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Graft ruptures increased in ACL reconstruction with allograft-augmented autografts
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There was a significantly increased risk of graft ruptures in adolescent patients who underwent ACL reconstruction with hamstring tendon autografts augmented with allografts compared with patients who underwent reconstruction with comparably sized hamstring tendon autografts, according to recently published results.
"Our clinical study led to an important finding that has changed our clinical practice,” Crystal Perkins, MD, told Healio.com/Orthopedics. “Due to higher rates of ACL graft injury associated with allografts, the use of allografts for ACL reconstruction in our pediatric and adolescent patients is now highly unusual. Our sports medicine team prides ourselves in tracking our outcomes and modifying our practice based on this information to ensure the highest quality care for our patients and families."
Researchers identified 354 patients, with a mean age of 15.3 years, who underwent hamstring autograft ACL reconstruction with or without soft tissue allograft augmentation. Mean follow-up was 26 months. Graft constructs used included four-strand doubled semitendinosus and gracilis autograft (4-STG), five-strand tripled semitendinosus and doubled gracilis autograft (5-STG), and six-strand doubled gracilis and semitendinosus autograft augmented with a soft tissue allograft (6-STGAllo). Graft rupture was the primary outcome measure.
Results showed graft constructs averaged 8.33 mm for 4-STG, 8.9 mm for 5-STG and 9.2 mm for 6-STGAllo. Investigators noted 50 graft ruptures and 24 contralateral ACL tears. Time to graft failure on average was 16 months.
After age and graft size were adjusted, patients who had allograft-augmented grafts had a 2.6-times chance of graft ruptures compared with patients in the 4-STG group. No significant difference was seen between patients who had 5-STG vs. those with 4-STG with regard to failure rate. – by Monica Jaramillo
Disclosures: The authors report no relevant financial disclosures.
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