In the young (< 35 years old), active patient cohort, there is strong evidence to support the use of an autograft for ACL reconstruction. Purpose: Studies have suggested good long-term success rates … AUTOGRAFT VS ALLOGRAFT IN ADOLESCENTS Anterior cruciate ligament (ACL) reconstruction in adolescents is commonly performed using hamstring tendon autografts [13]. Revision Rates After Anterior Cruciate Ligament Reconstruction Using BoneePatellar TendoneBone Allograft or Autograft in a Population 25 Years Old and Younger F. Alan Barber, M.D., Courtney H. Cowden III, M.D., and Eric J The most common reason for an ACL graft to fail is due to technical issues with the original surgery. Autograft vs. Allograft in ACL Reconstruction Surgeons and patients have two main choices for their grafts: autograft and allograft. Another study 4 that involved 788 ACL autograft and 228 ACL allograft patients reported a significant difference in the reinjury rates in patients under the age of 25 (9% and 25%, respectively; p < .0001). One of the main concerns surrounding allograft reconstruction surgery is young or active patients who seem to have a higher re-tear rate with this type of surgery. maximum load to failure is 2600 Newtons (intact ACL is 1725 Newtons) complications. The mechanism of ACL graft failure is multifactorial. It is believed that the bone-patella tendon-bone graft has a stronger fixation because of the bone plugs that can incorporate into the femoral and tibial tunnels by 6-8 weeks after surgery. Foster et al, 9 in their review of level 1 and 2 studies, calculated graft failure rates of 4.7% and 8.2% for autograft and allograft tissues, respectively. There can be many reasons for an ACL reconstruction failure. One of the known reasons for ACL allograft failure is premature return to sporting activities [2]. Although only 10% of grafts fail, this is still a large number of cases. Author information: (1)Department of Orthopaedic Surgery Sports Health, Orthopaedic and Rheumatologic Center, Cleveland Clinic Florida, Weston, Florida, U.S.A.. 10 When comparing patients younger and older than 25, failure rates of 35 and 13% were reported respectively. In one study by Singhal et al. The autologous bone-patellar tendon-bone autograft has long been the graft of choice for reconstruction of the ligament. Cost-effectiveness analysis A decision tree model in Microsoft Excel® was considered the most appropriate choice as ACL reconstruction is usually successful and most patients return to a functioning knee after reconstructive surgery. Failure rates of ACL reconstruction are difficult to assess because the definition of failure is not absolute, but many clinical outcome studies place the failure rate between 5 and 20% [1-5]. [] found revision ACL reconstruction had failure rates similar to autograft or allograft reconstruction. associated with age < 20 years and graft size < 8mm. The initial graft tensile strength of bone-patellar tendon-bone autograft is 2977 N with a stiffness of 620 N/mm. Allograft vs. Autograft •Pallis, AJSM 2012 –Prospective cohort of 122 ACLR in West Point cadets –Avg 2 yr f/u –Failure rate measured as need for revision ACLR –Results: •BTB autograft: 11% failure rate •HS autograft: 13% failure To me, the gold standard of ACL reconstruction is the patella tendon autograft and should be considered for most people in their teens, 20’s and for many in their 30’s or 40’s. An autograft is tissue taken from a patient’s own body. Animal studies have demonstrated slower incorporation of allograft tissue and demonstrated decreased failure loads for allografts up to one year following reconstruction [ 12 ]. ACLR_using_patellar_tendon_allograft_an_age-dependant_outcome_evaluation_p8.pdf Allograft_vs_Autograft_infection_rates A large study looking at infection rates after allograft use did not show any increased rates of infection. A Meta-analysis of Patellar Tendon Autograft Versus Patellar Tendon Allograft in Anterior Cruciate Ligament Reconstruction Aaron J. Krych, M.D., Jeffrey D. Jackson, M.D., Tanya L. Hoskin, M.S., and Diane L. Dahm, M.D. Methods: A retrospective chart review of primary ACL reconstructions performed by 4 sports fellowship trained surgeons at a single institution between 2010-2016 identified 23 patients with hamstring autografts and allograft … In stark contrast, the group that underwent an ACL reconstruction with a cadaver (Allograft) ACL graft had a failure rate of 26%. 