Outcomes of Anterior Cruciate Ligament Reconstruction Using Biologic Augmentation in Patients 21 Years of Age and Younger

Abstract

Purpose: To report on the outcomes of a subset of patients 21 years of age after anterior cruciate ligament (ACL) reconstruction coupled with biologic augmentation using platelet-rich plasma (PRP) and a porous collagen carrier. Methods: A cohort of patients was retrospectively reviewed after ACL reconstruction with hamstring autograft tendon. All reconstructive surgeries combined biologic augmentation in which the ACL graft was coupled with PRP contained within porous collagen membrane. Patients were included if they maintained a minimum follow-up period of 24 months. Outcomes were assessed through patient-reported questionnaires and physical examination in the clinical setting. Patientreported outcomes including International Knee Documentation Committee (IKDC), Lysholm, Tegner, and Single Assessment Numeric Evaluation (SANE) scores were collected. ACL stability was evaluated using Lachman and KT-1000 testing. Patients were also evaluated for return to play at the same level of competition, family history of ACL injury, and time to complete rehabilitation. Results: A total of 194 patients were initially eligible; 143 (74%) patients with 151 knees were ultimately evaluated. The average patient age was 16 years; 79 patients were female and 64 were male. Follow-up duration averaged 52 months. IKDC and Lysholm scores averaged 91 and 91; the average SANE score was 94. The KT-1000 side-to-side difference averaged 1.2 mm. The average time to complete physical therapy was 22 weeks, and 132 patients (92%) returned to their preinjury level of competition. There were 23 cases of contralateral ACL injury (15%) and 7 cases of ACL reinjury necessitating revision surgery (5%). Conclusions: Biologic augmentation with hamstring autograft in ACL reconstruction shows a decreased rate of second ACL injury, specifically with regard to ACL revision surgery. The patients in this study also show higher return to preinjury level of competition at a faster rate than other studies have shown. Level of Evidence: Level IV, Therapeutic Case Series.

A Novel Approach to Augmenting Allograft Hamstring Anterior Cruciate Ligament Reconstructions Utilizing a Resorbable Type I Collagen Matrix with Platelet Rich Plasma

“…Several articles have discussed the risk of ACLR failure associated with allograft tissue [6][7][8][9][10][11][12][13][14][15][16][17][18][19]. A significant increase in ACLR failure has been shown in young patients who received allograft tissue in their reconstruction procedures [10][11][12][13]19]. Kaeding et al, in a review of the data from the Multicenter Orthopaedic Outcomes Network (MOON) trials, found a four times higher ACLR graft failure rate when using allograft versus autograft in the population of 10-19 years.…”

“…Delay in biologic graft incorporation has been of primary concern when considering allograft failures [19][20][21]. Rappé et al found a 33% failure rate when using irradiated Achilles tendon allografts to a 2.4% failure rate when using nonirradiated Achilles tendon allografts [18].…”

“…The concept of utilizing biologics as an augment for ACLR has gained popularity in recent years [19][20][21][22][23]. Fleissner et al reported on 143 patients who underwent ACLR with autograft augmented with type I collagen matrix hydrated with PRP.…”

“…This trend of "incorporation lag" continued out to 52 weeks. Various factors have been theorized as to the delayed incorporation, including allograft processing and purifications methods [14][15][16][17][18][19].…”

Editorial Commentary: Platelet-Rich Plasma: The Devil Is in the Details, and the Details Need to Be Better Reported

“…I n the Level IV study, "Outcomes of Anterior Cruciate Ligament Reconstruction Using Biologic Augmentation in Patients 21 Years of Age and Younger," 1 Berdis, Veale, and Fleissner report on 143 patients who underwent a primary hamstring anterior cruciate ligament (ACL) reconstruction coupled with a platelet-rich plasma (PRP)/collagen membrane augmentation. At an average duration of follow-up of 52 months, their KT-1000 sideto-side difference averaged 1.2 mm.…”