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Low Revision Risk In Primary Anterior Cruciate Ligament Reconstruction With Allograft In The Masters Athlete

Low Revision Risk In Primary Anterior Cruciate Ligament Reconstruction With Allograft In The Masters Athlete

Ian DeYoe Engler, MD, UNITED STATES Audrey Y. Chang, BA, UNITED STATES Janina Kaarre, MD, MSc, UNITED STATES Michael Shannon, BS, UNITED STATES Andrew Curley, MD, UNITED STATES Clair Smith, MSc, UNITED STATES Jonathan D Hughes, MD, PhD, UNITED STATES Bryson P. Lesniak, MD, UNITED STATES Volker Musahl, MD, Prof., UNITED STATES

Department of Orthopaedic Surgery, University of Pittsburgh, UPMC Freddie Fu Sports Medicine Center, Pittsburgh , Pennsylvania , UNITED STATES


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Diagnosis / Condition

Treatment / Technique

Anatomic Location

Anatomic Structure

Ligaments

ACL


Summary: Allograft tissue type, bone block versus all-soft tissue allograft, and sterilization technique had similar low (0-6%) revision rates for primary ACL reconstruction in 421 patients with mean age of 39 years. Surgeons may consider appropriately processed allograft tissue with or without bone block when indicating ACL reconstruction in the masters athlete.


Background

While there is extensive literature on use of allograft versus autograft in anterior cruciate ligament (ACL) reconstruction, there is very limited clinical evidence to guide the surgeon in choice of allograft tissue type.

Purpose

To assess the revision risk of allograft primary ACL reconstruction and to compare revision risk based on allograft tissue type and characteristics.
Study Design: Cohort study

Methods

All primary allograft ACL reconstructions from an academic institution from 2015-2019 with minimum two-year follow-up were included. Exclusion criteria included absent surgical or allograft type data. Demographics, operative details, and subsequent surgical procedures were collected. Allograft details included graft tissue type, all-soft tissue versus bone block, donor age, irradiation duration and intensity, and chemical cleansing process. Revision risk overall and by allograft characteristics were analyzed.

Results

A total of 421 patients were included with a mean age of 39 ± 12 years and a mean BMI of 30 ± 9 kg/m2. Overall revision risk was 3% (11/421) at mean follow-up of 4.9 ± 1.4 years. There was no difference detected in revision risk by allograft tissue type across Achilles (3%, 3/95), bone-patellar tendon-bone (5%, 3/58), tibialis anterior or posterior (3%, 5/164), and semitendinosus (0%, 0/46) (p=0.38). There was no difference detected in revision risk between all-soft tissue versus bone block allograft (soft tissue 2%, 6/286, vs bone block 4%, 5/135; p=0.34). Of grafts with irradiation data, all grafts were irradiated, with levels varying from 1.5-2.7 Mrad and 83% of grafts having levels of <2.0 Mrad. There was no difference detected in revision rate between low-dose irradiation and medium-to-high dose irradiation cohorts (4% vs 6%, p=0.64).

Conclusion

Allograft tissue type, bone block versus all-soft tissue allograft, and sterilization technique had similar low (0-6%) revision rates for primary ACL reconstruction in 421 patients with mean age of 39 years. Surgeons may consider appropriately processed allograft tissue with or without bone block when indicating ACL reconstruction in the masters athlete.


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