A Novel Approach to Augmenting Allograft Hamstring Anterior Cruciate Ligament Reconstructions Utilizing a Resorbable Type I Collagen Matrix with Platelet Rich Plasma

Abstract

Background. Anterior cruciate ligament reconstruction (ACLR) is one of the most common lower extremity orthopedic surgeries performed in the United States. Annually, between 100,000 and 200,000 ACL tears affect 1 in 3,000 people. The selection of autograft versus allograft for ACLR has been widely discussed in terms of risk of graft failure. Allograft reconstructions have been shown to have higher rerupture rates. One factor contributing to this risk is delayed biologic graft incorporation. Methods. A retrospective review was performed examining 14 patients who underwent an augmented quadruple-stranded hamstring allograft ACLR with a type I resorbable collagen matrix impregnated with platelet-rich plasma (PRP). Results. Within our clinical practice, the augmentation of quadruple-stranded hamstring allograft ACLR with a type I resorbable matrix impregnated with PRP has yielded good early clinical success at 2-year outcomes ( N = 14 ). Zero ACLR failures have been reported to date in this series. Conclusion. This case series offers a novel approach for soft tissue allograft ACLR augmented with a type I collagen matrix impregnated with PRP. The authors theorize that this augmentation may improve biologic graft incorporation into the host bone tunnels.

There is no difference in the efficacy of anterior cruciate ligament reconstruction using autograft combined with or without ligament augmentation: a systematic review and meta‐analysis

“…The potential risk of increasing graft failure rate alongside ligament augmentation has been widely debated. Biomechanical models supported that anterior cruciate ligament graft augmentation may theoretically protect the graft against irreversible lengthening, especially during the maturation and remodeling phases of healing and improve biologic graft incorporation [28, 30, 38]. However, some surgeons have concerns about the subsequent stress shielding, which may slow down the healing and the formation of appropriate mechanical structures of autografts, thus increasing the risk of re‐rupture.…”

Anterior Cruciate Ligament Reconstruction: Is Biological Augmentation Beneficial?

“…The authors observed that their technique produced good early clinical results (at the 2-year follow-up) and had no ACLR failures. This novel ACLR approach could improve the incorporation of biologic grafts into host bone tunnels [82]. However, the series by McMillan et al is very small; better designed and statistically powered studies are therefore needed to confirm that this novel technique is truly effective in patients undergoing ACLR.…”