Tuesday, April 19, 2016

Revision ACL Reconstruction Graft Choice Part 1

Revision ACL reconstruction requires careful thought about the appropriate graft to utilize.  In the revision (redo) situation a previous graft has already been used and failed.  This can force surgeons to potentially use a graft that is not their first choice.  As the basis for the MARS (Multicenter ACL Revision Study) we allowed surgeons to choose their graft that they felt most appropriate in the clinical situation.  Many surgeons believed that graft choice was a fait accompli and that they had no real choice in the matter.  They were forced to many times use a graft not of their choice based on other factors including patient's age, patient’s sport, previous graft utilized, gender etc. In a propensity study the MARS Group performed (Accepted for publication in The Journal of Knee Surgery) we analyzed a variety of factors that impacted revision ACL graft choice. Below you can see the factors analyzed and their impact on what graft the patient eventually received.

As can be seen despite a variety of factors that impact graft choice the most important factor was the particular surgeon that treated you.  Thus, a surgeon that wants to use an allograft (cadaver) for the reconstruction can do that.  Likewise, a surgeon that wants to utilize an autograft has the ability to control that decision most of the time.  The top 5 choices are expanded below and as can be seen in this table ---in fact the particular surgeon involved was 5 times higher impact on graft choice than anything else analyzed including the previous graft the patient had utilized for the primary ACL reconstruction.

Following this study we knew that if we could improve what type of graft gave the best results we could then recommend to surgeons to use that graft and impact patient outcomes.  In Part 2 I will discuss the follow-up study that analyzed outcomes depending on the patient's graft utilized in the MARS study.

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