With an estimated 300,000 anterior cruciate ligament (ACL) tears occuring each year in the United States, choosing the best replacement ligament for surgery is one key to success. A study released at the 2008 American Orthopaedic Society for Sports Medicine's Annual Meeting, found that, with a failure rate of almost 24 percent, the use of cadaver replacement ligaments (e.g. allografts) may not be the best choice for young, athletic patients.
"Choosing a replacement ligament, whether it comes from a cadaver or the patient's own tissue (e.g. autograft) is a decision that must be made by the surgeon and patient," said co-author Kurre Luber, MD, orthopedic surgery fellow at Mississippi Sports Medicine and Orthopaedic Center. "This study found a very high failure rate in patients 40 years and younger with high activity levels in ACL-dependent sports like tennis, basketball, soccer and downhill skiing. Certainly, it would be naïve to think that only the graft selection led to these failures, we also need to look at surgical technique (single versus double bundle). Better outcome measures also need to be developed. However, this study definitely raises questions about the validity of using cadaver tissue in this patient subgroup."
The ACL is one of the major stabilizing ligaments of the knee. Located in the center of the knee joint, it runs from the thigh bone to the shin bone through the center of the knee. Typically, tearing the ACL occurs with a sudden direction change. To repair a torn ACL, a surgeon replaces the damaged ligament with a new one, either from a cadaver or the patient's own body. Typically, either the patellar-tendon bone or the hamstring tendons is used.
In the study, 64 patients, 40 years old or younger with high activity levels who had ACL reconstruction with a cadaver replacement ligament, were followed for a minimum of two years. ACL reconstruction failure was defined as requiring a second reconstruction due to injury or graft failure or poor scores on a combination of orthopaedic outcome measure tests. The study found that 15 (23.4 percent) of the 64 patients' ACL reconstructions failed as defined by the study.
"This failure rate in this young, active population is exceedingly high when compared to a previous study that looked at failure rates of cadaver replacement ligament in patients older than 40," said corresponding author Dr. Gene Barrett. "The older group's failure rate was 2.4 percent. So while there are obvious benefits of using the cadaver ligament, like 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."
Update: research presented at the 2014 annual meeting of the American Academy of Orthopaedic Surgeons found that use of auto-graft (vs. allograft) tissue resulted in lower percent failure after ACLR surgery for high school, college, and competitive athletes. A meta-analysis published online in the journal Sports Health: A Multidisciplinary Approach (1) found that the failure rate in young athletes for allograft was 25% versus 9.6% for auto-graft.
Source: AOSSM Press Release
The American Orthopaedic Society for Sports Medicine (AOSSM) is a world leader in sports medicine education, research, communication and fellowship, and includes national and international orthopaedic sports medicine leaders. The Society works closely with many other sports medicine specialists, including athletic trainers, physical therapists, family physicians, and others to improve the identification, prevention, treatment, and rehabilitation of sports injuries.
Updated March 31, 2015