Failure rates and functional outcomes of allograft and autograft bone-patellar tendon-bone (BPTB) anterior cruciate ligament reconstruction in patients < 30 year
ESSKA Academy. Briggs K. 11/08/19; 285253; epESMA-62 Topic: Arthroscopic Surgery
Karen Briggs
Karen Briggs
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Introduction: The controversy of allograft versus autograft bone-patellar tendon-bone anterior cruciate ligament (ACL) reconstruction is highly debated in the literature. The purpose of this study was to investigate differences in failure rates and functional outcomes between BPTB autograft and allograft ACL reconstruction in patients < 30 years of age.
Methods: All patients 17-30 years of age who underwent a BPTB allograft/autograft ACLR with bioabsorbable interference screws (ConMed Linvatec, Largo, FL) by a single surgeon (1995-2017) were included. Exclusion criteria were follow-up < 2 years, osteochondral drilling, revision ACLR and multi-ligamentous injuries. Allograft source was always five years younger than patient age and not terminally irradiated. An independent physical exam including knee ROM and stability testing, including KT-1000, Lachman, and pivot shift, was performed. Patients completed Lysholm, IKDC, and Tegner questionnaires to assess clinical outcomes. Failure was defined as recurrent subjective knee instability or positive Lachman and/or pivot shift test. Independent samples t-tests were used to assess differences between patients with allograft and autograft ACLR (p< 0.05).
Results: 35 patients with BPTB autograft ACLR (8 females, 22.0±4.4 years of age) and 13 patients with BPTB allograft ACLR (8 female, 23.8±3.9 years of age) were included. Average follow-up was 8.7±5.2 years in the autograft group and 6.7±3.7 years in the allograft group (p=0.155). Postoperative VAS pain score was 2.7±1.0 in autograft group and 2.6±0.7 in allograft group (p=0.0872) and postoperative flexion ROM did not differ between the groups (p=0.1218). Postoperative IKDC score was 82.6±16.4 in autograft group and 92.2±7.0 in allograft group (p=0.0259). Postoperative Lysholm score was 89.3±7.0 vs. 93.4±8.0 (p=0.1538). Manual maximum KT-1000 knee stability did not differ between the groups (p=0.740). All patients returned to preoperative sport at Tegner score >5. Overall failure rate was 2.1% (1/48). There were no failures in the allograft group and 1 failure in the autograft group (2.9%, 1/35) which occurred 4 years postoperatively. The patient underwent revision BPTB allograft ACLR without recurrence at 15 year follow up.
Discussion: Allograft BPTB ACLR, contrary to recent literature, is a good alternative graft option to return young patients >17 years of age and < 30 years of age to pre-operative sports with no evidence of increased failure rates.
Introduction: The controversy of allograft versus autograft bone-patellar tendon-bone anterior cruciate ligament (ACL) reconstruction is highly debated in the literature. The purpose of this study was to investigate differences in failure rates and functional outcomes between BPTB autograft and allograft ACL reconstruction in patients < 30 years of age.
Methods: All patients 17-30 years of age who underwent a BPTB allograft/autograft ACLR with bioabsorbable interference screws (ConMed Linvatec, Largo, FL) by a single surgeon (1995-2017) were included. Exclusion criteria were follow-up < 2 years, osteochondral drilling, revision ACLR and multi-ligamentous injuries. Allograft source was always five years younger than patient age and not terminally irradiated. An independent physical exam including knee ROM and stability testing, including KT-1000, Lachman, and pivot shift, was performed. Patients completed Lysholm, IKDC, and Tegner questionnaires to assess clinical outcomes. Failure was defined as recurrent subjective knee instability or positive Lachman and/or pivot shift test. Independent samples t-tests were used to assess differences between patients with allograft and autograft ACLR (p< 0.05).
Results: 35 patients with BPTB autograft ACLR (8 females, 22.0±4.4 years of age) and 13 patients with BPTB allograft ACLR (8 female, 23.8±3.9 years of age) were included. Average follow-up was 8.7±5.2 years in the autograft group and 6.7±3.7 years in the allograft group (p=0.155). Postoperative VAS pain score was 2.7±1.0 in autograft group and 2.6±0.7 in allograft group (p=0.0872) and postoperative flexion ROM did not differ between the groups (p=0.1218). Postoperative IKDC score was 82.6±16.4 in autograft group and 92.2±7.0 in allograft group (p=0.0259). Postoperative Lysholm score was 89.3±7.0 vs. 93.4±8.0 (p=0.1538). Manual maximum KT-1000 knee stability did not differ between the groups (p=0.740). All patients returned to preoperative sport at Tegner score >5. Overall failure rate was 2.1% (1/48). There were no failures in the allograft group and 1 failure in the autograft group (2.9%, 1/35) which occurred 4 years postoperatively. The patient underwent revision BPTB allograft ACLR without recurrence at 15 year follow up.
Discussion: Allograft BPTB ACLR, contrary to recent literature, is a good alternative graft option to return young patients >17 years of age and < 30 years of age to pre-operative sports with no evidence of increased failure rates.
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