J Knee Surg 2018; 31(09): 827-833
DOI: 10.1055/s-0037-1617417
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Clinical Outcomes Following Primary Anterior Cruciate Ligament Reconstruction with Hamstring Autograft versus Planned Hybrid Graft

Matthew J. Kraeutler
1   Department of Orthopaedic Surgery, Seton Hall-Hackensack Meridian School of Medicine, South Orange, New Jersey
,
Seong H. Kim
2   Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado
,
Colin C. Brown
2   Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado
,
Darby A. Houck
2   Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado
,
Brian C. Domby
3   Department of Orthopaedics and Sports Medicine, Florida Medical Clinic, Zephyrhills, Florida
,
Kirk A. Reynolds
4   Department of Orthopaedics, Arkansas Specialty Orthopaedics, Little Rock, Arkansas
,
Eric C. McCarty
2   Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado
› Institutsangaben
Weitere Informationen

Publikationsverlauf

19. August 2017

22. November 2017

Publikationsdatum:
02. Januar 2018 (online)

Abstract

Few studies have compared outcomes between autografts versus hybrid grafts (combination of autograft and allograft) for anterior cruciate ligament reconstruction (ACLR). The purpose of this study was to compare revision rate and patient-reported outcomes following primary ACLR with a hamstring autograft versus a preoperatively planned hybrid autograft-allograft. At a minimum 2-year follow-up, patients who had undergone primary ACLR with a double-stranded semitendinosus and gracilis hamstring autograft (A) or a planned hybrid (H) graft (single-strand semitendinosus with nonirradiated peroneus longus or tibialis posterior allograft) were contacted to fill out a survey containing the Knee Injury and Osteoarthritis Outcome Score (KOOS), Subjective International Knee Documentation Committee (IKDC) score, Single Assessment Numeric Evaluation (SANE), 12-Item Short-Form Health Survey (SF-12), and visual analog scale (VAS) for activity level prior to injury and at follow-up. From this collection of patients, a matched-pair comparison was made between groups, with patients matched by gender, age at the time of surgery, and follow-up time. Revision rate at follow-up was 8.4 and 2.4% in the A and H groups, respectively (p = 0.073). A total of 148 surveys were completed (83 A, 65 H), from which 36 matched pairs were formed. Within the matched pairs, average age at surgery did not differ significantly between groups (A: 35.7 years, H: 36.0 years, p = 0.23). Time to follow-up was 4.3 and 3.7 years in the A and H groups, respectively. Patients with a hybrid graft had significantly higher KOOS Quality of Life subscores (A 69.6, H 79.2, p = 0.028), subjective IKDC scores (A 72.6, H 79.7, p = 0.031), and SANE scores (A 83.2, H 91.4, p = 0.015) at follow-up. Otherwise, no significant differences were found in patient-reported outcome scores between groups. A preoperatively planned hybrid graft, with use of a fresh-frozen, nonirradiated allograft, should be considered as a viable alternative for primary ACLR in older patients.

