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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