Comparison of Clinical Outcomes After Anterior Cruciate Ligament Reconstruction Using a Hybrid Graft Versus a Hamstring Autograft

Wang, Hongde; Gao, Shijun; Zhang, Yingze

doi:10.1016/j.arthro.2017.11.020

Cited by 41 publications

(71 citation statements)

References 32 publications

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“…However, we believe that this may not have significantly impacted PROMs, as the current literature is conflicted over whether allograft augmentation improves or worsens PROMs. 11,12 Although these studies suggest there may be a small but significant difference due to allograft augmentation, these differences are marginal and may not be clinically significant. 11,12 Another possible explanation for these results could be the synthetic augmentation of the graft utilizing internal bracing, which briefly is a transosseous suture tape construct that reinforces the graft.…”

Section: Discussionmentioning

confidence: 97%

“…11,12 Although these studies suggest there may be a small but significant difference due to allograft augmentation, these differences are marginal and may not be clinically significant. 11,12 Another possible explanation for these results could be the synthetic augmentation of the graft utilizing internal bracing, which briefly is a transosseous suture tape construct that reinforces the graft. Biomechanical studies and ACL repairs utilizing internal bracing have shown promising results, especially in terms of improving mechanical strength.…”

Section: Discussionmentioning

confidence: 97%

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Posteromedial versus Anteromedial Hamstring Tendon Harvest for Anterior Cruciate Ligament Reconstruction: A Retrospective Comparison of Accidental Gracilis Harvests, Outcomes, and Operative Times

et al. 2018

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Hamstring autografts are frequently harvested for anterior cruciate ligament reconstruction (ACLR), traditionally through the anteromedial (AM) approach. Recently, a posteromedial (PM) approach has been described. The primary purpose of this study was to compare rates of unintentional gracilis (Gr) harvest or premature tendon amputation with these approaches. We also sought to compare operative times and patient-reported outcome measures (PROMs) between both groups and between those with only semitendinosus (ST) grafts or with combined ST and Gr grafts. Patients who underwent ACLR with hamstring autograft by a single surgeon from 2014 to 2016 were retrospectively reviewed. An accidental harvest was identified as an unintentional Gr harvest or premature graft amputation. PROMs included the Knee Osteoarthritis and Outcomes Score, Western Ontario and McMaster Universities Osteoarthritis Index, and International Knee Documentation Committee score. Two out of 22 (9.1%) patients in the AM group had unintentional Gr tendon harvests, while none (out of 29) were identified in the PM group (p = 0.101). Group mean PROMs were not significantly different between patients in either group or patients with either ST-only grafts and those with combined ST + Gr. Average operative times and tourniquet times were significantly shorter with the PM approach versus the AM approach (101 ± 18.2 vs 129 ± 25.6 minutes, p = 0.002; 68 ± 14.8 vs 90 ± 28.9 minutes, p = 0.005). The PM approach was associated with a trend toward decreased risk of unintentional harvest of the Gr tendon and significantly decreased operative and tourniquet times without affecting knee outcomes compared with the traditional AM approach. Accidental Gr harvest was not associated with worse outcomes.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 97%

Posteromedial versus Anteromedial Hamstring Tendon Harvest for Anterior Cruciate Ligament Reconstruction: A Retrospective Comparison of Accidental Gracilis Harvests, Outcomes, and Operative Times

et al. 2018

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“…However, it should be noted that irradiation was used to sterilize the allografts in all three studies which demonstrated inferior results among hybrid graft patients. 6,10, 22 Irradiated allografts have been shown to result in lower biomechanical strength 23 and higher laxity and graft failure rates 24,25 compared with nonirradiated allografts, and so their use in hybrid grafts may diminish the outcomes in these patients. Only nonirradiated, aseptically procured allografts were used in the present study.…”

