Increased Failure Rates After Anterior Cruciate Ligament Reconstruction With Soft-Tissue Autograft-Allograft Hybrid Grafts

Failure Rate and Clinical Outcomes of Anterior Cruciate Ligament Reconstruction Using Autograft Hamstring Versus a Hybrid Graft

“…26,33 The authors realize that autograft patellar tendon has been shown to have the lowest rerupture rate, although not statistically significantly different, when compared with autograft hamstring tissue. 28 Our preferred graft for ACL reconstruction is autograft hamstring tendons; however, we preoperatively counsel and educate our patients at the 34 We realize that a recent level 3 retrospective study by Burrus et al 35 analyzing primary outcomes for autograft versus soft tissue hybrid graft found that soft tissue hybrid grafts failed in 13.8% of reconstructions performed. This more closely aligns with the reported failure rate of allograft reconstruction, and their clinical outcomes for hybrid reconstruction were significantly worse than their matched autograft group.…”

“…Our study limited confounding bias from other knee pathology, most notably meniscal tears, as this variable cannot be easily standardized between study arms. 35 Other clinical variables were minimized here as we report results from a single surgeon using common femoral and tibial implants and uniform independent femoral drilling technique comparing autograft hamstring to hybrid soft tissue grafts that used all of the patients' autograft tissue augmented with the minimal amount of allograft to achieve the desired graft size for the implant chosen. In addition, we use nonirradiated soft tissue tibialis allografts when hybridization was indicated as they provide superior clinical outcomes compared with low dose irradiated allografts 37 and preserve a similar retear risk as autografts.…”

“…32 In addition, patients with ACL tears were treated by 1of 4 different surgeons using either transtibial or independent femoral drilling, several different femoral fixation devices, and included patients with meniscal injuries that may introduce clinical outcome bias. 35 In our study, the inclusion criteria and design attempted to reduce confounding factors as we included only isolated ACL ruptures. Our study limited confounding bias from other knee pathology, most notably meniscal tears, as this variable cannot be easily standardized between study arms.…”

Clinical Outcomes Following Primary Anterior Cruciate Ligament Reconstruction with Hamstring Autograft versus Planned Hybrid Graft

“…Few published studies have analyzed outcomes following ACLR with hybrid autograft-allografts. [9][10][11][12][13] Li et al 11 performed a level II, prospective randomized study to compare hamstring autograft, γ-irradiated tibialis anterior allograft, and hybrid graft composed of semitendinosus autograft and γ-irradiated tibialis anterior allograft. A total of 95 patients completed a minimum 5-year follow-up.…”

“…Irradiated allografts have been shown to result in lower biomechanical strength 15 and higher laxity and graft failure rates 16,17 compared with nonirradiated allografts, and so their use in hybrid grafts may diminish the outcomes in these patients. Many of the studies mentioned above [9][10][11]13 have utilized irradiated allografts to augment hamstring tendon autografts with small diameter. This may be one of the main reasons for the equivalent or inferior results of hybrid grafts demonstrated in most of these studies, in comparison to a hamstring autograft.…”