Change in Anterior Cruciate Ligament Graft Choice and Outcomes Over Time

Abstract

Purpose To analyze failure rate in two-year increments to determine if graft choice changed over time and graft failure rate. Methods A prospective 2002–2008 database was used to identify risk factors for anterior cruciate ligament retear (ACLR). Subjects who had primary ACLR with no history of contralateral surgery and 2-year follow-up were included. Subjects who underwent a multi-ligament reconstruction were excluded. Graft type, age, sex, smoking status, body mass index, Marx activity level at index surgery, medial and lateral meniscus status at time of ACLR, sport played post-ACLR, and clinical site were evaluated. Analysis was repeated using 2002–2003 (early) and 2007–2008 (late) two-year databases. ANOVA with post-hoc analysis was performed to detect significant differences in age and Marx score by graft type over time. Results Two-year follow-up for graft failure was obtained on 2497/2692 (93%) subjects. There were 112/2497 (4.5%) ACLRs identified at two-year follow-up. The only predictor that changed between early/late periods was allograft use. Allograft odds ratio decreased from 13.1 to 9.5 (p<.01). Allografts were used in older patients (31–40 years) and with lower Marx scores (10–8) from early to late periods. Mean age of subjects receiving BTB autografts did not significantly change over time (22.8 to 23.5) Mean age of subjects receiving hamstring autografts fell (27.9 to 25.5). Mean age of subjects receiving allografts rose significantly (31.3 to 39.8, p<.01). Mean Marx score of subjects who received BTB and hamstring autografts did not significantly change over time. Mean Marx score of subjects receiving allografts decreased significantly (p<.01). Conclusions After early recognition allograft use in young active patients was a risk factor for retear, graft choice by surgeons changed in the late period to use of allografts in older and less-active patients, which correlated with significant decrease in retear risk. Level of Evidence Therapeutic-III, case control study

Clinical efficacy of multiple prevention measures against infection following anterior cruciate ligament reconstruction

“…An ACL reconstruction aims to recover the structural integrity of the ACL and remodel its biomechanical properties and physiological functions. After surgery, the ACL graft has to undergo a special "creeping substitution" process in order to remodel the fibrocytes [3] . N o m a t te r wh a t s u rg i c a l p ro c e d u re s a n d technologies are used, an infection following an ACL reconstruction is hard to eliminate, and it can result in many problems, including restricted functional rehabilitation, graft and articular cartilage damage, fixation loosening, and delayed healing of the incision [13.14].…”

“…Surgery should be performed to reconstruct the ligament and its functions. Thus, ACL reconstructions have always been a key subject in the field of orthopedics and sports injuries [3] . The arthroscopic method was the earliest developed minimally invasive technology used in orthopedics, and it largely guarantees the diagnoses and treatment of joint diseases.…”

Editorial Commentary: Registries, Prospective Cohorts, and Predictors of Outcomes: Why Bother?

“…A recent study demonstrated that when surgeons are presented credible outcomes data, they will change their practice patterns and the subsequent patient outcomes are improved. 10 As improving the care of our patients is our ultimate goal and quality outcomes data are the key to achieving this goal with confidence, viva the researchers who embrace the challenges of clinical outcomes research!…”

ACL Reconstruction in the Multiple Ligament Injured Knee

“…2,20 Age is also an important consideration, as ACL allografts have an unacceptably high failure rate in patients less than 25 years old. 10,20 For young athletes who plan to return to sports following multiligament knee reconstruction, autograft ACL should be considered.…”