Sports Medicine Research: In the Lab & In the Field: Young and Active = Lean Towards Autograft (Sports Med Res)


Thursday, October 12, 2017

Young and Active = Lean Towards Autograft

Change in Anterior Cruciate Ligament Graft Choice and Outcomes Over Time

Kaeding CC, Pedrosa AD, Reinke EK, Huston LJ, Hewett TE, Flanigan DC, MOON Knee Group, & Spinder KP. Arthroscopy. 2017; Online Ahead of Print July 24, 2017.  

Take Home Message: Younger and highly active participants may be more appropriately advised to have an autograft for anterior cruciate reconstruction over an allograft. 

Graft choice for an anterior cruciate ligament (ACL) reconstruction remains debatable for short- and long-term health after an ACL injury.  Generally speaking, risk of reinjury is high after ACL reconstruction, but it remains unclear as to what role graft choice plays in this risk and how graft choices and retear rates have changed over time at 7 clinical sites (across 17 surgeons).  Hence, the authors studied graft selection and failure rates from 2002 to 2008. The researchers followed about 2500 patients 2 years after an ACL reconstruction.  Almost 5% of patients had an ipsilateral graft retear. Overall, patients with an allograft, younger age, or higher activity level were more likely to tear a graft. Over time, the typical person getting an allograft became older (2002: 31 years, 2007: 40 years) and less active. Meanwhile, the typical person receiving a hamstring autograft became younger (2002: 28 years, 2007: 25.5 years). These changes corresponded to a 68% decrease in the frequency of retears among people getting an allograft (2002: 11.7% to 2007: 3.7%).   

This study demonstrates that as these surgeons became more aware of the risk of retear with allografts among young active patients they changed their practice to offer allografts primarily to older and less active individuals, which corresponded to less allograft retears. This is a nice example of how epidemiological research can change clinical practice. Knowing risk factors, clinicians can change their recommendations. In this case, they changed recommendations of graft choice based on risk factors for subsequent ACL graft failure.  If you are consulting a younger or extremely active participant – it would appear that an autograft is a better choice given the risk of retear information in this large study.  It would be interesting to compare what patient perceptions are of pain, symptoms, and function based on age, graft choice, and physical activity levels.  It would also be interesting to see how these people progressed in regards to long-term disability, radiographic changes of osteoarthritis, and physical activity changes.  Overall, clinicians should use epidemiological studies to help inform their recommendations and how they educate patients.  For example, a younger patient who is very active might be best advised to get an autograft. 

Questions for Discussion:  What do you tell your patients when they are getting ready for ACL surgery?

Written by: Nicole Cattano
Reviewed by: Jeffrey Driban

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