Outcomes and Revision Rate After Bone-Patellar Tendon-Bone Allograft Versus Autograft Anterior Cruciate Ligament Reconstruction in Patients Aged 18 Years or Younger With Closed Physes
Steadman Philippon Research Institute, Vail, Colorado.Arthroscopy The Journal of Arthroscopic and Related Surgery (Impact Factor: 3.21). 10/2012; 28(12). DOI: 10.1016/j.arthro.2012.06.016
PURPOSE: The purpose of this study was to compare revision rates and outcomes after anterior cruciate ligament (ACL) reconstruction with bone-patellar tendon-bone (BPTB) autografts versus BPTB allografts in patients aged 18 years or younger with closed physes. METHODS: Institutional review board approval was obtained for this study. This study included 90 consecutive patients aged 18 years or younger with closed physes who underwent primary ACL reconstruction by a single surgeon between 1998 and 2009, with either BPTB autograft (n = 70) or BPTB allograft (n = 20). Patients who had concomitant ligament injuries were excluded. Outcome measures included the Lysholm score, Tegner activity scale, and patient satisfaction (0, very unsatisfied; 10, very satisfied). Failures were defined as cases requiring ACL revision surgery. RESULTS: Of the 90 patients, 79 (88%) were contacted (20 of 20 with allografts and 59 of 70 with autografts). Of these 79 patients, 9 (11%) required revision ACL reconstruction. In the autograft group, 3% (2 of 59) required revision ACL reconstruction at a mean of 15.4 months (range, 13.0 to 17.7 months) after the index procedure. In the allograft group, 35% (7 of 20) required revision ACL reconstruction at a mean of 9.1 months (range, 5.3 to 12.0 months) after the index procedure. The allograft group was 15 (95% confidence interval [CI], 2 to 123) times more likely to require revision reconstruction than the autograft group (P = .001). The mean Lysholm score at follow-up was 85 (95% CI, 80.4 to 90.3) for the autograft group and 91 (95% CI, 88.1 to 97.3) for the allograft group (P = .46). The median Tegner activity scale was 7.0 (95% CI, 6.9 to 8.0) for autograft group and 6.5 (95% CI, 4.9 to 8.4) for the allograft group (P = .27). Median patient satisfaction score was 10 of 10 in both cohorts. No failures were seen in either group at 2 years postoperatively. Five of seven allograft failures occurred because of a premature return to sports. CONCLUSIONS: No significant differences in function, activity, or satisfaction were found between allograft and autograft reconstructions in this patient population. The allograft group had a failure rate 15 times greater than that in the autograft group, with all failures occurring within the first year after reconstruction. LEVEL OF EVIDENCE: Level III, retrospective comparative study.
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ABSTRACT: The ACL is composed of two bands, anteromedial band and posterolateral band. Its main function consists on restraint to anterior subluxation of the tibia on the femur. ACL injury is very common, above all in active people. The diagnosis of the injury is based on the physical examination and MRI. Concomitant injuries such as meniscal tears, osteochondral defects, bone bruises and other ligamentous injuries can appear. The option of surgical treatment of the injury depends on the activity level of the patient and the stability of the knee. There are different options in graft selection but patellar tendon graft, bone-tendon-bone (BTB) graft is the gold standard. Hamstring tendon graft, quadriceps tendon graft and allografts are other choices with good outcomes, too. After surgery, bracing has not been shown to have impact on results and strengthening leg muscles takes an important role in postoperative rehabilitation. Infection, deep vein thrombosis, loss of motion, patellofemoral pain, and general pain syndromes are the major complications that can significantly diminish the results of ACL surgery but fortunately, they are very uncommon.
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ABSTRACT: Searching the Internet is one of the most popular methods for acquiring information related to health. The Internet offers physicians and patients easy access to a wide range of medical material from anywhere in the world. For many patients, this information helps formulate decisions related to their health and health care. An important caveat is that virtually anything can be published on the Internet. Although academic publications require rigorous peer review, Internet websites have no regulatory body monitoring quality and content. With a lack of external regulation, the information retrieved may be incorrect or outdated. The Internet can be a valuable asset for educating patients, but because of significant variability physicians should be familiar with the quality of information available. This article discusses both the strengths and weaknesses of information available on the Internet regarding anterior cruciate ligament repair.
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ABSTRACT: Purpose The purpose of this study is first to report the outcomes, at 4 years follow-up, in revision ACL surgery using allografts in patients younger than 40 years old, and then compared soft tissue allografts to bone tendon allografts. Methods This retrospective study included 47 patients who underwent ACL revision surgery with fresh-frozen allografts. Patellar tendon allograft or tibialis anterior allograft was used. Twenty-seven patients undergoing ACL revision with patellar tendon allograft were compared retrospectively with twenty-two patients undergoing the same procedure with soft tissue tibialis anterior allograft. Lysholm, IKDC, and KT-1000 values were obtained preoperatively and postoperatively. Results The average patient follow-up was 4.6 years (±2.5). The mean age at time of the revision was 34 years old (±6.3). Overall, patients reported the overall condition of their knee as excellent or good in 85 % of the patients (10 excellent, 33 good). Based on their experience, 85 % would have the surgery again if they had the same problem in the other knee. Both subgroups experienced significant improvement in Lysholm, IKDC, and KT-1000 values, with no difference found between groups at final follow-up. Conclusion Revision ACL with allografts has excellent and good results in 85 % of patients younger than 40 years old. No statistical difference was seen between soft tissue (tibialis anterior) and patellar tendon allograft. Level of evidence IV.
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