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A Retrospective Review of Anterior Cruciate Ligament Reconstruction Using Patellar Tendon: 25 Years of Experience.

Chahal J, Lee A, Heard W, Bach BR - Orthop J Sports Med (2013)

Bottom Line: There were no significant differences in revision rates between primary autograft (1.6%) and allograft (2.0%) ACLR.With allograft use, the method of sterilization did not affect revision rates.The observed results in this series also emphasize that allograft ACLR can produce sustainable results with low complication rates in appropriately selected patients.

View Article: PubMed Central - PubMed

Affiliation: Division of Sports Medicine, Rush University Medical Center, Chicago, Illinois, USA. ; University of Toronto Sports Medicine Program, Women's College Hospital and Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada.

ABSTRACT

Background: The comparative data in the literature regarding rates of reoperation, revision ligament surgery, and contralateral surgery following anterior cruciate ligament reconstruction (ACLR) are variable and are often derived from studies with multiple surgeons, multiple centers, different surgical techniques, and a wide variety of graft choices.

Purpose: To describe and analyze a single surgeon's experience with ACLR using bone-patellar tendon-bone (BPTB) as the primary graft choice over a 25-year period.

Study design: Retrospective case series.

Methods: All patients who underwent ACLR from 1986 to 2012 were identified from a prospectively maintained database. Traditional follow-up was only for patients who sought subsequent surgery with the index surgeon or presented with contralateral ACL injury. Covariates of interest included age, sex, time, and graft selection. Outcomes of interest included reoperation rates after primary/revision ACLR, rate of revision ACLR, success of meniscal repair with concomitant ACLR, and the proportion of patients undergoing contralateral surgery.

Results: A total of 1981 patients (mean age, 29 years; 49% male) were identified. Of patients undergoing primary ACLR (n = 1809), 74% had BPTB autograft and 26% had a central third BPTB allograft. The mean age of patients undergoing autograft and allograft ACLR was 26 and 36 years, respectively (P < .05). Allograft tissue usage increased over time (P < .05). The rate of personal ACLR revision surgery was 1.7% (n = 30) for primary cases and 3.5% (n = 6) for revision cases. There were no significant differences in revision rates between primary autograft (1.6%) and allograft (2.0%) ACLR. With allograft use, the method of sterilization did not affect revision rates. The overall reoperation rate following primary ACLR was 10%; the 5-year reoperation rate was 7.7%. The reoperation rate was lower for primary cases reconstructed with allograft versus autograft (5% vs 12%) (P < .0001). Among primary ACLR cases, 332 patients (18%) underwent concomitant meniscal repair; 14% required revision meniscal surgery. The rate of contralateral ACLR was 6%.

Conclusion: This information is useful for patients in the informed consent process, for perioperative decision making regarding graft choice, and for identifying patients who are at risk for injuring the uninvolved knee. The observed results in this series also emphasize that allograft ACLR can produce sustainable results with low complication rates in appropriately selected patients.

No MeSH data available.


Related in: MedlinePlus

Graft selection based on patient age. (A) Distribution of total autograft and allograft use according to age. More than 50% of autograft cases are in patients <25 years, while more than 50% of allograft cases are in patients >35 years. (B) Percentage of total anterior cruciate ligament reconstructions (ACLRs) performed with autograft versus allograft based on patient age.
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fig3-2325967113501789: Graft selection based on patient age. (A) Distribution of total autograft and allograft use according to age. More than 50% of autograft cases are in patients <25 years, while more than 50% of allograft cases are in patients >35 years. (B) Percentage of total anterior cruciate ligament reconstructions (ACLRs) performed with autograft versus allograft based on patient age.

Mentions: Among patients treated with primary ACLR, 74% (n = 1332) were treated with an autograft, while 26% (n = 477) had a reconstruction with an allograft. In the autograft group, 1321 (99%) patients had a BPTB graft, compared with 11 patients reconstructed with quadrupled semitendinosis-gracilis hamstring grafts. In allograft ACLRs, there were 458 cases (96%) of central-third BPTB graft and 19 cases (4%) of hamstring allograft use; 116 patients had a nonirradiated allograft (prior to September 2003) and 361 patients had allografts that were processed and sterilized with low-dose (1.5 Mrad) irradiation (September 2003 and beyond). The mean age of patients undergoing autograft and allograft reconstruction was 26 years (range, 12-57 years; SD, 8.8 years) and 36 years (range, 11-65 years; SD, 11.5 years), respectively (P < .05). Allograft tissue use increased over time from 1% of all primary cases in 1986-1991 to 23% (1998-2003) and, most recently, to 46% (2009-2012) (P < .05). Trends for allograft use over time are illustrated in Figure 2. The use of allograft tissue also increased with patient age (P < .05) (Figure 3, A and B).


