Reconstruction of the anterior cruciate ligament

Abstract

We examined the association of graft type with the risk of early revision of primary anterior cruciate ligament reconstruction (ACLR) in a community-based sample. A retrospective analysis of a cohort of 9817 ACLRs recorded in an ACLR Registry was performed. Patients were included if they underwent primary ACLR with bone-patellar tendon-bone autograft, hamstring tendon autograft or allograft tissue. Aseptic failure was the main endpoint of the study. After adjusting for age, gender, ethnicity, and body mass index, allografts had a 3.02 times (95% confidence interval (CI) 1.93 to 4.72) higher risk of aseptic revision than bone-patellar tendon-bone autografts (p < 0.001). Hamstring tendon autografts had a 1.82 times (95% CI 1.10 to 3.00) higher risk of revision compared with bone-patellar tendon-bone autografts (p = 0.019). For each year increase in age, the risk of revision decreased by 7% (95% CI 5 to 9). In gender-specific analyses a 2.26 times (95% CI 1.15 to 4.44) increased risk of hamstring tendon autograft revision in females was observed compared with bone-patellar tendon-bone autograft. We conclude that allograft tissue, hamstring tendon autografts, and younger age may all increase the risk of early revision surgery after ACLR.

Anterior cruciate ligament reconstruction best practice: A review of graft choice

“…It is important to note that they acknowledge a drop-out rate of 75% from initial enrolment which may bring a large bias into the results. Maletis et al [6] reported from 2791 BTPB autograft patients a revision rate of 1.18% at 1.5 years (or 0.66% per 100 years observation) which was favourable in comparison to both HS and Allograft.…”

“…Autografts usually consist of either hamstrings tendons (HS) or Bonepatella tendon-bone (BPTB). Allografts are varied but can consist of tibialis posterior tendon, Achilles tendon, tibialis anterior tendon, BPTB and peroneus longus tendon [6,7] . Synthetic grafts have been developed over the years and are currently on their "third generation" but have encountered considerable problems in the past [8][9][10][11] .…”

“…Re-rupture occurred in 1.5% of patients in this shorter follow-up study. Maletis et al [6] reported retrospectively from the prospective Kaiser Permanente ACL Recon-struction Registry revision rates after HS grafts in 3012 patients was 1.56% (1.1% revision rate per 100 years of observation), however follow-up was short at a mean of 1.5 years. No assessment of patient outcome/satisfaction was performed.…”

“…They do further note that these rates were high in comparison to autograft studies with similar length follow-up. In the recent study by Maletis et al [6] , they included 4014 allograft patients and reported a rerupture rate of 1.74% for allograft (1.23% per 100 observation years). A ready supply of allograft tissue requires a well co-ordinated and reliable human tissue bank with a consistent tissue cleaning and decontamination processes.…”

“…In the multicentre study of 9817 patients by Maletis et al [6] they compared revision rate only and found a tendency to increasing revision rates from BPTB to HS to Allograft (1.18%, 1.56% and 1.74% respectively) with 2.7 year survival rates of 98.0%, 96.9% and 96.0% respectively. The other significant findings were increasing revision rates of 3.02 comparing Allograft to BPTB, and 1.82 comparing HS to BPTB grafts.…”