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Association Between Graft Choice and 6-Year Outcomes of Revision Anterior Cruciate Ligament Reconstruction in the MARS Cohort.
Wright, Rick W; Huston, Laura J; Haas, Amanda K; Pennings, Jacquelyn S; Allen, Christina R; Cooper, Daniel E; DeBerardino, Thomas M; Dunn, Warren R; Lantz, Brett Brick A; Spindler, Kurt P; Stuart, Michael J; Albright, John P; Amendola, Annunziato Ned; Andrish, Jack T; Annunziata, Christopher C; Arciero, Robert A; Bach, Bernard R; Baker, Champ L; Bartolozzi, Arthur R; Baumgarten, Keith M; Bechler, Jeffery R; Berg, Jeffrey H; Bernas, Geoffrey A; Brockmeier, Stephen F; Brophy, Robert H; Bush-Joseph, Charles A; Brad Butler V, J; Campbell, John D; Carey, James L; Carpenter, James E; Cole, Brian J; Cooper, Jonathan M; Cox, Charles L; Creighton, R Alexander; Dahm, Diane L; David, Tal S; Flanigan, David C; Frederick, Robert W; Ganley, Theodore J; Garofoli, Elizabeth A; Gatt, Charles J; Gecha, Steven R; Giffin, James Robert; Hame, Sharon L; Hannafin, Jo A; Harner, Christopher D; Harris, Norman Lindsay; Hechtman, Keith S; Hershman, Elliott B; Hoellrich, Rudolf G.
Afiliação
  • Wright RW; Vanderbilt University, Nashville, Tennessee, USA.
  • Huston LJ; Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA.
  • Haas AK; Vanderbilt University, Nashville, Tennessee, USA.
  • Pennings JS; Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA.
  • Allen CR; Washington University in Saint Louis, Saint Louis, Missouri, USA.
  • Cooper DE; Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA.
  • DeBerardino TM; Vanderbilt University, Nashville, Tennessee, USA.
  • Dunn WR; Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA.
  • Lantz BBA; Yale University, New Haven, Connecticut, USA.
  • Spindler KP; Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA.
  • Stuart MJ; W.B. Carrell Memorial Clinic, Dallas, Texas, USA.
  • Albright JP; Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA.
  • Amendola AN; The San Antonio Orthopaedic Group, San Antonio, Texas, USA.
  • Andrish JT; Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA.
  • Annunziata CC; Texas Orthopedic Hospital, Houston, Texas, USA.
  • Arciero RA; Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA.
  • Bach BR; Slocum Research and Education Foundation, Eugene, Oregon, USA.
  • Baker CL; Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA.
  • Bartolozzi AR; Cleveland Clinic, Cleveland, Ohio, USA.
  • Baumgarten KM; Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA.
  • Bechler JR; Mayo Clinic, Rochester, Minnesota, USA.
  • Berg JH; Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA.
  • Bernas GA; University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
  • Brockmeier SF; Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA.
  • Brophy RH; Duke University, Durham, North Carolina, USA.
  • Bush-Joseph CA; Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA.
  • Brad Butler V J; Cleveland Clinic, Cleveland, Ohio, USA.
  • Campbell JD; Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA.
  • Carey JL; Commonwealth Orthopaedics & Rehabilitation, Arlington, Virginia, USA.
  • Carpenter JE; Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA.
  • Cole BJ; University of Connecticut Health Center, Farmington, Connecticut, USA.
  • Cooper JM; Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA.
  • Cox CL; Rush University Medical Center, Chicago, Illinois, USA.
  • Creighton RA; Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA.
  • Dahm DL; The Hughston Clinic, Columbus, Georgia, USA.
  • David TS; Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA.
  • Flanigan DC; 3B Orthopaedics, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA.
  • Frederick RW; Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA.
  • Ganley TJ; Orthopedic Institute, Sioux Falls, South Dakota, USA.
  • Garofoli EA; Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA.
  • Gatt CJ; University Orthopaedic Associates LLC, Princeton, New Jersey, USA.
  • Gecha SR; Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA.
  • Giffin JR; Town Center Orthopaedic Associates, Reston, Virginia, USA.
  • Hame SL; Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA.
  • Hannafin JA; State University of New York at Buffalo, Buffalo, New York, USA.
  • Harner CD; Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA.
  • Harris NL; University of Virginia, Charlottesville, Virginia, USA.
  • Hechtman KS; Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA.
  • Hershman EB; Washington University in Saint Louis, Saint Louis, Missouri, USA.
  • Hoellrich RG; Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Am J Sports Med ; 49(10): 2589-2598, 2021 08.
Article em En | MEDLINE | ID: mdl-34260326
ABSTRACT

