in Anterior Cruciate Ligament Graft Choice and Outcomes Over Time
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
for Discussion:  What do you tell your patients when they are getting ready for ACL surgery?
by: Nicole Cattano
by: Jeffrey Driban