13,15,17,18,22,29,30 They concluded that there was no statistical difference in Increased activity level and the use of allograft tissue in ACL reconstruction have been associated with increased graft failure rates []. The purpose of this study was to investigate differences in failure rates and functional outcomes between BPTB autograft and allograft ACL reconstruction in patients <30 years of age. An ACL reconstruction is one of the most common surgical procedures in orthopaedic surgey. It is often but not always a tendon—tissue Hamstring Autograft versus Patellar Tendon Autograft for ACL Reconstruction: Is There a Difference in Graft Failure Rate? New research from Canada has found that when it comes to anterior cruciate ligament (ACL) repair in younger athletes, those patients receiving their own tissue fare MUCH better. It has higher tensile load and stiffness (2977 N and 620 N/mm, respectively) compared with the native ACL (2160 N and 242 N/mm, respectively). Failure Rates of 5-Strand and 6-Strand vs Quadrupled Hamstring Autograft ACL Reconstruction: A Comparative Study of 413 Patients With a Minimum 2-Year Follow-up Ahmed Khalil Attia, MD , Hazem Nasef, MD , Kareem Hussein ElSweify, MD , Mohammed A. Adam, MD , Faris AbuShaaban, MD , and Kariyal Arun, MD, FRCS Re-tear rates are higher than quad tendon ACL grafts and more likely for female patients, with up to 20% re-tearing in female athletes. evaluating outcomes of ACL reconstruction with anterior tibialis allograft, a failure rate of 23.1% was reported. This study was the first to A Meta-analysis of 47,613 Patients Samuelsen, Brian T. MD, MBA 1; Webster, Kate E. PhD 2; Johnson, Nick R. BS 1; Hewett, Timothy E. PhD 1; Krych, Aaron J. MD 1,3,a Allograft vs. Autograft in Orthopedic Surgery Using Your Own Tissue vs. The graft has been processed to remove tendon cells which are known to be responsible for transplant rejection. the chance of the graft Purpose: To assess clinical outcomes and failure rates of an adult population who undergo augmentation with allograft compared to patients with hamstring autograft alone. However, new data in 2012 suggest that allograft should be avoided in athletic patients under the age of 25 years due to an unacceptably high failure rate in this group. re-rupture. Results Both autograft and allograft reconstruction are highly effective. Although there are several allograft and autograft options available for ACL reconstruction, Owens noted a higher failure rate when allografts are used in young athletes. Although failure of ACL reconstruction is not limited to cases of persistent or recurrent instability [ 3 , 6 , 7 ], instability is the most frequent reason for revision ACL reconstruction. However, the patients who underwent allograft ACL reconstruction returned to normal sport activity earlier than the patients who underwent autograft reconstruction (11.7 ± 10.3 vs … Allograft-autograft hybrid hamstring ACL grafts fail or become structurally compromised at a higher rate than matched autograft hamstring controls. The results of this research showed that people who had ACL surgery with a hamstring ACL graft from their own body had an 8% failure rate at 10 year follow up. Allograft Augmentation of Hamstring ACL Autografts is Associated with Increased Graft Failure S. Clifton Willimon, MD Michael T. Busch, MD Melissa A. Christino, MD Children’s Healthcare of Atlanta Background • Rates of second Hamstring autograft – Potential post-surgical pain around the harvest site. Autograft versus Allograft for ACL Reconstruction Allografts Have Higher Overall Failure Rates Although some papers have shown identical autograft versus allograft failure rates, our Meta-analysis published in the July 2007, Knee Surgery, Sports Traumatology, Arthroscopy showed that the literature has found there to be an overall three times higher failure rate for allografts versus autografts. Whereas, Mohan et al. Allograft – Higher failure rates and reports of graft stretching over time. The failure rate of hybrid ACL grafts was 13.8% (4 of 29 patients). patella fracture (usually postop during rehab), patellar tendon rupture. Methods All patients 17-30 years of age who underwent a BPTB allograft/autograft ACLR with bioabsorbable interference screws (ConMed Linvatec, Largo, FL) by a single surgeon (1995-2017) were included. The study, published online in Sports Health: A Multidisciplinary Approach, utilized a systematic review of 1, 016 young, very active patients to compare ACL failure rates using allograft versus autograft tissues. Leo BM(1), Krill M(2), Barksdale L(3), Alvarez-Pinzon AM(3). Allograft tissue is associated with a significant higher failure rate (ie. Background: An autograft has traditionally been the gold standard for anterior cruciate ligament reconstruction (ACLR), but the use of allograft tissue has increased in recent years. Failure Rate and Clinical Outcomes of Anterior Cruciate Ligament Reconstruction Using Autograft Hamstring Versus a Hybrid Graft. the highest incidence of anterior knee pain (up to 10-30%) and kneeling pain.

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