A Retrospective Review of Anterior Cruciate Ligament Reconstruction Using Patellar Tendon: 25 Years of Experience.

Chahal J, Lee A, Heard W, Bach BR - Orthop J Sports Med (2013)

Graft selection based on patient age. (A) Distribution of total autograft and allograft use according to age. More than 50% of autograft cases are in patients <25 years, while more than 50% of allograft cases are in patients >35 years. (B) Percentage of total anterior cruciate ligament reconstructions (ACLRs) performed with autograft versus allograft based on patient age.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4555486&req=5

fig3-2325967113501789: Graft selection based on patient age. (A) Distribution of total autograft and allograft use according to age. More than 50% of autograft cases are in patients <25 years, while more than 50% of allograft cases are in patients >35 years. (B) Percentage of total anterior cruciate ligament reconstructions (ACLRs) performed with autograft versus allograft based on patient age.
Mentions: Among patients treated with primary ACLR, 74% (n = 1332) were treated with an autograft, while 26% (n = 477) had a reconstruction with an allograft. In the autograft group, 1321 (99%) patients had a BPTB graft, compared with 11 patients reconstructed with quadrupled semitendinosis-gracilis hamstring grafts. In allograft ACLRs, there were 458 cases (96%) of central-third BPTB graft and 19 cases (4%) of hamstring allograft use; 116 patients had a nonirradiated allograft (prior to September 2003) and 361 patients had allografts that were processed and sterilized with low-dose (1.5 Mrad) irradiation (September 2003 and beyond). The mean age of patients undergoing autograft and allograft reconstruction was 26 years (range, 12-57 years; SD, 8.8 years) and 36 years (range, 11-65 years; SD, 11.5 years), respectively (P < .05). Allograft tissue use increased over time from 1% of all primary cases in 1986-1991 to 23% (1998-2003) and, most recently, to 46% (2009-2012) (P < .05). Trends for allograft use over time are illustrated in Figure 2. The use of allograft tissue also increased with patient age (P < .05) (Figure 3, A and B).

Bottom Line: There were no significant differences in revision rates between primary autograft (1.6%) and allograft (2.0%) ACLR.With allograft use, the method of sterilization did not affect revision rates.The observed results in this series also emphasize that allograft ACLR can produce sustainable results with low complication rates in appropriately selected patients.

View Article: PubMed Central - PubMed

Affiliation: Division of Sports Medicine, Rush University Medical Center, Chicago, Illinois, USA. ; University of Toronto Sports Medicine Program, Women's College Hospital and Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada.

ABSTRACT

Background: The comparative data in the literature regarding rates of reoperation, revision ligament surgery, and contralateral surgery following anterior cruciate ligament reconstruction (ACLR) are variable and are often derived from studies with multiple surgeons, multiple centers, different surgical techniques, and a wide variety of graft choices.

Purpose: To describe and analyze a single surgeon's experience with ACLR using bone-patellar tendon-bone (BPTB) as the primary graft choice over a 25-year period.

Study design: Retrospective case series.

Methods: All patients who underwent ACLR from 1986 to 2012 were identified from a prospectively maintained database. Traditional follow-up was only for patients who sought subsequent surgery with the index surgeon or presented with contralateral ACL injury. Covariates of interest included age, sex, time, and graft selection. Outcomes of interest included reoperation rates after primary/revision ACLR, rate of revision ACLR, success of meniscal repair with concomitant ACLR, and the proportion of patients undergoing contralateral surgery.

Results: A total of 1981 patients (mean age, 29 years; 49% male) were identified. Of patients undergoing primary ACLR (n = 1809), 74% had BPTB autograft and 26% had a central third BPTB allograft. The mean age of patients undergoing autograft and allograft ACLR was 26 and 36 years, respectively (P < .05). Allograft tissue usage increased over time (P < .05). The rate of personal ACLR revision surgery was 1.7% (n = 30) for primary cases and 3.5% (n = 6) for revision cases. There were no significant differences in revision rates between primary autograft (1.6%) and allograft (2.0%) ACLR. With allograft use, the method of sterilization did not affect revision rates. The overall reoperation rate following primary ACLR was 10%; the 5-year reoperation rate was 7.7%. The reoperation rate was lower for primary cases reconstructed with allograft versus autograft (5% vs 12%) (P < .0001). Among primary ACLR cases, 332 patients (18%) underwent concomitant meniscal repair; 14% required revision meniscal surgery. The rate of contralateral ACLR was 6%.

Conclusion: This information is useful for patients in the informed consent process, for perioperative decision making regarding graft choice, and for identifying patients who are at risk for injuring the uninvolved knee. The observed results in this series also emphasize that allograft ACLR can produce sustainable results with low complication rates in appropriately selected patients.

No MeSH data available.


Related in: MedlinePlus