Graft Choice in ACL reconstructions - The Place of Allografts

[jamiec123]

Well good luck with the op Tony and make sure u post as soon as u can to let us know how it went!!

Jay

[tony1233]

Thanks Jay,

getting excited and nervous now, o nly one more night of sleep, if you can even call it that at this point. I know I havenèt really slept well in the last few nights so Im sure I wont sleep tomorrow night at all

I plan on trying to post wednesday evening, not 100% sure how well that will go though LOL please forgive if nothing makes sense.

Tony

[ACLDad]

I am new hear.  My 18yr old college freshman tore her acl a month ago.  Her doctor did a anterior tibial allograft.  I am not sure of the attachment method he used.  Everything happened so fast we had about 10 days from the tear to the surgery.  Now we hear all of these horror stories about allograft failures happening all the time.  Am just looking for some reassurance here.  I want to thank Steve for his excellent advice.  It would seem that there is no need to try to return as quickly as possible but rather resign yourself to 8 to 12 months to let the graft (regardless of allo or auto) fully vascularize, and at her age the chances of that occuring fully are good right.

Tony - ACLDad

[drmark]

I don't think the "allograft is where its at"
Finally, a multicenter study, with a minimum of 6 years followup, and Level 2 evidence.  (Level 1 evidence may not be possible to procure considering it would be unethical to not inform patients what was implanted in them)

Sorry to bust the bubble.........

http://ajs.sagepub.com/content/39/2/348.abstract

[sherwooa]

So that MOON study is definitely interesting, and I can't see the full text, but I have read elsewhere (http://www.orthosupersite.com/view.aspx?rid=32440) that this study only compares tibialis allografts with hamstring autografts.  Given that, it doesn't seem scientifically valid to say that all autografts are superior to all allografts, especially since many allografts now are done with B-P-B instead of free tissue.  Thoughts?

[drmark]

If you are interested, you can email me at sandersclinc@comcast.net and I will forward to you the entire PDf.  Many different autografts and allograft types were used in the study.  For purposes of analysis the autografts were grouped together and the allografts were grouped together. 

In my not so humble opinion, the hopes, prayers, and desires of the immediate world will never be answered that dead tissues taken from a dead person, soaked in caustic stuff to kill the  "cooties", or worse irradiated, can ever work as good as living tissue taken from the person who is receiving that same tissue.  Even as we continually grasp at straws in order to show it.  When will nutrasweet and skim milk be shown to make a dessert as tasty as the one made with real sugar and real cream?
Mark Sanders MD FACS

[nathanappasamy]

Hello everybody,



I am looking for people who have had Anterior Cruciate Ligament Reconstruction on at least one of their knees to take part in a study focusing on the effects and impact of ACL Reconstruction surgery on someone's Athletic Identity.



As someone who has had multiple knee surgeries, I am very interested in the psychological effects of such mobility impairing surgery and do not believe there has been enough research undertaken in the field. The hope for this study (which is part of an MSc in Psychology) is to provide a greater insight into the short term and longterm effects of ACL reconstruction on a person's sense of Self and Identity. If you have had ACL reconstruction surgery and would like your experiences to count towards our understanding within the field, your contribution is of value.



If you would like to take part in the study (which should take no longer than 15 minutes to complete), please click on the below link for further information. Alternatively, copy and paste the link directly into the address bar of your browser. If you know of anyone who may also be interested, then I would be grateful if you would notify them of this opportunity to participate:



https://www.surveymonkey.com/s/NNAquestionnaire



If you have any questions (which are not answered by the information sheet, after clicking on the link), please contact me by email at u1037913@uel.ac.uk, and I'll be happy to help.



Nathan Appasamy

[sherwooa]

Thought I'd post some of the recent research on auto vs. allo, though it adds to the confusion a bit.  Though not as big as the MOON study, here is a recent prospective, multicenter cohort study with Level II evidence that shows no statistically significant differences between the two types of grafts:

http://www.ncbi.nlm.nih.gov/pubmed/21694588

"Abstract

OBJECTIVE:
To compare the clinical outcomes after anterior cruciate ligament (ACL) reconstruction with bone-patellar tendon-bone autograft (BPTBAu), BPTB allograft (BPTBAll), or hamstring (semitendinosus-gracilis) tendon autograft (HTAu), performing bone drilling with same methods in terms of transtibial drilling, orientation, positioning, and width of femoral and tibial tunnels.
DESIGN:
Multicenter prospective cohort study (level of evidence II).
SETTING:
Departments of Orthopedic Surgery of Centro Médico Teknon (Barcelona, Spain) Clínica Universitaria de Navarra (Navarra, Spain), and Clínica FREMAP (Gijón, Spain).
PATIENTS:
All patients with ACL tears attending 3 different institutions between January 2004 and June 2006 were approached for eligibility and those meeting inclusion criteria finally participated in this study.
INTERVENTION:
Each institution was assigned to perform a specific surgical technique. Patients were prospectively followed after undergoing ACL reconstruction with BPTBAu, BPTBAll, or HTAu, with a minimum follow-up of 24 months.
MAIN OUTCOME MEASURES:
Included knee laxity and International Knee Documentation Committee (IKDC) score. Knee laxity was assessed with the KT-1000 arthrometer (evaluated with neutral and external rotation positions) and both Lachman and pivot shift tests. Additional outcomes included main symptoms (anterior knee pain, swelling, crepitation, and instability), disturbance in knee sensation, visual analogue scale (VAS) for satisfaction with surgery, range of motion (ROM), and isokinetic knee strength.
RESULTS:
There were no significant differences among the 3 groups for any of the clinical outcomes, except for a slightly greater KT-1000-measured knee laxity in external rotation in the BPTBAu compared with the other groups. All patients demonstrated grade A or B of the IKDC. The mean VAS for satisfaction with surgery in all patients was 8.5.
CONCLUSIONS:
The selection of the surgical technique for ACL reconstruction may be based on the surgeon's preferences."