Dr Prodromos ACL blog September 2015

Dr Prodromos ACL blog September 2015

PATELLAR TENDON GRAFTS FOUND TO HAVE INCREASING INCIDENCE OF KNEELING PAIN AFTER SURGERY ALLOGRAFTS FOUND TO HAVE THREE TIMES THE FAILURE RATE OF AUTOGRAFTS

  1. PATELLAR TENDON GRAFTS FOUND TO HAVE INCREASING INCIDENCE OF KNEELING PAIN AFTER SURGERY
  2. ALLOGRAFTS FOUND TO HAVE THREE TIMES THE FAILURE RATE OF AUTOGRAFTS

PATELLAR TENDON GRAFTS FOUND TO HAVE INCREASING INCIDENCE OF KNEELING PAIN AFTER SURGERY

Am J Sports Med. 2015 Sep;43(9):2164-74. doi: 10.1177/0363546515591263. Epub 2015 Jul 17.

Twenty-Year Outcomes of a Longitudinal Prospective Evaluation of Isolated Endoscopic Anterior Cruciate Ligament Reconstruction With Patellar Tendon Autografts.

Thompson S1, Salmon L1, Waller A1, Linklater J2, Roe J3, Pinczewski L4. PUBMED 26187130

KNEELING PAIN FOUND TO INCREASE OVER TIME WITH PATELLAR TENDON GRAFTS FOR ACL RECONSTRUCTION

This remarkable study, provided 20 year follow up of patients who had Patellar Tendon, BTB Autograft for ACL reconstruction. Although the overall stability rates were good, the striking finding was that the known high rate of kneeling pain in Patellar Tendon Graft patients actually increased over time to a high of 69% of all patients 15 years after surgery. The follow up in this study is among the longest in the world’s literature, rendering the results even more persuasive.

Patellar Tendon grafts have a known higher incidence of kneeling pain and frontal knee pain than is found with hamstring grafts, or allografts. This fact largely has prompted a decline in the usage of BTB grafts over the last decade such that hamstring grafts are now the most commonly used graft for ACL reconstruction worldwide. The incidence of kneeling pain with BTB grafts is usually quoted at about 45% versus about 20% with hamstring grafts. In this study the two year incidence of kneeling pain was 33%. What was remarkable, and unexpected, was the incidence increased at each time point. At five years kneeling pain was found in 44%, at 10 years in 60% at 15 years in 69%, and at twenty years in 63%. This would tend to reinforce the trend away from use of the Patellar Tendon graft in favor of hamstring grafts, since both provide similar levels of postoperative stability in the hands of experienced surgeons.

ALLOGRAFTS FOUND TO HAVE THREE TIMES THE FAILURE RATE OF AUTOGRAFTS

Am J Sports Med. 2015 Aug 26. pii: 0363546515596406. [Epub ahead of print]

Autograft Versus Allograft Anterior Cruciate Ligament Reconstruction: A Prospective, Randomized Clinical Study With a Minimum 10-Year Follow-up.

Bottoni CR(1), Smith EL(2), Shaha J(3), Shaha SS(4), Raybin SG(3), Tokish JM(3), Rowles DJ(3). PMID: 26311445

This excellent high quality level 1 study with ten year follow up showed a strikingly greater failure rate for allografts versus autografts. Specifically the incidence of graft failure for autografts requiring revision was 8.3% for autografts, versus 26.5% for allografts, a three times greater failure and reoperation rate for allografts. While some studies have found similar rates of stability with autografts and allografts, many studies have found higher rates of failure with allografts. Indeed in a meta-analysis published from our center we also found a three times greater rate of failure in allografts versus autografts. And several other studies, have found allograft failure rates in the mid 20% range. However, this study is notable because it is such a high quality study showing such dramatically different results.

This information, along with the known slower rate of healing and graft incorporation and the risk of disease transmission with allografts, must be weighed by surgeons and patients when choosing which graft to use. In addition the high cost of allografts, usually over $2000.00 compared to autografts which have no cost, is of interest from a public health perspective as well in this era of limited health resources.

  • American Academy of Regenerative Medicine
  • American Board of Regenerative Medicine
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  • Rush University Medical Center
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