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Combination of hamstring graft, ALL reconstruction yielded lower failure rate in ACL reconstruction
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Patients who underwent ACL reconstruction with a hamstring tendon graft combined with anterolateral ligament reconstruction experienced a lower rate of graft failure and greater odds of returning to preinjury levels of sport, according to results.
“The main message of this study is that performing anterolateral ligament reconstruction at the same time as ACL reconstruction is associated with significantly lower graft rupture rates than with isolated ACL reconstruction using either one of the two most frequently used graft choices in contemporary practice,” Bertrand Sonnery-Cottet, MD, of the Centre Orthopedique Santy, FIFA Medical Center of Excellence in Lyon, France, told Healio.com/Orthopedics.
Sonnery-Cottet and colleagues conducted a prospective study of 502 patients who underwent primary ACL reconstruction with either a bone-patellar tendon-bone graft, a quadrupled hamstring tendon graft or a hamstring tendon graft combined with anterolateral ligament (ALL) reconstruction. To identify the prognosticators of graft rupture and return to sport, researchers analyzed survivorship data from Kaplan-Meier analysis using multivariate Cox regression models.
Results showed the mean preoperative and postoperative subjective IKDC scores, side-to-side laxity and postoperative Lysholm and Tegner scores were not significantly different between the groups. Researchers noted quadrupled hamstring tendon grafts, bone-patellar tendon-bone grafts and hamstring tendon grafts combined with ALL reconstruction had graft rupture rates of 10.77%, 16.77% and 4.13%, respectively, at a mean follow-up of 38.4 months.
Use of hamstring tendon grafts combined with ALL reconstruction had a rate of graft failure 2.5-times less than bone-patellar tendon-bone grafts and 3.1-times less than quadrupled hamstring tendon grafts. However, researchers found quadrupled hamstring tendon grafts and bone-patellar tendon-bone grafts had no significant differences in graft failure rate.
Graft failure was also predicted by age of 25 years or younger and preoperative side-to-side laxity greater than 7 mm. Researchers noted higher odds of returning to preinjury levels of sport associated with hamstring tendon grafts combined with ALL reconstruction vs. quadrupled hamstring tendon grafts, but not compared with bone-patellar tendon-bone grafts. – by Casey Tingle
Disclosure: Sonnery-Cottet reports he receives royalties from, is a paid consultant for, receives research support from and has made presentations for Arthrex Inc.
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