Demographics and Clinical Outcomes of Patients Undergoing Anterior Cruciate Ligament Reconstruction with a Planned or Unplanned Hybrid Graft

Kraeutler, Matthew J.; Houck, Darby A.; Carver, Trevor J.; Bravman, Jonathan T.; Vidal, Armando F.; McCarty, Eric C.

doi:10.1055/s-0038-1675785

Cited by 4 publications

(7 citation statements)

References 25 publications

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“…Our cohort demonstrated similar SANE scores to the internally braced cohort in the study described by Bodendorfer et al 24 and Kitchen et al 35 as well as studies describing traditional ACLR. 42,43 This suggests that ACLR with internal bracing does not negatively impact SANE scores. Additionally, our mean Lysholm score yielded a mean of 91.8 (range: 90.7-92.9) signifying "good" results, 44 even with such a wide age range.…”

Section: Discussionmentioning

confidence: 95%

Primary Anterior Cruciate Ligament Reconstruction with Suture Tape Augmentation: A Case Series of 252 Patients

et al. 2023

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Anterior cruciate ligament reconstruction (ACLR) using suture tape augmentation to internally brace is a relatively new technique. The primary goal of this study was to prospectively collect patient-reported outcomes (PROs) and surgical history from patients who underwent primary ACLR with internal bracing to determine if internal bracing resulted in a low graft failure rate while maintaining acceptable PROs. A total of 252 patients with a mean age of 23.6 years (95% confidence interval [CI]: 22.1–25.1) and a mean follow-up of 37.9 months (95% CI: 35.8–40.0) were included in this study. Patients who underwent primary ACLR with internal brace augmentation between July 12, 2016 and July 31, 2021 were eligible. A total of 222 patients were contacted via telephone and administered the visual analog scale (VAS), the single assessment numeric evaluation (SANE), the Lysholm knee score scale, and, if applicable, the short version ACL return to sport after injury (SV-ACL-RSI) survey. Additionally, patients were asked to give an updated orthopaedic history. Thirty additional patients were included from either our institution's registry or by completing their surveys in-office or by e-mail. The minimal clinically important difference (MCID) and patient-acceptable symptom states (PASS) were calculated based on our patient population and applied to each individual patient. The patients' electronic health record (EHR) was searched for pre- and postoperative clinical data including KT-1000 arthrometer measurements. Two patients (0.8%) had subsequent graft failures and one patient (0.4%) required a revision surgery. MCID was achieved in 242 patients (96.0%) for the Lysholm, 227 patients (90.1%) for the SANE, and 146 patients (57.9%) for the VAS. PASS was achieved in 214 patients (84.9%) for the Lysholm, 198 patients (78.6%) for the SANE, and 199 (80.0%) patients for the VAS, postoperatively. Of note, 65 patients (25.8%) exceeded the PASS threshold for the VAS preoperatively. A total of 127 patients (84.4%) met the cutoff of ≥60/100 for the SV-ACL-RSI survey postoperatively. Postoperative KT-1000 measurements showed near-identical side-to-side differences at both the 13.6-kg pull and manual maximum pull. When stratifying patients based on age at the time of surgery, it was noted that patients younger than 25 years had significantly higher SANE scores (91.6 [95% CI: 90.2–92.9] vs. 82.6 [95% CI: 79.0–86.2]; p < 0.0001) and lower VAS pain scores (0.7 [95% CI: 0.5–0.8] vs. 1.2 [95% CI: 0.8–1.5]; p = 0.004). Primary ACLR with internal bracing led to acceptable patient outcomes and a graft failure rate of less than 1%. Level of Evidence: case series, IV

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Section: Discussionmentioning

confidence: 95%

Primary Anterior Cruciate Ligament Reconstruction with Suture Tape Augmentation: A Case Series of 252 Patients

et al. 2023

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“…The first description of a HY was by Alvarez‐Pinzon et al in 2015 [2], and has become a preferred technique when faced with a small HA diameter. Inconsistent results of HY being inferior to autologous graft have been reported, with most showing no difference in failure rates [3, 6, 8, 11, 14–16, 22, 28], one showing a higher failure rate in autologous graft [10], and another reporting a higher failure rate in HY [21]. In one prospective randomized clinical trial, Li et al [16] compared HA (n = 32; average age 29.8) versus HY comprising of semitendinosus and tibialis anterior allograft with a minimum graft diameter of 8 mm (n = 31; average age 31.6).…”

Section: Discussionmentioning

confidence: 99%

No difference in revision risk between autologous hamstring graft less than 8 mm versus hybrid graft 8 mm or larger in anterior cruciate ligament reconstruction