Section: Discussionmentioning

confidence: 99%

Demographics and Clinical Outcomes of Patients Undergoing Anterior Cruciate Ligament Reconstruction with a Planned or Unplanned Hybrid Graft

et al. 2018

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The purpose of this study was to report the demographics and clinical outcomes of patients at our institution following anterior cruciate ligament reconstruction (ACLR) with a planned or unplanned hybrid autograft–allograft. At a minimum 2-year follow-up, patients at our institution who had undergone primary ACLR with a planned (P) or unplanned (U) hybrid graft using fresh-frozen allografts were contacted to complete a survey containing the Knee Injury and Osteoarthritis Outcome Score, Subjective International Knee Documentation Committee score, Single Assessment Numeric Evaluation, 12-Item Short Form Health Survey, and visual analog scale for activity level. Demographics were compared between groups. Patient-reported outcomes (PROs) and a revision rate were reported for each group. Mean follow-up among all patients was 3.3 years. Revision rate at follow-up was 0.8 and 6.3% in the P and U groups, respectively (p = 0.03). Among patients reached for follow-up (90 P, 30 U), a lower proportion of males was found in the unplanned hybrid graft group (P: 52%, U: 23%, p < 0.01). Unplanned hybrid graft patients were significantly younger at the time of surgery (P: 41.0 years, U: 31.0 years, p < 0.0001). Graft size did not differ between groups (P: 9.1 mm, U: 8.9 mm, p = 0.11). Patients in both groups achieved moderate to high PROs. Demographics differ between patients undergoing ACLR with a planned or unplanned hybrid graft. Patients with a planned hybrid graft are at a significantly reduced risk of postoperative graft failure, likely due to the older age of this group.

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“…These 3 potential causes of hybrid graft ACL reconstruction failure have been confirmed in an original scientific article published in Arthroscopy by our team in 2018. 10 All allografts used in hybrid graft ACL reconstruction were g-irradiated at a dose of 2.5 Mrad. 10 At second-look arthroscopic examination performed 3 years postoperatively, incomplete revascularization and ligamentization could still be observed in the allograft portion of the hybrid graft, and marked laxity was found when the reconstructed ACL was probed.…”

Section: See Related Article On Page 2927mentioning

confidence: 99%

“…10 All allografts used in hybrid graft ACL reconstruction were g-irradiated at a dose of 2.5 Mrad. 10 At second-look arthroscopic examination performed 3 years postoperatively, incomplete revascularization and ligamentization could still be observed in the allograft portion of the hybrid graft, and marked laxity was found when the reconstructed ACL was probed. 10 These differing maturity levels may potentially compromise not only the mechanical properties of the hybrid graft but also the fixation strength.…”

Section: See Related Article On Page 2927mentioning

confidence: 99%

Editorial Commentary: Reduce the Failure Risk: A Challenge to Reduce the Risk of Using Hybrid Graft in Anterior Cruciate Ligament Reconstruction

Wang

Zhang

2018

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Hybrid grafting (augmentation of small hamstring autografts with allograft tissue) is preferred by many surgeons for anterior cruciate ligament (ACL) reconstruction. Although a recent, well-conducted, systematic review reported no significant differences in failure risk between hybrid graft and autograft ACL reconstruction, a trend toward a greater failure risk using the hybrid graft existed in many of the included studies. Three potential causes of hybrid graft ACL reconstruction failure that are absent in autograft ACL reconstruction are different levels of graft revascularization and ligamentization, differences in the tendon-bone healing capacity between the allograft and autograft portions in the bone tunnel, and processing of the graft. Research advances in these areas will further reduce the failure risk of hybrid graft ACL reconstruction.

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Comparison of Clinical Outcomes After Anterior Cruciate Ligament Reconstruction Using a Hybrid Graft Versus a Hamstring Autograft

Cited by 41 publications

References 32 publications

Posteromedial versus Anteromedial Hamstring Tendon Harvest for Anterior Cruciate Ligament Reconstruction: A Retrospective Comparison of Accidental Gracilis Harvests, Outcomes, and Operative Times

Posteromedial versus Anteromedial Hamstring Tendon Harvest for Anterior Cruciate Ligament Reconstruction: A Retrospective Comparison of Accidental Gracilis Harvests, Outcomes, and Operative Times

Demographics and Clinical Outcomes of Patients Undergoing Anterior Cruciate Ligament Reconstruction with a Planned or Unplanned Hybrid Graft

Editorial Commentary: Reduce the Failure Risk: A Challenge to Reduce the Risk of Using Hybrid Graft in Anterior Cruciate Ligament Reconstruction

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