruciate ligament and anterolateral ligament reconstruction (ACL+ALLR) over isolated ACL reconstruction (ACLR) with respect to reduced graft rupture rates, a lower risk of reoperation for secondary meniscectomy, improved knee stability, and higher rates of return to sports. However, no long-term studies exist. Purpose/Hypothesis: The purpose of this study was to compare the outcomes of isolated ACLR versus ACL+ALLR at long-term follow-up. The hypothesis was that patients who underwent combined procedures would experience significantly lower rates of graft rupture. Study Design: Cohort study; Level of evidence, 3. Methods: Patients undergoing primary ACL+ALLR between January 2011 and March 2012 were propensity matched in a 1:1 ratio to patients who underwent isolated ACLR during the same period. A combination of face-to-face and telemedicine postoperative follow-up was undertaken. At the end of the study period (March 2020), medical notes and a final telemedicine interview were used to determine whether patients had experienced any complications or reoperations. The Knee injury and Osteoarthritis Outcome Score, International Knee Documentation Committee score, Lysholm score, and Tegner score were collected for all patients. Graft survivorship was assessed using Kaplan-Meier analysis. Logistic regression was performed to account for the potential effect of activity level on graft rupture rates. Results: A total of 86 matched pairs were included in the study. The mean ± SD age was 32.2 ± 8.8 years (range, 22-67 years) in the ACL+ALLR group and 34.7 ± 8.5 years (range, 21-61 years) in the isolated ACLR group. The mean duration of follow-up was 104.33 ± 3.74 months (range, 97-111 months). Patients who underwent combined ACL+ALLR versus isolated ACLR experienced significantly better ACL graft survivorship (96.5% vs 82.6%, respectively; P = .0027), lower overall rates of reoperation (15.3% vs 32.6%; P < .05), and lower rates of revision ACLR (3.5% vs 17.4%; P < .05). Patients undergoing isolated ACLR were at >5-fold greater risk of graft rupture (odds ratio, 5.549; 95% CI, 1.431-21.511; P = .0132), regardless of their preinjury activity level. There were no significant differences between groups with respect to other complications or any clinically important differences in patient-reported outcome measures. Conclusion: Patients who underwent combined ACL+ALLR experienced significantly better long-term ACL graft survivorship, lower overall rates of reoperation, and no increase in complications compared with patients who underwent isolated ACLR. Further, patients who underwent isolated ACLR had a >5-fold increased risk of undergoing revision surgery at a mean follow-up of 104.3 months.

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