Allograft Use Results in Higher Re-revision Rate for Revision Anterior Cruciate Ligament Reconstruction

Abstract

Background:The literature on revision anterior cruciate ligament (ACL) reconstruction (ACLR) outcomes is generally sparse, but previous studies have demonstrated that autograft use results in improved sports function and patient-reported outcome measures compared with allograft. However, knowledge is still lacking regarding the impact of graft type on rates of re-revision.Purpose:To investigate the clinical outcomes and failure rates of revision ACLRs performed with either allograft or autograft.Study Design:Cohort study; Level of evidence, 3.Methods:A search of the Danish Knee Ligament Reconstruction Registry identified 1619 revision ACLRs: 1315 were autograft procedures and 221 were allograft procedures (type of graft was not identified for 83 procedures). Clinical outcomes after 1 year were reported via the Knee injury and Osteoarthritis Outcome Score (KOOS), the Tegner activity score, and an objective knee stability measurement that determined side-to-side differences in instrumented sagittal knee laxity. Failure was determined as re-revision. Outcomes for revision were provided for the full life of the registry, up to 10 years.Results:The re-revision rate was significantly higher for allograft compared with autograft (12.7% vs 5.4%; P < .001), leading to a hazard ratio for re-revision of 2.2 (95% CI, 1.4-3.4) for allografts compared with autografts when corrected for age. At 1-year follow-up, objective knee stability was significantly different (2.1 ± 2.1 mm for allograft vs 1.7 ± 1.8 mm for autograft; P = .01), and the KOOS subscale scores for symptoms, pain, activities of daily living, sports, and quality of life were 67, 76, 84, 49, and 46 for allograft and 67, 78, 84, 51, and 48 for autograft, respectively, with no difference between groups.Conclusion:In this observational population-based study, the ALCR re-revision rate was 2.2 times greater for allograft compared with autograft procedures. Allograft was associated with greater knee laxity at 1-year follow-up. However, subjective clinical outcomes and knee function were not inferior for allograft patients. These results indicate that autograft is a better graft choice for revision ALCR.

Patellar Tendon Reconstruction Utilizing Autograft Hamstring: A Docking Technique for the Sports Medicine Surgeon

“…In regard to anterior cruciate ligament (ACL) reconstructions, age and gender play a role in the graft-selection decision-making process [26,27]. There are well-documented increased rates of allografts compared to autograft tissue on widely research ACL reconstructions [26,28]. Gangliano, et al determined that the structure of aging tendons is preserved, and aging tenocytes maintained their ability of extracellular matrix remodeling when evaluating semitendinosus and gracilis tendons in older patient populations (mean group ages of 41.8 versus 72.7 years old) [29].…”

Registry Studies Use Inconsistent Methods to Account for Patients Lost to Follow-up, and Rates of Patients LTFU Are High

“… 27 DKRR 17,204 ACLR KOOS, Tegner Activity Pre-op: 67 Post-op :78 2 Nissen et al. 30 DKRR 1619 ACLR KOOS, Tegner Activity 1 year: 73 2 Lind et al. 31 DKRR 22,401 ACLR, PCLR KOOS, Tegner Activity Pre-op: 65 1 year: 73 2 Bjerre et al.…”

“…Twelve papers 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 referenced a validation study only, and an additional 3 articles 7 , 19 , 20 referenced both a validation study and carried out a dropout analysis. Two validation studies were carried out on the dataset of 2 registries: the SNKLR and DKRR.…”

Iliotibial Band Tenodesis With a Tenodesis Screw for Augmentation of Anterior Cruciate Ligament Reconstruction

“…Because competitive athletes have increased demands for pivoting and revision ACLR has a significantly higher failure rate than a primary procedure, 11 we indicate this procedure in individuals receiving revision ACLR who wish to return to athletic activity. In addition, this procedure should be considered if an allograft anterior cruciate ligament (ACL) is being used, because the ACLR re-revision rate is up to 2.2 times higher for ACL allografts than ACL autografts 15 . Finally, patients with joint hypermobility, a high-grade pivot-shift examination finding, or primary graft failure in the absence of technical error would warrant an indication for this technique because these patients may have an elevated risk of graft failure.…”