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Fig. 1 Prepared bone-patellar tendon-bone graftReproduced from Matava MJ. Complications of Anterior Cruciate Ligament Reconstruction: Graft Issues. Instr Course Lect 2006;55:489-96.

AAOS Now

Published 11/1/2018
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Maureen Leahy

Study Compares Tendon Autografts for ACL Reconstruction in Young Females

Research presented during the American Orthopaedic Society for Sports Medicine 2018 Annual Meeting found that the use of bone-patellar tendon-bone (BTB) autograft for anterior cruciate ligament (ACL) reconstruction in females 15–20 years old yielded better outcomes than quadruple hamstring (HS) autograft. The study was presented by Kevin B. Freedman, MD, of Rothman Orthopaedics in Philadelphia.

Dr. Freedman noted that both female sex and younger age have been shown in the literature to be risk factors for graft failure in ACL reconstruction, and the optimal graft choice for this high-risk population remains unknown.

Retrospective review

The researchers reviewed the records of 256 female patients ages 15–25 years who had undergone primary ACL reconstruction with either BTB (n = 175) or HS (n = 81) autograft at a single institution between January 2012 and May 2015. Patients with a history of ACL injury in either knee or multiligament injury were excluded. Patients were subdivided into two age groups: 15–20 years and 20–25 years.

All ACL reconstructions utilizing BTB were performed with interference screw fixation. Surgeries utilizing HS were performed with interference screw fixation (63 percent), femoral suspension and tibial screw (27 percent), or femoral cross-pins and tibial screw (10 percent). Due to inadequate size, 22.2 percent of HS autografts were augmented with allograft.

The occurrence of chondral, meniscal, or ligamentous injury to the ipsilateral or contralateral knee in the first two years following ACL reconstruction was documented.

Fig. 1 Prepared bone-patellar tendon-bone graftReproduced from Matava MJ. Complications of Anterior Cruciate Ligament Reconstruction: Graft Issues. Instr Course Lect 2006;55:489-96.
Fig. 2 Hamstring graftReproduced from Matava MJ. Complications of Anterior Cruciate Ligament Reconstruction: Graft Issues. Instr Course Lect 2006;55:489-96.

BTB resulted in fewer retears

The researchers found no difference in average age or follow-up between the BTB and HS groups. Most patients in both groups were 15–20 years old (BTB, 80 percent; HS, 77.8 percent).

The overall graft retear rate was 6.9 percent in BTB patients and 12.3 percent in HS patients; contralateral ACL tear occurred in 7.4 percent of BTB patients and 6.2 percent of HS patients. Seventy-five percent of BTB and 100 percent of HS graft retears occurred in females aged 15–20 years, with a significantly lower rate of BTB graft retears (6.4 percent) compared to HS graft retears (15.9 percent). This difference was not observed in patients aged 20–25 years.

Allograft augmentation was used in four of the 10 HS graft retears. The authors noted a higher risk of failure with HS augmentation with allograft compared to that of HS autograft alone; however, the difference was not significant.

“Higher rates of retears were seen in our youngest patients using HS autografts,” said Dr. Freedman. “More research is needed to better understand female ACL injury and what the best methods for repair are in our youngest patients who are at highest risk of reinjury. We hope that our research will add to the literature and treatment prospects for this complex problem.”

Dr. Freedman’s coauthors of “Anterior Cruciate Ligament Reconstruction in Young Females: Patellar versus Hamstring Tendon Autografts” are Hytham Salem; Vahe Varzhapeyan; Nimit Patel, MD; Zaira Chaudhry; Christopher C. Dodson, MD; and Fotios P. Tjoumakaris, MD.

Maureen Leahy is a freelance writer and editor for AAOS Now.