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Allograft/Autograft Anterior Cruciate Ligament Reconstruction Equal Outcomes at All Ages With No Anterior Knee Pain: Average 7 Year Follow-Up

      Introduction

      Anatomic ACLR yields superior outcomes by restoring knee kinematics and stability though optimal graft source remains controversial. Bone-patellar-tendon-bone (BPTB) autograft ACLR is superior to hamstring for stability; however, anterior knee pain has been reported. Additionally, allografts are associated with higher risks of failure and infection. We hypothesize that allograft BPTB ACLR using biointerference screw will yield successful return to sports comparable to autograft ACLR without anterior knee pain.

      Methods

      Patients with allograft (17-58 years) and autograft (15-50 years) ACLR by a single surgeon (N=153) underwent evaluations including knee ROM, stability testing, Lysholm, IKDC, and Tegner questionnaires. Radiographic evaluation included preoperative plain film knee series and MRI, and postoperative MRI and CT scans. Allograft source was <40years of age and non-irradiated. Modified rehabilitation programs included return to pivoting sports at ≥6months. 2x2 ANOVA and independent samples t-test evaluated differences in outcomes (p<0.05).

      Results

      Follow-up was 7.2±5.4years (range:2-15). Functional scores (Lysholm:87±18 vs. 87±15, p=0.974; IKDC:80±18 vs 82±15, p=0.618) and KT-1000 measurements (30lbs p=0.926; manual maximum p=0.490) were not statistically significant between groups. Activities associated with anterior knee pain were not difficult for either group and all patients returned to moderate and vigorous sports. There were two autograft failures (1.3%) after 5 years due to unknown reasons and four allograft failures (2.6%) due to traumatic reinjuries at an average of 3.8 years postoperatively. All but one underwent revision allograft ACLR without recurrence. To date, there is no evidence of lysis from the interference screws.

      Conclusion

      Allograft and autograft single-bundle ACLR successfully return individuals to high level sports (e.g. skiing, soccer) and restore knee stability. Allograft is an acceptable option for ACLR in patients >16 years of age without evidence of increased re-rupture rate or any signs of infection. Modified harvest and closure techniques reduce anterior knee pain after autograft BPTB.