Summary

Allograft ACLR is a valid treatment option for functional knee instability in the absence of multiple risk factors for reinjury, including not returning to high-risk sports.

Abstract

Purpose

The primary purpose of this study was to assess the clinical, functional and disease-specific quality-of-life outcomes following primary allograft anterior cruciate ligament reconstruction (ACLR).

Methods

A cohort of 206 patients who underwent ACLR surgery with allograft between 2010 and 2015 were included. Demographic and clinical information including age, sex, body mass index (BMI) and generalized joint hypermobility (Beighton score) were collected pre-operatively. Functional tests including single-leg balance and the 4 single-leg hop tests were used to assess limb symmetry indices (LSI) at 2-years. Patients completed the ACL-QoL questionnaire pre-operatively and at 1- and 2-years post-operative. Descriptive statistics were used to evaluate patient demographics, intra-operative surgical findings, ACL graft rupture rate, LSI, and ACL-QoL scores. Differences in ACL-QoL scores from pre- to post-operative were assessed using a one-way ANOVA.

Results

The cohort included 110 males (53.4%) and 96 females (46.6%), with a mean age of 43.4 years (SD ±9.7). The mean BMI of the cohort was 25.9 (SD ±4.0), and a positive Beighton score was present in 23%. Intra-operative assessment demonstrated 162 patients (78.6%) with evidence of meniscal injury, and 112 patients (54.4%) with evidence of chondral injury. Mean graft diameter was 8.1mm. At 2-years post-operative 179 patients had completed follow-up (86.9%) and 10 graft failures were assessed (5.6%).

Functional testing comparing the operative to non-operative limbs revealed a mean LSI of 103% on the single-leg balance test at 2-years. The 4 single-leg hop tests demonstrated an LSI of 98.3%. Mean ACL-QoL scores prior to surgery were 27.8/100 (SD ±14.5), with evidence of statistically significant increases to 69.6 (SD ±20.9) at 1-year, and 74.8 (SD ±20.8) at 2-years post-operative (p<0.001).

Conclusion

Two-years after primary allograft ACL reconstruction, 5.5% of patients demonstrated ACL graft failure. Overall functional performance on single-limb balance and hop-tests demonstrated excellent LSI at 2-years post-operative. ACL-QoL scores improved statistically significantly from pre-operative to 1-year and 2-years post-operative. In this select patient cohort, allograft ACLR was a valid treatment option for functional knee instability in the absence of multiple risk factors for reinjury, including not returning to high-risk sports.