Anterior Cruciate Ligament Reconstruction Using Achilles Tendon Allograft: an Assessment of Outcome for Patients Age 30 Years and Older

Abstract

Achilles allografts have become popular for anterior cruciate ligament (ACL) reconstructions in older patients. Primary ACL reconstructions using Achilles tendon allografts in patients age 30 years and older are successful in restoring the knee to "normal" or "near normal." During a three-year period, the two senior authors performed 65 primary ACL reconstructions using Achilles tendon allografts in patients aged 30 years and older. Our exclusion criteria were periarticular fracture, ipsilateral/contralateral knee ligament injury, and previous or concomitant osteotomy or cartilage restoration procedure. Each patient was evaluated via physical examination, functional and arthrometric testing, and radiographic and subjective outcome. Knees were considered normal, near normal, or abnormal based on the International Knee Documentation Committee (IKDC) system. Forty-three patients were examined at an average of 33 months (minimum, 24 months) postoperatively. At the time of ACL reconstruction, 35% had normal articular cartilage in all three compartments and 70% had meniscal tears. No re-ruptures occurred. While 24% had mean maximal translation differences less than or equal to 3 mm, none had side-to-side differences greater than 5 mm. Postoperative IKDC, Activities of Daily Living, and Activity Rating Scale scores averaged 88, 94, and 7.7, respectively. Despite the overall favorable outcomes, 29% had worsened radiographic grades at follow-up. Using an Achilles allograft for ACL reconstruction in patients older than 30 years, we restored over 90% of knees to normal or near normal while limiting postoperative complications. Poor subjective results may be related less to instability and more to pain, which may result from progressive arthritis.

Aseptically processed and chemically sterilized BTB allografts for anterior cruciate ligament reconstruction: a prospective randomized study

“…Clinical studies that evaluated outcomes reported positive results for chronic ligamentous laxity [23]. Subsequently, there have been a number of reports of successful outcomes using allografts in surgery [7, 15, 16]. Further support for the use of allografts can be seen in long-term studies which have reported positive results for patients as long as 10 years after surgery [1, 20, 23].…”

Prevalence and Predictors of Patellofemoral Osteoarthritis after Anterior Cruciate Ligament Reconstruction with Hamstring Tendon Autograft

“… 24) Despite the overall favorable outcomes, radiographic osteoarthritis including PFOA could worsen in middle-aged patients. 25) Culvenor et al 5) evaluated the patellofemoral pain following HT ACL reconstruction in 110 patients, and they showed that the patients ≥ 27 years of age at ACL reconstruction were 2.6 times more likely to have patellofemoral pain compared to < 27 years at 12 months after the surgery. They speculated that the higher rates of patellofemoral pain might be a result of ongoing patellofemoral cartilage thinning known to develop in older people during the first 2 years after the ACL reconstruction based on previous research.…”

A Systematic Review for Anterior Cruciate Ligament Reconstruction

“…Most surgeons have preferred autograft and the most two common autografts are Bone-Patellar-tendon-bone (BPTB) and HTs [20] . Less risk of donor site morbidity, superior mechanical properties autografts are preferred to allograft [21] .…”