Isolated ACL reconstruction had increased graft failure vs. combined ACL reconstruction
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Key takeaways:
- Combined ACL and anterolateral ligament reconstruction had better clinical outcomes than isolated bone-tendon-bone autografts.
- Some outcomes differed between age and demographic groups.
NEW ORLEANS — Isolated ACL reconstruction with bone-tendon-bone autograft yielded an increased risk of graft failure compared with ACL reconstruction plus anterolateral ligament reconstruction with hamstring autograft, according to results.
Adnan Saithna, MD, FRCS, and colleagues prospectively collected data and medical records from more than 600 primary ACL operations from 2003 to 2019 to evaluate and compare the clinical outcomes after an isolated ACL reconstruction with bone-tendon-bone (BTB) autograft vs. a ACL plus anterolateral ligament reconstruction with hamstring tendon autograft.
Patients in both the isolated and combined reconstruction groups underwent the same postoperative rehabilitation process, according to Saithna.
“Our main outcome was graft failure,” Saithna said in his presentation at the Arthroscopy Association of North America Annual Meeting. “And what we demonstrated was that if you have an isolated ACL reconstruction with BTB, you have a threefold increased risk of graft failure compared to the combined reconstruction with hamstrings.”
Saithna noted that the results also showed differences between age groups.
“One of the groups that is favored in BTB is the younger, athletic, high-risk patient,” Saithna said. “In that younger group, patients under the age of 20 [years], that benefit assisted threefold increased risk of graft rupture if you have an isolated BTB reconstruction.”
Meanwhile, Saithna said that combined reconstruction was associated with reduced overall reoperation rate, reduced risk of arthrofibrosis and reduced secondary meniscectomy rate.
“In conclusion, isolated BTB is associated with a threefold higher rate of graft failure and also non-graft rupture-related reoperations, including cyclops and secondary meniscectomy,” Saithna said.
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Saithna A, et al. Combined ACL and ALL reconstruction confers lower graft rupture rates. Presented at: Arthroscopy Association of North America Annual Meeting; May 4-6, 2023; New Orleans.
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