 
  • References

  • 1 Alvarez-Pinzon AM, Barksdale L, Krill MK, Leo BM. Hybrid graft anterior cruciate ligament reconstruction: a predictable graft for knee stabilization. Orthopedics 2015; 38 (06) e473-e476
  • 2 Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD. Knee Injury and Osteoarthritis Outcome Score (KOOS)--development of a self-administered outcome measure. J Orthop Sports Phys Ther 1998; 28 (02) 88-96
  • 3 Irrgang JJ, Anderson AF, Boland AL. , et al. Development and validation of the international knee documentation committee subjective knee form. Am J Sports Med 2001; 29 (05) 600-613
  • 4 Ware Jr J, Kosinski M, Keller SDA. A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care 1996; 34 (03) 220-233
  • 5 Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42 (02) 377-381
  • 6 Kaeding CC, Aros B, Pedroza A. , et al. Allograft versus autograft anterior cruciate ligament reconstruction: predictors of failure from a MOON prospective longitudinal cohort. Sports Health 2011; 3 (01) 73-81
  • 7 Kraeutler MJ, Bravman JT, McCarty EC. Bone-patellar tendon-bone autograft versus allograft in outcomes of anterior cruciate ligament reconstruction: a meta-analysis of 5182 patients. Am J Sports Med 2013; 41 (10) 2439-2448
  • 8 Tian S, Wang B, Liu L. , et al. Irradiated hamstring tendon allograft versus autograft for anatomic double-bundle anterior cruciate ligament reconstruction: midterm clinical outcomes. Am J Sports Med 2016; 44 (10) 2579-2588
  • 9 Burrus MT, Werner BC, Crow AJ. , et al. Increased failure rates after anterior cruciate ligament reconstruction with soft-tissue autograft-allograft hybrid grafts. Arthroscopy 2015; 31 (12) 2342-2351
  • 10 Darnley JE, Léger-St-Jean B, Pedroza AD, Flanigan DC, Kaeding CC, Magnussen RA. Anterior cruciate ligament reconstruction using a combination of autograft and allograft tendon: a MOON cohort study. Orthop J Sports Med 2016; 4 (07) 2325967116662249 . Doi: 10.1177/2325967116662249
  • 11 Li J, Wang J, Li Y, Shao D, You X, Shen Y. A prospective randomized study of anterior cruciate ligament reconstruction with autograft, γ-irradiated allograft, and hybrid graft. Arthroscopy 2015; 31 (07) 1296-1302
  • 12 Liu CT, Lu YC, Huang CH. Half-peroneus-longus-tendon graft augmentation for unqualified hamstring tendon graft of anterior cruciate ligament reconstruction. J Orthop Sci 2015; 20 (05) 854-860
  • 13 Pennock AT, Ho B, Parvanta K. , et al. Does allograft augmentation of small-diameter hamstring autograft ACL grafts reduce the incidence of graft retear?. Am J Sports Med 2017; 45 (02) 334-338
  • 14 Leo BM, Krill M, Barksdale L, Alvarez-Pinzon AM. Failure rate and clinical outcomes of anterior cruciate ligament reconstruction using autograft hamstring versus a hybrid graft. Arthroscopy 2016; 32 (11) 2357-2363
  • 15 Curran AR, Adams DJ, Gill JL, Steiner ME, Scheller AD. The biomechanical effects of low-dose irradiation on bone-patellar tendon-bone allografts. Am J Sports Med 2004; 32 (05) 1131-1135
  • 16 Guo L, Yang L, Duan XJ. , et al. Anterior cruciate ligament reconstruction with bone-patellar tendon-bone graft: comparison of autograft, fresh-frozen allograft, and γ-irradiated allograft. Arthroscopy 2012; 28 (02) 211-217
  • 17 Sun K, Tian S, Zhang J, Xia C, Zhang C, Yu T. Anterior cruciate ligament reconstruction with BPTB autograft, irradiated versus non-irradiated allograft: a prospective randomized clinical study. Knee Surg Sports Traumatol Arthrosc 2009; 17 (05) 464-474
  • 18 Conte EJ, Hyatt AE, Gatt Jr CJ, Dhawan A. Hamstring autograft size can be predicted and is a potential risk factor for anterior cruciate ligament reconstruction failure. Arthroscopy 2014; 30 (07) 882-890
  • 19 Magnussen RA, Lawrence JT, West RL, Toth AP, Taylor DC, Garrett WE. Graft size and patient age are predictors of early revision after anterior cruciate ligament reconstruction with hamstring autograft. Arthroscopy 2012; 28 (04) 526-531
  • 20 Park SY, Oh H, Park S, Lee JH, Lee SH, Yoon KH. Factors predicting hamstring tendon autograft diameters and resulting failure rates after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2013; 21 (05) 1111-1118
  • 21 Spragg L, Chen J, Mirzayan R, Love R, Maletis G. The effect of autologous hamstring graft diameter on the likelihood for revision of anterior cruciate ligament reconstruction. Am J Sports Med 2016; 44 (06) 1475-1481
  • 22 Boniello MR, Schwingler PM, Bonner JM, Robinson SP, Cotter A, Bonner KF. Impact of hamstring graft diameter on tendon strength: a biomechanical study. Arthroscopy 2015; 31 (06) 1084-1090
  • 23 Beyzadeoglu T, Akgun U, Tasdelen N, Karahan M. Prediction of semitendinosus and gracilis autograft sizes for ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2012; 20 (07) 1293-1297
  • 24 Erquicia JI, Gelber PE, Doreste JL, Pelfort X, Abat F, Monllau JC. How to improve the prediction of quadrupled semitendinosus and gracilis autograft sizes with magnetic resonance imaging and ultrasonography. Am J Sports Med 2013; 41 (08) 1857-1863
  • 25 Grawe BM, Williams PN, Burge A. , et al. Anterior cruciate ligament reconstruction with autologous hamstring: Can preoperative magnetic resonance imaging accurately predict graft diameter?. Orthop J Sports Med 2016; 4 (05) 2325967116646360 . Doi: 10.1177/2325967116646360
  • 26 Janssen RPA, van der Velden MJF, van den Besselaar M, Reijman M. Prediction of length and diameter of hamstring tendon autografts for knee ligament surgery in Caucasians. Knee Surg Sports Traumatol Arthrosc 2017; 25 (04) 1199-1204
  • 27 Kyung HS, Lee HJ, Oh CW, Hong HP. Comparison of results after anterior cruciate ligament reconstruction using a four-strand single semitendinosus or a semitendinosus and gracilis tendon. Knee Surg Sports Traumatol Arthrosc 2015; 23 (11) 3238-3243
  • 28 Sharma A, Flanigan DC, Randall K, Magnussen RA. Does gracilis preservation matter in anterior cruciate ligament reconstruction? A systematic review. Arthroscopy 2016; 32 (06) 1165-1173