Current Trends With ACL Reconstruction

In a recently published paper in the Orthopaedic Jourmal of Sports Medicine- Safer Return to Play After Anterior Cruciate Ligament Reconstruction: Evaluation of a Return-to-Play Checklist re-injury rates were calculated for knees after ACL reconstruction looking at relative risk for knees that passed return to sports criteria and those that did not. 7 criteria were used for the study and to pass a total of 6 out of 7 criteria needed to be met.

Of 222 knees determined to be eligible for the study 146 ‘passed’ the return to sports criteria and 38 did not pass. Of the 222 knees a total of 34 knees suffered a re-injury that required repeat surgery. From the group of 34 knees that required re-operation 24/146 or 16.4% were from the group that passed the return to sports criteria and 10/38 or 26.3% from the group that did not pass. Therefore on this basis there was a much higher rate overall of knee injury in the group of patients that were unable to pass the return to sports criteria . It would therefore be prudent to recommend that to reduce the risk for re-injury of the same or contra lateral knee after ACL reconstruction all patients should not only complete a comprehensive rehabilitation program but also pass formal objective and subjective testing criteria.

Another interesting finding was that of the 34 re-injuries 31 (91.1%) were in knees that had an autograft and only 3 (8.8% ) were in knees that had an allograft reconstruction.

This is also a very significant finding since there is ongoing debate between graft types and whether to use your own tissue (autograft) or donor tissue (allograft). The benefits of using donor tissue (allograft ) is substantial including shorter surgery time, better cosmetics with smaller scars, less pain after surgery, quicker recovery and reduced risk of complications from graft harvesting such as patella tendon rupture, anterior knee pain etc. The use of allograft has been criticized on the basis of some studies suggesting a higher rate of re-tearing however this was certainly not the finding of this study and in fact appears to show an opposite trend whereby autograft appears to put knees at a substantially higher risk for knee re-injury as compared to allograft. Using this study as well as others that favorably compare allograft to autograft in terms of risk of tear recurrence one could make that argument strongly in favor of allograft for most ACL reconstructions especially in consideration of the myriad of additional benefits that allograft has over autograft for ACL reconstruction.

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