Allograft Donor Characteristics Significantly Influence Graft Rupture After Anterior Cruciate Ligament Reconstruction in a Young Active Population

Abstract

Background: Graft selection in anterior cruciate ligament (ACL) surgery can be difficult in a young active population given their high rates of reinjury. Allografts allow for control over graft size and reduce morbidity of autograft harvest. There are mixed results about the use of allograft in the literature; however, the influence of the properties of the allograft on outcomes has not been considered. Hypothesis: ACL reconstruction with allografts from older donors will have a higher rate of graft rupture when compared with allograft from young donors. Study Design: Cohort study; Level of evidence, 3. Methods: Patients (N = 211) aged 13 to 25 years underwent primary ACL reconstruction with fresh-frozen nonirradiated allograft. Four graft types were used: patellar tendon, Achilles tendon, tibialis anterior, and tibialis posterior. Details were collected on allograft donor age and sex. At a minimum of 24 months, patients were evaluated for any further injuries and subjective analysis by International Knee Documentation Committee (IKDC) questionnaire. Results: ACL graft rupture occurred in 23.5%. When grafts were separated into single strand (patellar and Achilles tendon) and multistrand (tibialis anterior and posterior), there was a significantly higher rate of reinjury in the single-strand grafts (29.9% vs 11%; P = .014). Grafts from female donors aged ≥50 years had significantly higher rates of ACL graft rupture (52.6%; P = .003) with increased odds by 6.7 times when compared with grafts from male donors aged <50 years. There was no significant difference in mean IKDC scores among the groups based on the age and sex of the allograft donor. Conclusion: The age and sex of the allograft donor and the morphology of the graft significantly influenced the rate of ACL graft rupture in young active patients. Tendons from female donors aged ≥50 years should be avoided given the higher rerupture rates as compared with male donors of any age and younger females.

Allograft Donor Characteristics Significantly Influence Graft Rupture After Anterior Cruciate Ligament Reconstruction in a Young Active Population: Letter to the Editor

“…We read with great interest the paper by Shumborski et al entitled “Allograft Donor Characteristics Significantly Influence Graft Rupture After Anterior Cruciate Ligament Reconstruction in a Young Active Population.” 1 This study corroborated many of the findings reported in our (Tejwani et al) paper entitled “Revision Risk After Allograft Anterior Cruciate Ligament Reconstruction: Association with Graft Processing Techniques, Patient Characteristics, and Graft Type.” 2…”

Allograft Donor Characteristics Significantly Influence Graft Rupture After Anterior Cruciate Ligament Reconstruction in a Young Active Population: Response

“…We thank Dr Maletis and his team for their interest in our study. 1 We agree that there were notable conclusions supported by both our study and the large study of 5968 allograft anterior cruciate ligament (ACL) reconstruction patients examined by Tejwani et al, 2 including the influence of graft morphology and male sex on graft rupture rate after ACL reconstruction with allograft. We feel that an important distinction between the study designs would be the inclusion of irradiated grafts in 4783 or 80% of their cohort, as well as the differences in the age of the cohorts—Tejwani et al’s patients had a significantly older age with a mean of 34 years (range, 24-42 years).…”

Bone Mesenchymal Stem Cells Contribute to Ligament Regeneration and Graft–Bone Healing after Anterior Cruciate Ligament Reconstruction with Silk–Collagen Scaffold

“…As a common athletic injury, ACL rupture can cause serious damage such as knee joint instability, injury to other ligaments, dislocation, and osteoarthritis [2,3]. ACL reconstruction is currently consid-ered the gold standard for treating ACL rupture, and grafts including autografts, allografts, and synthetic grafts are used for this purpose [4][5][6]. However, these grafts have some limitations.…”