Mirzayan

Chang

Royse

et al. 2023

Knee Surg Sports Traumatol Arthrosc

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PurposeHamstring autograft (HA) is commonly used for primary anterior cruciate ligament reconstruction (ACLR). However, if the harvested HA is inadequate in diameter, it is often augmented with an allograft tendon, forming a hybrid graft (HY). This study sought to evaluate aseptic revision risk following HA versus HY ACLR. MethodsA retrospective cohort study was performed using data obtained from our healthcare system’s ACLR registry. Patients ≤ 25 years of age who underwent primary isolated ACLR were identified (2005–2020). Graft type and diameter size was the primary exposure of interest: < 8 mm HA and ≥ 8 mm HY. A secondary analysis was performed to examine 7 mm HA and 7.5 mm HA vs ≥ 8 mm HY. Propensity score‐weighted Cox proportional hazard regression was used to evaluate the risk of aseptic revision. ResultsThe study sample included 1,945 ACLR: 548 ≥ 8 mm HY, 651 7 mm HA, and 672 7.5 mm HA. The crude cumulative aseptic revision probability at 8‐years for ≥ 8 mm HY was 9.1%, 11.1% for 7 mm HA, and 11.2% for 7.5 mm HA. In adjusted analysis, no difference in revision risk was observed for < 8 mm HA (hazard ratio [HR] 1.15, 95% confidence interval [CI] 0.72–1.82), 7 mm HA (HR 1.23, 95% CI 0.71–2.11), or 7.5 mm HA (HR 1.16, 95% CI 0.74–1.82) compared to ≥ 8 mm HY. ConclusionIn a US‐based cohort of ACLR patients aged ≤ 25 years, we failed to observe any differences in aseptic revision risk for HA < 8 mm compared to HY ≥ 8 mm. Augmentation of a HA as small as 7 mm is not necessary to prevent a revision surgery. Level of evidenceLevel III.

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“…32 These grafts, typically formed from a combination of autologous flexor graft and soft tissue allograft, have gained interest from orthopedists for use in ACL reconstructions. 33 They are generally used in cases of small size of flexor grafts. 32 When planning to use hybrid grafts, only the semitendinosus graft can be removed instead of the semitendinosus and gracilis.…”

Section: Synthetic Graftsmentioning

confidence: 99%

“…Therefore, the use of hybrid grafts can reduce postoperative morbidity at the donor site. 33 A non-irradiated posterior tibial or peroneus longus allograft is generally used. In addition to the benefit of lower donor site morbidity, hybrid grafts also allow the graft to have a larger diameter than the semitendinosus/gracilis autograft, which may reduce the risk of postoperative failure.…”

Section: Synthetic Graftsmentioning

confidence: 99%

“…32 Esses enxertos, tipicamente formados de uma combinação de enxerto autólogo de flexores com aloenxerto de partes moles, ganharam interesse dos ortopedistas para uso em reconstruções de LCA. 33 São utilizados geralmente em casos de tamanho pequeno dos enxertos de flexores. 32 Ao planejar usar enxertos híbridos, pode-se retirar apenas o enxerto do semitendíneo ao invés do semitendíneo e grácil.…”

Section: Enxertos Sintéticosunclassified

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Novas técnicas de enxertia para reconstrucão do LCA: Artigo de atualização

Lara,

Novaretti,

Nunes

et al. 2024

Rev Bras Ortop (Sao Paulo)

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ResumoA reconstrução do ligamento cruzado anterior (LCA) é um procedimento comum para lesões desse ligamento, especialmente em atletas. Existem diferentes tipos de enxertos utilizados, e a escolha depende de vários fatores. Os enxertos autólogos, do próprio paciente, são a opção mais comum, com rápida incorporação e menor taxa de falha. Enxertos aloenxertos, de doadores, têm seu papel em casos específicos. Os enxertos sintéticos, usados na década de 80, têm vantagens como ausência de morbidade no local doador, mas estudos mostraram complicações a longo prazo. Os enxertos híbridos, combinando enxertos autólogos e aloenxertos, têm ganhado interesse, permitindo um diâmetro maior e reduzindo a morbidade. O enxerto autólogo do tendão do músculo fibular longo tem recebido atenção, com resultados positivos, boa função do joelho e menor hipotrofia da coxa no local doador. O enxerto autólogo do tendão quadricipital tem ganhado popularidade, com resultados comparáveis aos enxertos de tendão patelar e de flexores, menor morbidade no local doador e menor taxa de re-ruptura. A escolha do enxerto evoluiu, com os enxertos autólogos de flexores sendo preferidos para pacientes menos ativos e o enxerto patelar com fragmento ósseo para atletas de alta performance. Enxertos aloenxertos, sintéticos e híbridos têm seu papel em circunstâncias específicas. A escolha deve ser baseada em evidências científicas, considerando vantagens e desvantagens. A reconstrução do LCA é um procedimento complexo que requer considerações individuais para selecionar o enxerto mais adequado.

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Demographics and Clinical Outcomes of Patients Undergoing Anterior Cruciate Ligament Reconstruction with a Planned or Unplanned Hybrid Graft

Cited by 4 publications

References 25 publications

Primary Anterior Cruciate Ligament Reconstruction with Suture Tape Augmentation: A Case Series of 252 Patients

Primary Anterior Cruciate Ligament Reconstruction with Suture Tape Augmentation: A Case Series of 252 Patients

No difference in revision risk between autologous hamstring graft less than 8 mm versus hybrid graft 8 mm or larger in anterior cruciate ligament reconstruction

Novas técnicas de enxertia para reconstrucão do LCA: Artigo de atualização

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