BACKGROUND:

Although graft choice may be limited in the revision setting based on previously used grafts, most surgeons believe that graft choice for anterior cruciate ligament (ACL) reconstruction is an important factor related to outcome.

HYPOTHESIS:

In the ACL revision setting, there would be no difference between autograft and allograft in rerupture rate and patient-reported outcomes (PROs) at 6-year follow-up. STUDY

DESIGN:

Cohort study; Level of evidence, 2.

METHODS:

Patients who had revision surgery were identified and prospectively enrolled in this cohort study by 83 surgeons over 52 sites. Data collected included baseline characteristics, surgical technique and pathology, and a series of validated PRO measures. Patients were followed up at 6 years and asked to complete the identical set of PRO instruments. Incidence of additional surgery and reoperation because of graft failure were also recorded. Multivariable regression models were used to determine the predictors (risk factors) of PROs, graft rerupture, and reoperation at 6 years after revision surgery.

RESULTS:

A total of 1234 patients including 716 (58%) men were enrolled. A total of 325 (26%) underwent revision using a bone-patellar tendon-bone (BTB) autograft; 251 (20%), soft tissue autograft; 289 (23%), BTB allograft; 302 (25%), soft tissue allograft; and 67 (5%), other graft. Questionnaires and telephone follow-up for subsequent surgery information were obtained for 809 (66%) patients, while telephone follow-up was only obtained for an additional 128 patients for the total follow-up on 949 (77%) patients. Graft choice was a significant predictor of 6-year Marx Activity Rating Scale scores (P = .024). Specifically, patients who received a BTB autograft for revision reconstruction had higher activity levels than did patients who received a BTB allograft (odds ratio [OR], 1.92; 95% CI, 1.25-2.94). Graft rerupture was reported in 5.8% (55/949) of patients by their 6-year follow-up 3.5% (16/455) of patients with autografts and 8.4% (37/441) of patients with allografts. Use of a BTB autograft for revision resulted in patients being 4.2 times less likely to sustain a subsequent graft rupture than if a BTB allograft were utilized (P = .011; 95% CI, 1.56-11.27). No significant differences were found in graft rerupture rates between BTB autograft and soft tissue autografts (P = .87) or between BTB autografts and soft tissue allografts (P = .36). Use of an autograft was found to be a significant predictor of having fewer reoperations within 6 years compared with using an allograft (P = .010; OR, 0.56; 95% CI, 0.36-0.87).

CONCLUSION:

BTB and soft tissue autografts had a decreased risk in graft rerupture compared with BTB allografts. BTB autografts were associated with higher activity level than were BTB allografts at 6 years after revision reconstruction. Surgeons and patients should consider this information when choosing a graft for revision ACL reconstruction.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Reconstrução do Ligamento Cruzado Anterior / Lesões do Ligamento Cruzado Anterior Tipo de estudo: Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Humans / Male Idioma: En Ano de publicação: 2021 Tipo de documento: Article
Texto completo
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Reconstrução do Ligamento Cruzado Anterior / Lesões do Ligamento Cruzado Anterior Tipo de estudo: Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Humans / Male Idioma: En Ano de publicação: 2021 Tipo de documento: Article