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Young athletes experienced similar outcomes with hamstring vs patellar tendon autografts
KOOS scores, IKDC and Marx scales showed no significant differences between groups.
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COLORADO SPRINGS, Colo. — Use of hamstring autografts or patellar tendon autografts for treatment of primary ACL reconstruction in young athletes had no significant or clinically relevant predicted differences, according to study results presented at the American Orthopaedic Society for Sports Medicine Annual Meeting.
“The take home message is that for the 14[-year-old] to 22-year-old athlete, autograft choice does not affect 2-year patient reported outcomes — taking into account patient gender, age, laxity, sport or competition level,” Laura J. Huston, MS, co-director of Sports Medicine Research at Vanderbilt University Medical Center, said in her presentation on behalf of the Multicenter Orthopaedic Outcomes Network. “Our findings suggest that autograft choice should not be made on the basis of patient-reported outcomes.”
Hamstring vs patellar tendon
Huston and her colleagues identified 889 patients (51% men) aged 14 years to 22 years who underwent primary ACL reconstruction for a sports injury with either a hamstring autograft or a patellar tendon autograft. Patients completed a series of validated patient-reported outcome instruments at the time of surgery and at 2-years follow-up.
Researchers included the Knee injury and Osteoarthritis Outcome score (KOOS) and the International Knee Documentation Committee (IKDC) and Marx activity rating scales as outcome instruments, and controlled for age, gender, ethnicity/race, BMI, sport at injury, competition level, knee laxity and baseline outcome score.
Results showed the preferred strategy for the IKDC outcome was the combined modeling strategy, while the separate model strategy was preferred for the Marx model. Hamstring autografts were significantly and highly correlated with patellar tendon autografts in both the KOOS quality of life and KOOS sports/recreation, Huston noted. According to results, scatter plot showed 9% of observations had a change in KOOS quality of life and 7% of observations had a change in KOOS sports/recreation by 10 points.
Huston also noted hamstring autografts had no differences in 2-year Marx activity levels or in IKDC score compared with patellar tendon autografts.
Customized risk calculator
Although autograft ACL reconstruction had good patient-reported outcomes in high school and college-aged athletes regardless of graft choice, Huston noted “the risk of recurrent disruption rate varied between graft choice by patient characteristics and defies a simple comparison.” She added orthopedic surgeons should utilize a customized risk calculator to tailor the risk of future ACL injury to each individual patient.
“This personalized risk calculator provides a side-by-side failure rate comparison for both a [patellar tendon bone-tendon-bone] BTB and hamstring autograft, while allowing the user to input and modify a patient’s age, gender, race/ethnicity, BMI, sport at injury, competition level and knee laxity level,” Huston told Orthopedics Today. – by Casey Tingle
- Reference:
- Huston LJ, et al. Paper #131. Presented at: American Orthopaedic Society for Sports Medicine Annual Meeting; July 7-10, 2016; Colorado Springs, Colo.
- For more information:
- Laura J. Huston, MS, can be reached at Vanderbilt Orthopaedic Institute, 1215 21st Ave., S. #4200, Nashville, TN 37232; email: laura.huston@vanderbilt.edu.
Disclosure: Huston reports she received research support from the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the NIH.