SAN DIEGO — Donor age has no impact upon subjective
clinical outcomes in cases of
ACL reconstruction with patellar tendon allograft when a
standard technique is used, according to a presentation at the
2011 Annual Meeting of the Arthroscopy Association of North
“ACL reconstruction with allograft is becoming
increasingly common,” study investigator Daniel Hampton, MD, said during
his presentation. “As we are all well aware, there is a limited supply of
grafts, and there is a lack of evidence regarding the influence of donor age on
the clinical results of our reconstructions.”
Hampton and his colleagues reviewed case logs to find
cases of primary ACL reconstruction with patellar tendon allograft performed by
a single surgeon through an endoscopic trans-tibial technique using
interference screw fixation. They excluded cases that involved
“We did include some of the simpler procedures that
are done in combination with an ACL reconstruction, such as microfracture or
simple meniscal surgeries,” Hampton said.
Overall, 83 patients met the inclusion criteria. The
patellar tendon allografts used were fresh frozen and harvested from a single
tissue bank. Donor ages were obtained from the tissue bank. The investigators
determined clinical outcomes through retrospective chart review and by
contacting patients for follow-up. Preoperative and postoperative activity
levels, and Lysholm scores were used to compare results.
No significant impact
The team was able to obtain follow-up data from 77
patients, two of whom were excluded from the final analysis due to failures.
One case involved a failure at 3 years in a patient who received tissue from a
52-year-old donor, and the other case involved a failure at 18 months in a
patient who had tissue from a 14-year-old donor.
Overall, patients in the study had an average age of 37
years and an average follow-up of 2 years. The average donor age was 44 years,
with a range of 14 years to 65 years. Overall, the team found statistically
significant improvements in preoperative and postoperative Lysholm scores and
activity levels, Hampton said.
Donor age, when used as a continuous variable, was found
to have no significant impact on postoperative Tegner or Lysholm scores.
“Overall, we did have a mean Lysholm
improvement,” Hampton said. “As far as a trend of what the donor age
meant to the clinical outcomes, there was a non-significant trend to each year
of increasing donor age resulting in a small Lysholm increase.”
Female donors were found to be associated with a
“small and not significant” increase in Lysholm scores when compared
with male donors. The investigators found similar results in Tegner scores.
“Ultimately all models that we used — age of
the donor, sex of the donor, age of the patient, sex of the patient — did
not show a significant effect on the Lysholm and Tegner scores as we measured
them,” Hampton said. “We did not find any effect of advancing donor
age on clinical outcomes after ACL reconstruction with our bone-tendon-bone
allografts as measured by both the Lysholm and Tegner scores.” –
by Robert Press
- Hampton D, Lamb J, Klimkiewicz J. Effect of donor age on patellar
tendon allograft anterior cruciate ligament reconstruction. Paper #SS-64.
Presented at the 2011 Annual Meeting of the Arthroscopy Association of North
America. April 14-16. San Diego.
- Daniel Hampton, MD, can be reached at
- Disclosure: Hampton has no relevant financial disclosure.
Daniel Hampton provided us [with] a very interesting
study. It was a retrospective chart review, and there was a potential for
selection bias because the patient is the one who made the choice of graft. The
clinical outcomes were the Tegner and the Lysholm score, and these were
obtained by telephone. There was no physical examination of these patients done
at the time of the study. The average follow-up was 24 months, the minimum
follow-up was not reported in the manuscript and there was no power analysis
carried out [in the study].
Their conclusion was an average donor age was 44 years
in this group — ranging from 14 to 65 years — and that the donor age
did not affect the Tegner or Lysholm score. But in the absence of a power
analysis, the lack of difference does not necessarily mean that none exists. I
think that a little bit more statistical data would be helpful to reinforce
— F. Alan Barber, MD
Disclosure: Barber receives royalties from DePuy-Mitek; is on the
speakers bureau for ConMed Linvatec and DePuy-Mitek; owns stock or stock
options in Johnson & Johnson; receives research support from Arthrex, Inc.,
Arthrocare, Biomet Sports Medicine, ConMed Linvatec, DePuy-Mitek,
Musculoskeletal Transplant Foundation, Smith & Nephew Endoscopy, Stryker
Endoscopy, Tornier and Wright Medical Technology; is on the editorial/governing
board for Arthroscopy, Orthopedics Today, Sports
Medicine and Arthroscopy, and Techniques in Knee Surgery; and he is
a board member or committee appointment for the Arthroscopy Association of