Whats New In Sports Medicine

Anterior Cruciate Ligament Substitutes … Under 40 go for Hamstrings Over Allograft BTB

The most commonly used grafts are bone-patellar tendon-bone and hamstring autografts. The improvements in fixation devices for soft-tissue grafts have popularized the use of hamstring autografts in recent years; many surgeons base their graft selection on minimizing harvest-site complications. There are substantial complications in association with the use of bone-patellar tendon-bone autograft, including anterior knee pain, pain with kneeling, loss of extension, and poorer recovery of quadriceps strength.

The use of hamstring autograft avoids these complications but has been reported to result in weakness of knee flexion and internal rotation, which may be crucial for certain athletes who rely on these important hamstring functions for optimum performance.

Sensory deficits resulting from injury to branches of the saphenous nerve during hamstring harvest have been reported. It has been well documented that the hamstring tendons regenerate, but the function of regenerated tendons has been called into question as the tendon often heals in a non-anatomic position. Tiger Woods had a hamstring graft substitute in 2009

To completely eliminate harvest-site morbidity, the use of allograft for primary reconstruction is becoming increasingly popular. The use of allograft in revision settings and multiple-ligament reconstructions will continue to be necessary as autologous tissue may not be available in these situations.

A New study , presented at the American Orthopaedic Society for Sports Medicine 2008 Annual Meeting, found that because of the almost 24% failure rate, the use of cadaver replacement ligaments might not be the best choice for young athletic patients. The older group’s failure rate was 2.4%. So although there are obvious benefits to using the cadaver ligament, such as avoiding a second surgical site on the patient, a quicker return to work, and less postoperative pain, for a young patient who is very active, it may not be the right choice.

A article in Arthroscopy in 2009? compared, 156 (76 in the autograft group and 80 in the allograft group) were available for full evaluation. Evaluations included a detailed history, physical examination, functional knee ligament testing, KT-2000 arthrometer testing (MEDmetric, San Diego, CA), The mean follow-up was 5.6 years for both groups.

There were no statistically significant differences according to evaluations of outcome between the 2 groups except that patients in the allograft group had a shorter operation time and longer fever time postoperatively compared with the autograft group.

The postoperative infection rates were 0% and 1.25% for the autograft group and allograft group, respectively. There was a significant difference (P < .05) in the development of osteoarthritis between the operated knee in comparison to the contralateral knee according to radiographs.

However, no significant difference was found between the 2 groups at the final follow-up examination . CONCLUSIONS: Both groups of patients achieved almost the same satisfactory outcomes after a mean of 5.6 years of follow-up. Allograft is a reasonable alternative to autograft for ACL reconstruction.

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