Summary

The use of allografts in ACL reconstruction during bicruciate ligament surgeries is associated with a higher risk of graft failure

Abstract

Introduction

Multiligamentous knee injuries involving both the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) pose a significant challenge, often resulting in substantial knee instability and impaired daily function. Although early bicruciate ligament reconstruction has been shown to better restore knee stability and function compared to non-operative treatments, concerns remain regarding the high incidence of graft failure following surgery. This study aims to identify key factors associated with graft failure in patients undergoing combined ACL and PCL reconstruction and to evaluate the related patient-reported outcomes (PROs).

Method

We conducted a retrospective analysis of patients who underwent bicruciate (combined ACL and PCL) ligament reconstruction at our institution between 2002 and 2021, with a minimum follow-up period of two years. Graft failure was rigorously defined as either a re-tear of the graft or clinically significant laxity compromising knee stability. Clinical outcomes were evaluated using established scoring systems, including the International Knee Documentation Committee (IKDC) score, Lysholm score, Tegner activity score, and visual analog scale (VAS). Statistical analyses were performed using SPSS software, with descriptive statistics, independent samples t-tests, and Chi-square tests (with Fisher's exact test for nonparametric data) to identify patterns and associations. P-value < 0.05 was considered statistically significant.

Results

Among the 57 patients (mean age: 35.8 ± 12.1 years; 18 female and 39 male) included in the study, 9 patients (15.8%) experienced graft failure, involving a total of 11 grafts (ACL:PCL= 8:3). Clinical patient demographics did not significantly differ between the failure and non-failure groups. However, a significant association was observed between the use of allografts for ACL reconstruction and both ACL graft failure (p = 0.017) and overall graft failure across both ligaments (p = 0.004). No significant association was found between graft failure and the type of PCL graft used. Average PROs remained satisfactory, with IKDC scores averaging 80.5 ± 14.4, Lysholm scores at 84 ± 13.4, Tegner scores at 4.6 ± 1.8, and VAS scores at 1.7 ± 1.9. There was no significant difference in PROs based on graft selection for ACL reconstruction in patients undergoing bicruciate ligament reconstruction.

Discussion

This study highlights a 15.8% graft failure rate among patients undergoing bicruciate ligament reconstruction, particularly affecting ACL reconstructions. The significant correlation between ACL graft failure and the use of allografts suggests that autografts may offer greater reliability in maintaining graft integrity over time. These findings emphasize the critical importance of graft selection in enhancing long-term outcomes and reducing the risk of failure in bicruciate ligament reconstructions.

Conclusion

Our findings indicate that the use of allografts in ACL reconstruction during bicruciate ligament surgeries is associated with a higher risk of graft failure. To improve graft integrity and reduce failure rates, autografts are recommended for ACL reconstruction in cases involving combined ligament injuries.