Wednesday, April 20, 2016

Revision ACL Reconstruction Graft Choice Part 2

Revision ACL reconstruction Graft choice is an important Issue that impacts patient outcome.  In the AOSSM O'Donoghue award winning study published in American Journal of Sports medicine the MARS group analyzed the impact of allograft versus autograft choice on patient reported outcomes, reoperation and return to sports.Read the full study HERE In this study of 1205 patients that underwent revision anterior cruciate ligament reconstruction at 52 sites by 83 different surgeons 58% were male, median age was 26.  48% underwent autograft reconstruction and 49% underwent allograft reconstruction.  3% had a combination.  We obtained followup on 989 with questionnaires (82%) and an additional 10% phone followup for a total of 92% followup At 2 years. The IKDC Sports score improved with the use of autograft with an odds ratio of 1.33. The Knee Osteoarthritis
Outcome Score subscales sports and recreation and quality of life improved with autograft use with an odds ratio of 1.33.  37/1112 (3.3%) patients sustained a graft rerupture. Use of an autograft resulted in a 2.78 times less risk for graft rerupture.  Graft irradiation versus nonirradiated grafts did not affect the allograft failure rate.  More grafts had not undergone a radiation that ultimately failed.  Many people previously had believed that if the graft had not undergone irradiation then the results were equal to autograft. Reoperation risk was not affected by allograft versus autograft use.

Based on these findings many people now recommend if at all possible using an autograft for revision anterior cruciate ligament reconstruction.  This can involve the quadriceps, patellar tendon or hamstring grafts.  Frequently I will use a graft from the opposite knee if no other autograft options remain. 

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