Issue: July 2011
July 01, 2011
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Study finds no link between donor age and results of patellar tendon ACL reconstruction

Issue: July 2011
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Discuss in OrthoMind
Discuss in OrthoMind

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 America.

“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.”

Retrospective review

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 multi-ligamentous surgeries.

“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

Reference:
  • 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 Hampton.dan@gmail.com.
  • Disclosure: Hampton has no relevant financial disclosure.

Perspective

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 this conclusion.

— F. Alan Barber, MD
Session Moderator
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 North America.